Uncategorized

Electronic Medical Records Attack Hospitals

Readers know of my criticisms of the electronic medical record (EMR) juggernaut that is oozing over the medical landscape. Ultimately, this technology will make medical care better and easier to practice. All systems will be integrated, so that a physician will have instant access to his patients’ medical data from other physicians’ offices, emergency rooms and hospitals. In addition, data input in the physician’s office will use reliable voice activated technology, so that some antiquated physician behaviors, such as eye contact, can still occur. Clearly, EMR is in transition. I place it on the 40 yard line, a long way from a touch down or field goal position.

A colleague related a distressing meeting he had at the community hospital he works at. This hospital, like nearly every hospital in Cleveland, is owned by one of the two towering medical behemoths. I’m not a businessman, but I have learned that when something owns you, it’s generally better for the owner than the ownee. This meeting was about the hospital’s upcoming EMR policy. Sometimes, these hospital meetings are ostensibly to seek physician input, but the true purpose is to inform the medical staff about decisions that have already been made. In the coming months, this hospital will adopt a computerized ordering system for all patients. In theory, this would be a welcome advance. It would create a digital and permanent record of all physician orders that could be accessed by all medical personnel involved in the patients’ care. It would solve the perennial problem of inscrutable physician handwriting, including mine.

One advantage that computerized ordering aficionados claim is that physicians’ orders can now be standardized for various medical conditions, such as stroke, congestive heart failure and diabetes. Of course, patients are unique and may not neatly fit into packaged computerized ordering templates. Will deviating from these standard order sheets by easy, or will we need a 14-year old beside us to help us over the cyber hurdles? Most of us have been issuing medical orders on paper for decades, without loss of life or limb. When I write an order with a pen for a potassium supplement, for example, I have not found the task to be onerous. Will the computerized system be another example of solving problems that I didn’t know that I had?

One of the physicians at the hospital meeting asked if the verbal order policy would remain. The response suggested that verbal orders would no longer be permitted. The physicians wondered how they would give admitting or other orders at 2 a.m. Would they have to boot up a computer at that time? What if a nurse calls for an urgent blood transfusion order when the physician is in his car? Does this enlightened verbal order ‘reform’ sound like it originated from folks who understand doctors?

I have to hope that the speaker was misinformed, as this aspect of the policy is simply too dumb to survive, at least I hope so.

I am not a Luddite who opposes EMR on ideological grounds. I believe, and have written, that once perfected, it will accomplish its mission. My quarrel is with those who already claim that the goal line has been reached, or is in sight. I also believe that many of these systems were designed by folks who don’t practice medicine or understand physicians’ needs. What’s good for billers and coders may not help physicians in exam rooms with living, breathing patients.

I am sure that most physicians who are retiring now do not regret that they will miss the steep vertical climb from paper to electronic medical practice. Personally, I am glad to be part of it, although I wish that ‘point & click’ medicine was more about medicine than about pointing and clicking.

Perhaps, this approach can be extended to blogging. Right now, it takes me a while to pound out these posts. If I could use a packaged medical ranting blogging template instead, then I could post a Whistleblower twice daily. Point & click blogging. Hmm. I can see the goal line.Become a subscriber!

Michael Kirsch, MD, is a private practice gastroenterologist in the Cleveland, OH, area. He shares his thoughts about issues in medicine and medical practice at MD Whistleblower.

Livongo’s Post Ad Banner 728*90

Categories: Uncategorized

Tagged as: , ,

22
Leave a Reply

22 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
22 Comment authors
alex dsaç kaynakcharlaspenceDoc BHoward Crawford Recent comment authors
newest oldest most voted
alex d
Guest
alex d

Occupational health professionals must manage the complexities of medical surveillance. They have to record employee health data from workplace injuries and illnesses, clinic visits, immunizations, audiometric exams, flu clinics, wellness programs, and lab tests. And, it’s not enough to just collect the data: They must be able to report on it in multiple formats.

saç kaynak
Guest

it’s really interestly…

charlaspence
Guest

While electronic medical records will likely be a solution in the future the reality, from a patients perspective, is that they have a long way to go. In the meantime, life and medical issues do not stand still and wait for this development to take place. So, there needs to be a bridge system to accomodate current needs. I suggest that a Personal Healhcare Record maintained by the individual patient if the best way to do that. The patient becomes a the most complete source of truth and the most important member of the healthcare team. By taking charge and… Read more »

Doc B
Guest

EMR’s with templates that import labs, vitals and previous days’ progress notes also lead to errors and potential fraud.

