Sunday, December 26, 2010

BLOGSCAN - Are electronic medical records a health care cure or a disease?

This doctor writing at really doesn't like EMR:

... Our practice implemented EMR about three months ago, and it has not been a downhill sleigh ride thus far. Here's the scorecard.

• It saves time. It doesn't.

It saves money. It hasn't.

It promotes office flow and efficiency. Hardly.

It improves staff morale. Are you joking?

Patients prefer it. None that I know.

It's been a bonanza for document-scanning companies. Bingo!

What I find most troubling about EMR is that it is "point and click" medicine. It radically disrupts the doctor-patient relationship. Taking the patient's medical history -- the bedrock of doctoring -- is reduced to a sterile data-entry process. Taking the history, the conversation that physicians and patients have had since Hippocrates tended to the sick, is our opportunity to reach out and bond with our patients. During this time, we forge human-to-human connections with patients who are seeking our help. This is the scaffold upon which a sturdy doctor-patient relationship develops. EMR is taking a chainsaw to this structure.

Those who champion the technology are usually not practicing physicians. They are the insurance industry, billing personnel, medical coding specialists, the government, various bean counters and, of course, EMR vendors. Because these folks are not physicians, they do not appreciate how EMR affects doctoring at ground zero in our exam rooms ...

Read the whole thing.

-- SS


Anonymous said...

Undoubtedly, it is a disease. The question is no brainer. Perhaps HIT decision support can help explore the possibilities of treatment of this new disease?

Anonymous said...

This, and other recent post, once again reminds me we have done this before. During the Clinton administration there was decision to create a national child support data base. (SETS) Knowing this would not fly at the federal level it was decided to fund the project on a state by state basis.

The results were predictable. Billions were spent, Fraud was rampant. People were allowed to resign, others were demoted. Those who knew and understood the design criteria were excluded from the process in favor of the IT department.

When the whole thing was done you had a system that still required people since in many cases the original designers had shorted the design to set up a situation of perpetual upgrades. In our state GUI’s and drop down menus were not used so that there would be an immediate need for an upgrade. The 20 something head of the project said he intended to retire on this project alone.

Security continues to be an issue. Remember Joe the Plumber, he had his child support records reviewed by a number of people. People got fired and more security was added.

Unintended consequences? All of these records contain employment information so now everyone is subject to an IRS review. Terminals are turned away from windows, massive shredders have been installed, and a secured building is now locked down like the county jail. Fun place to work.

Think political leadership has a handle on these issues? The first HHS director for our state under the soon to depart governor tied her Blackberry to her work email and then sent political donation request out. The only problem is it is illegal to use State equipment for direct political activities. She resigned.

We really do not need to reinvent the wheel and make the same mistakes as with SETS. A recent WSJ piece highlighted the 10 years one hospital took to get a working EMR.

This rush will only enrich a few, while creating chaos for many, and sadly, unlike SETS, people can and will be injured.

Steve Lucas