Here is a case from the Agency for Healthcare Research and Quality (AHRQ) in which errors in an electronic medical record (EMR) led to an inaccurate diagnosis at an academic medical center in the US. It took three days for the patient’s care team to realize that the results entered into his EMR were for a biopsy they did not order of a lesion he did not have. Before the error was recognized, it had caused the patient “tremendous pain and mental anguish.”
At bottom, the error got as far as it did because of the “medical team” approach – no single person was responsible for this patient’s care. Each person relied on the (erroneous) electronic medical record for his view of the whole. Continue reading Patient at Risk in EMR System→
Interested consumers will in many cases spend hours tracking down information from doctors, hospitals and labs, and then painstakingly entering the data into the electronic record themselves.
The potential benefits:
One Cleveland Clinic patient with hypertension, a long-distance truck driver, was able, from the road, to feed his doctor daily results from his blood pressure monitor. Based on that data, the doctor instructed the man to adjust his medications, and the driver was able to stabilize his blood pressure in a matter of days.
The potential dangers:
You must be vigilant about updating your files every time a medical event takes place…… "If your doctor is under the impression the records are up to date, but a prescription is missing or a surgery follow-up isn't listed….. it can be dangerous."
The Department of Defense is no better when it comes to active duty servicemen, according to NextGov:
The Defense Department's top health officials lambasted the department's central electronic health record system that manages patient files for millions of active duty and retired service members, saying it frustrates doctors because it crashes as often as once a week and generates duplicate records.
[The system called AHLTA] stores the health records of 9.2 million personnel in a central data repository, which runs on an Oracle database and stores 25 terabytes of data. [But,] the Army Medical Department has faced "near mutiny" from clinicians who are dissatisfied with AHLTA, particularly its interface and templates used for note-taking.
According to Maj. Gen. Charles Bruce Green, deputy surgeon general for the Air Force, "AHLTA also is slow, unreliable and so cumbersome that clinicians spend 40 percent of their time inputting data into the system, which is time spent away from patients."
The Veterans Administration is often held up as the gold standard for Health IT, but the technology publication NextGov reports:
An eight-year-old, $167 million project to develop a core computer application to schedule patient appointments at hospitals run by the Veterans Affairs Department has all but collapsed, and senior executives are worried about the repercussions it could cause on the Hill and in the White House, according to an internal memo obtained by Nextgov.
The botched effort comes on the heels of another scheduling program — a five-year, $75 million failed project started in 2001. That program, the Scheduling Replacement Project, was started by IT staffs in the VA healthcare regions serving Louisiana, Oklahoma, Mississippi and Texas, but after five years of work they failed to develop a usable product.
Gerald Manar, spokesman for the Veterans of Foreign Wars, says, "VA has a decade-long history of initiating IT programs, only to experience extensive delays and major cost overruns. The fact that VA has frittered away eight years and millions of dollars in developing the RSA, with no viable results and no end in sight, is extremely disappointing but, based on its track record, not surprising."
If the mandatory health IT faddists have their way, your doctor’s office, your hospital, the lab that does your tests, and your Regional Health Information Organization (RHIO, the “key to the National Health Information Network” according to Wikipedia) will become prime targets for hackers and carders.
The question that should be asked, but isn’t, is whether the cost of trying to secure electronic health records, and cost of the inevitable security breaches, is less than the administrative overhead created by the current system of distributed records kept in a variety of formats. You can stop using a credit card if its security risks begin to outweigh its benefits. You can’t do that with mandatory electronic health records.Continue reading Mandatory Health IT and Cybercrime→
A consistent theme of this blog is: the lack of electronic medical records in medicine is due to the payment system, not to the personalities of doctors. Since this is the only place you are likely to find this point of view expressed, I go out of my way to verify it as evidence mounts here and there. In rural Kansas, doctors who provide care in multiple settings (office, hospital, nursing home) find that EMRs make sense. Therefore? Therefore, they use them.
While this sort of reform has popular support, there is little evidence that currently available computerized systems will improve care. It’s the wrong investment to make at this time.
After the Children’s Hospital of Pittsburgh added automated prescribing recommendations to a commercial electronic records system, the institution documented a more than threefold increase in the death rate among child patients.
Another leading system contributed to more than 20 different types of medical errors.
Studies in U.S. hospitals suggest that these systems can add a half-hour or more to a day for tasks such as electronic ordering
The false alerts that systems sometimes send can desensitize doctors to legitimate clinical recommendations.
Yet here is a pen and paper doctor whose office mate uses EMRs and who admits EMRs improve efficiency and quality of care.
Billions of stimulus dollars meant to spur doctors to switch to electronic record-keeping may not be enough to do the job, [according to a new study].
Using government cost estimates, researchers found that it would cost about $124,000 for a single doctor or small practice to upgrade to electronic health records over a five year period…….. But the total incentive payments a doctor could get over that time period only add up to $44,000.
In 2015, penalties start to kick in for doctors who haven't switched to electronic record-keeping. But in one scenario mapped by Avalere, the starting penalty would be $5,100 a year – far less than how much it would cost to install and maintain an electronic health system.
In the face of so much cheerleading, we have previously cautioned here, here and here. This is a doctor writing in the New York Times:
In short, the computer depersonalizes medicine. It ignores nuances that we do not measure but clearly influence care….. I have half-joked with residents that they could type "child has no head" in the middle of a computer record – and it might be missed.
A box clicked unintentionally is as detrimental as an order written illegibly – maybe worse because it looks official. It takes more effort and thought to write a prescription than to pull up a menu of medications and click a box. I have seen how choosing the wrong box can lead to the wrong drug being prescribed.