Howard Crawford
Guest
Howard Crawford

My background is in corporate IT management and project management. Perhaps this gives me a different view point from many others who have posted comments here. Still I hope some of you will find my comments at least worthy of consideration. The amount of misunderstanding of the process of rolling out any new IT service is truly perplexing to me. I understand that most of the people here are medical professionals and delivering medical care to patients is there focus, but haven’t some you been involved in projects where the process of acquiring inputs from various stakeholders is needed in… Read more »

Nabeel
Guest

As you can see their is a lot of different reactions from this post. I would like to share this with everybody: The Office of the National Coordinator for Health Information Technology (ONC) released statistics which showed that 81% of the nation’s hospitals and 41% of office-based physicians intend to register for federal incentive payments for adoption & meaningful use of certified Electronic Health Record (EHR) technology.David Blumenthal, national coordinator for health IT, in keeping true to staying abreast of technology posted a YouTube speech in which he laid out the work that was being done by the ONC &… Read more »

American Journal of Medicine
Guest

“I am not a Luddite who opposes EMR on ideological grounds. I believe, and have written, that once perfected, it will accomplish its mission. My quarrel is with those who already claim that the goal line has been reached, or is in sight. I also believe that many of these systems were designed by folks who don‚Äôt practice medicine or understand physicians‚Äô needs.” I agree. Our journal has published a few research articles that show EMR systems (in their current iteration) are not the saviors of the healthcare system that bureaucrats would like us to believe. Computerized records (in their… Read more »

Cheryl
Guest
Cheryl

Waiting until the EHR is ready before rolling out?!?! While you’re at it, I suggest you hold off on buying that next computer, phone, car, whatever, until ALL the bugs have been worked out? Are you sure all the kinks have been worked out of a newly minted surgeon or are we taking a risk that the training was adequate and sufficient?
CMS thinks the techonolgy is ready, and through the HITECH Act, mandates that hospitals use “certified” technology. So…whose certifying that technology if it’s still half-baked?

Michael Kirsch, M.D.
Guest

Great comments all. Agree with Craig who points out the obvious; why roll this stuff out half-baked? Would we approve a drug or certify a physician as qualified if they were only ‘on the forty yard line’? I doubt it. We’d release them when they’re ready.

HMathewson, MD, www.hubslist.org
Guest

“verbal orders”!?
Accrediating, regulatory, safety, and quality agencies have been dinging hospitals for them for years! In case the hospital has no hospitalists I would be happy to turn on my computer at home at 2 AM to enter orders for a patient admitted by an emergency room physician. In my hospital no GI physician comes in at night unless he/she can do a reimbursable procedure. This post not only sounds like sour grapes. It is “old” grapes.

pcp
Guest
pcp

‘3. Please do not give readers the impression that physicians ‘in exam rooms with living, breathing patients’ without an EMR do a better job that physicians who use EMR.’
It’s not an impression. The evidence shows no difference in performance, whether or not an EMR is used.
‘although “EHRs” may be “light years” away from this reality, appropriately designed computer systems are not.’
The problem is that, after being processed through EMRs that are just glorified billing machines, the data is so corrupted as to be useless (and maybe even dangerous).

Craig "Quack" Vickstrom, M.D.
Guest
Craig "Quack" Vickstrom, M.D.

My question was, and remains: why are we implementing EMRs when they are still in the beta phase? Not one of them is truly ready for deployment. Why are they being stuffed down our throats before they are truly safe and effective?

JF Sucher, MD FACS
Guest

Dear Judy, Dean is not kidding you.. and although “EHRs” may be “light years” away from this reality, appropriately designed computer systems are not. I have published on this fact here: Computerized clinical decision support: a technology to implement and validate evidence based guidelines. My group has created Computerized Clinical Decision Support(CCDS)systems that have augmented the clinical care of hundreds of patients, leading to improved practices, as well as changes in practice. This will ultimately be the way of the future. Unfortunately, we continue to be bound by a myriad of problems related to poor design, poor understanding, poor planning,… Read more »

Judy Osterman
Guest
Judy Osterman

Dear Dean,
“Then researchers could finally correlate therapies to damage and recovery and survivors would not be left in complete limbo as to what to do to recover.”
Are you kidding me? I suggest that you find a competent neurologist, physiatrist, and physical therapist. EHRs currentl result in deaths and injuries and strokes. Your dreams are light years away.

dean r
Guest

As a stroke survivor I really look forward to something like this, we might actually get to the point where a damage diagnosis is given for both the penumbra and the dead brain area. Then researchers could finally correlate therapies to damage and recovery and survivors would not be left in complete limbo as to what to do to recover.