Slashdot Mirror
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."
Everyone knows that everything should be computerized, since everyone knows that big, REALLY COMPLICATED data systems always work and always come in under budget.
Like the redesigned FBI data system that works so perfectly!
"I don't know, therefore Aliens" Wafflebox1
Digital Medical Records Are No Panacea... but they are pancreas!
Be relentless!
Interesting, for certain - and raises some good points for discussion in the how the system is implemented.
But it's anecdotal evidence, as much as it may affect the author, doesn't necessarily prove the point.
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?
There's also a stick: The feds will cut Medicare reimbursement for hospitals and practices that don't go electronic by 2015.
I know that might seem like a really bad thing at first, but consider this. Wal-Mart, Supermarkets, and any retailer with shelf space to "sell" to companies trying to get their product sold to the end user have major pull. Most all of these stores require some form of electronic invoicing. Many will require you to pay fees if you do not, and some will simply not carry your product.
That isn't much different from Medicare. If you want to accept patients with medicare, and get paid for the service you provide, you need to use *insert desired service here*. The government is the one with the pull (they have the cash), and so they can require you to do this. All I am saying is this might not be a case of the Big Brother, but just simple market forces.
No comprende? Let me type that a little slower for you...
Wouldn't it be better to spend that money on diagnostic equipment, and outfitting small town clinics. I would rather have a piece of paper that says "repaired cerebral aneurysm" than to have an electronic file that says "died waiting for MRI".
When our name is on the back of your car, we're behind you all the way!
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!
I currently work in healthcare IT (past 5 years). I used to work in food proccessing (3 years) and for a IT provider for various industries (banking, manufacturing, advertising) for 3 years. Of all the industries, I have to say that Healthcare is the worse. The software that hospitals purchase is extremely buggy. Software providers for IT, bank on the fact that the person making the final decision doesn't have any idea about IT. In other words, the doctors and administrators. Every vendor offers an EMR (Electronic Medical Record) in their software and they are different by company. Government oversight of this industry is desperately needed. If people knew the truth, they would be VERY afraid to go to a hospital.
This article reads like a lifetime made for TV movie. Heavy on emotion devoid of logic.
The author was repeated asked for his medical information, his doctor's written instructions were ignored and different departments within the hospital did not communicate. Therefore the problem is Obama's computerized data record system that doesn't exist yet.
The whole time I was reading it I was waiting for the author to tie his experience to how computerized medical records are bad. He never did, his experiences were caused by humans that did not care enough about patients to read computerized records OR paper records.
The author fails to explain how his experience proves anything other than that particular hospital is terrible and that the health professionals employed there are less than friendly.
More doctors. Break the back of the AMA, double the seats in medical school and let the market do more of the talking.
The tired old argument of "fewer, but better doctors" is bullshit. You know what they call the guy who barely got through medical school the day he graduates? "Doctor!"
All of the regulations miss the point entirely. There are not enough doctors, not enough competition. Even the "evidence-based medicine" advocates miss the point about mandating "best practices" when you have people like the orthopedic surgeon who treated my mother. The man was 15-20 years out of date on certain techniques, and did them according to the way he was trained, and screwed the pooch big time. A doctor at UVA medical school had to intervene to get her back to normal.
People like that couldn't exist in other professions that are less regulated and coddled. Imagine someone only knowing C/C++/Ada circa 1995 today and trying to compete in the mainstream software development market for new development work. It's laughable here, but doctors get away with that.
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
... and here we have just a single anecdote about how the system did not work in one instance. If we are playing the anecdote game, I'm sure I can find a similar example where non-computerized health records lead to bad care. Of course, while the anecdote game is very effective at playing at human emotional response (we tend to assign more weight to a story that we can associate with a single person versus aggregate statistics), it's useless as an actual policy question.
Since every complicated system has failures, even the critical ones like hospitals and air traffic control, the important policy question is not whether it works in all instances, it's whether it produces overall better care than the system it's replacing and whether that improvement is worth the difference in price. If the new system actually reduces costs, then it's a good idea so long as it doesn't degrade care (since, ultimately, reduced cost means either more health care or more dollars to satisfy other wants).
