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Why Digital Medical Records Are No Panacea
theodp writes "As GE, Google, Intel, IBM, Microsoft and others pile into the business of computerized medical files in a stimulus-fueled frenzy, BusinessWeek reminds us that electronic health records have a dubious history. Under the federal stimulus program, hospitals can get several million dollars apiece for tech purchases over the next five years, and individual doctors can receive up to $44,000. There's also a stick: The feds will cut Medicare reimbursement for hospitals and practices that don't go electronic by 2015. But does the high cost and questionable quality of products currently on the market explain why barely 1 in 50 hospitals have a comprehensive electronic records system, and why only 17% of physicians use any type of electronic records? Joe Bugajski's chilling The Data Model That Nearly Killed Me suggests that may be the case."
Major credit card companies either can't or won;t take the necessary precautions to protect credit card information. So what if there is a breach, identify theft, headaches, etc?
Now what makes you think hospitals, private doctors, etc. are going to be able to protect their data any better? They have less money then the credit card companies.
Can you imagine a million patient digital medical record breach? The black mail or power that could be leveraged over people?
When my wife was in the hospital with a broken ankle I tried to get a copy of the X-ray, because it was on a big monitor out of view of the patient. The user interface of the DICOM viewer did not provide a way to print or save the image... presumably to protect patient confidentiality.
The next day I went in to the hospital to pick up the "films" for her doctor, and they gave me a copy of the same files on a CD, completely uncontrolled, and I used OsiriX to convert them from DICOM to JPEG so my wife could see them.
Having the files in digital format is great, but let's have some appropriate level of controls. If the patient wants the images on a flash stick, it's THEIR records, let them have it!
the article did point out a lot of problems, but HIPAA is the culprit. It was passed in 1996 and took effect a few years ago. it says medical info has to be controlled so that only the people who need to know, get to know about your condition.
Any electronic data model has to be built around this. and medial people are as scared of HIPAA as other people are scared of SOX and everyone goes overboard
Like all software, digital medical records can be done badly. But they can also be done right. Joe Bugajski's story is gripping, but I want to compare it with the story of my mother.
My mom was in her mid-50s when she became ill, apparently healthy but in fact hiding a serious alcoholism problem. I'll skip the details, but suffice to say that a lifetime of drinking can destroy your body's natural blood-clotting system, leading to internal bleeding. So don't drink, kiddies.
Anyway, once she was medevaced to Queen's Hospital in Honolulu, we never saw a single obvious piece of paper. Everything was recorded digitally. But the key difference between my Mom's story and Joe Bugajski's is that the data was *available* once entered. I got a chance to look over the doctor's shoulder as he reviewed her chart. He was able to look at blood tests, x-rays, up-to-the-minute vitals, every piece of data the hospital recorded, at his fingertips in seconds. And he drove the software like a pro.
In the end, my mother died, but it definitely wasn't because of bad recordkeeping software.
I agree that medical records should be electronic for the most part. However, there are some big challenges that our current IT business model can't solve:
1. How do you prevent Oracle, IBM, SAP or some other large vendor from getting a permanent lock on the market for EMRs? If this happens, a closed standard will develop and mo one will ever be able to make changes without paying mullions of dollars.
2. Opposite problem -- if there is no standard, or it's so loose that it might as well not exist, what's to prevent a million small companies from developing EMR, EMR 2.0, OpenEMR, StarEMR, YetAnotherCoolEMR 3.2.10.23alpha8, and so on? How do you get providers using different standards to share? (The answer, I think, is open protocols, but that way lies 800 MB XML files and crappy J2EE applications written by developers who don't understand optimization.)
3. Privacy. In the US, healthcare and insurance are for-profit businesses. How much do you think a life insurance company would love it if they were able to see your entire birth-to-present health history? Insurance would be even less affordable than it is now. In countries where everyone's on the hook for medical costs, privacy is much less of an issue. But when it can cost you the ability to get treatment that doesn't bankrupt you, it's a big problem!
4. The huge "obfuscated mess" problem -- Go look at the system the Veterans' Administration uses for EMRs. It was written years and years ago in a language called M, and the source code (publically available) looks like line noise. It works fine from the front-end, but I can imagine it's a disaster to administer, make improvements, etc. How do you prevent a system from getting so stale that no one knows how to modify it anymore?
From what I've read, EMRs work well for the VA, precisely because they have to keep costs lower than for-profit hospital systems. Their patients are also ex-military. When you join the military, you give up the right to privacy.
Good points.
Any system can only be as good as the people that use it. I can't help but feel while reading 'The Data Model That Nearly Killed Me' that the problems encountered actually had very little to do with the electronic record system at all. It seemed more like an incompetent system was in place as a whole. The data model didn't seem to do anything wrong, it was the people using it, or not using it. Not saying whether it is actually a good electronic system or not, impossible to tell...but enough people had enough direct access to critical information, without even thinking about the electronic system, that this guy should not have had the problems he had.
Is it really the data model's fault that not only did no one use information provided on entry to the er, they didn't even READ it? Sounds to me like the real problem is that new systems were put in place without new processes or training being put in place...and then on top of that the users of the system failed to even fall back on the logical concept of direct communication!
I do not for one second believe that this situation wouldn't (Or for that matter hasn't) have happened even with the use of standard physical medical charts instead of the electronic record system in place. There is really nothing at all in the story that makes the problem specific to the system or the model being used in that system. Can't believe that had a physical medical chart been used that the same mistakes the medical staff made in this case would have somehow miraculously NOT been made on paper as well.
Basically, what I take as most important from this guy's story, is that that is NOT a medical facility I ever want to step foot into under any circumstances, electronic records or not!
No Comment.
I would go even a step further than that and posit that a good portion of his problem was stemming not from the system as much it came from the active resistance of the people attending him in using the system.
I don't directly work in healthcare, but I do work in a corporate environment for a large healthcare company that recently (in the past decade) made the switch from paper to a 'global' electronic system. At the start, stories like this were common, as people fought the system rather than use it.
Yes, not all systems are equal and it's entirely possible to design and implement an completely unusable one. But there is no avenue for improvement when the default behavior to burrs in the system is to revert to a far more inefficient (and porous) paper method, which, due to the introduction of the electronic system, is not even being monitored as well as it was when it was the only method.
In the end, the improvements that were introduced and enabled by converting to an electronic system far out weighed any of the temporary and transient issues such as this.