I'm not going to comment on the data myself, since you should read the studies for yourself and draw your own conclusions.
http://journals.cambridge.org/action/displayAbstract;jsessionid=7C274D08947B0625B3B540BEF2E70367.tomcat1?fromPage=online&aid=416400
http://content.nejm.org/cgi/content/abstract/348/22/2218
(PDF)
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1421388
PS. Of course there's no panacea for our medical problem. The question is whether EHR are better than the system we've got, not whether they represent the best possible system. The perfect is not the enemy of the good.
PPS. I have a sneaking suspicion, reading my post (yeah, some /.ers actually read their own posts before hitting submit :-P) that I will be accused of not having the proper sympathy for the guy in TFA. That's not true. I have sympathy for him as an individual, but I'm not going to let that sympathy for him cloud my judgment on the merits of a system.
For example, suppose there was a highway by you that had no center divider, just a grassy median. Suppose also, for the sake of argument, that installing a jersey barrier (http://en.wikipedia.org/wiki/Jersey_barrier will lower the injury/fatality rate in accidents by a statistically significant amount by preventing out-of-control cars from going into oncoming traffic. Now, hypothetically, someone could be in an accident where the jersey barrier caused him serious injury or death (say, by flipping his car even though they are designed to minimize that chance) where the old system would have been just fine (say, because there was no oncoming traffic at the time of the accident). Does someone that still says we have jersey barriers not have sympathy for that guy? No. His death is regrettable but because we can't make a perfect road, we have to settle for the best road we can make.
The problem is that you can point to someone that's injured (and provoke an emotional response related to his regrettable accident) but the only thing the jersey barrier proponent can do is point to the statistics that say there are fewer serious injuries since they've been installed. There's no emotional resonance to the thousands of people that travel without incident each day because they don't make a good story. "Man drives to work safely" isn't news, but because it happens much more often that "Man killed in car wreck", it's actually much more important in the grand scheme of things.
We aren't privy to all the stories where EHR made things smoother, cheaper or helped prevent calamity. Largely, these will be small victories, unsung
To prevent this problem, you might try contacting your regular health-care provider right away. Assuming they fall under HIPAA, you usually have the right to make requests to the provider regarding how they will handle your medical records, and who can access them. Make a request that your records not be stored in a shared electronic database.
The provider can refuse the request, but few do.
(Of course, 15 years from now, when your new doctor at General Hospital does not realize that you're the ONLY patient who still has paper records in that filing cabinet at the back of the server room, there could be a problem...)
Trying to use sarcasm in text-based forums does not work.
I saw my doctor last week and was presented with a new form to sign to opt-in or opt-out of putting my records into an electronic format. Being a paranoid, tinfoil-hat wearing, "I remember Diebold voting machines" kind of nerd, I opted out. The form explained what EHR's are and espoused the benefits of them. I'll continue to rely on good old fashioned paper records for now, thank you. This is very new because I lost saw this doctor four weeks before then. They also mentioned that psychiatric information will not be stored in the EHR.
In other related news:
This 2-page PDF from the Nebraska Medical Association and Creighton University Medical Center dated June 27th, 2007 gives some numbers on offices that have adopted or thinking about adopting an EHRs.
If you are a Nebraska health professional or just have too much time on your hands from hiding from the pending Swine flu pandemic, you can go to this website whose tag-line is, "Enhancing clinical practices through the adoption of health information technology in Nebraska".
Here is a letter (blog entry?) from the office of the Governor of Nebraska posted on April 10, 2009 talking about the pilot EHR project in Nebraska.
Enjoy!
Veritas patesco per quaestio questio. Truth is revealed through questions.
I've used electronic medical records in both the NHS (UK) and the United States. Cerner is the big player here and it is one of the most ugly, inefficient, and convoluted interfaces I've ever used. It makes some more famous UI messes discussed on Slashdot look line the Mona Lisa. For those of you who don't understand how electronic systems work and why there is so much resistance let me explain how a basic patient encounter works for me:
1. Do a history and physical (H&P) on the patient and record the results on paper.
2. Enter in pertinent information into the computer system about the type of management I want started.
3. Dictate my history and physical for transcription.
4. Wait several hours for the dictation to show up in the EMR. Until which time all other doctors and nurses must refer to my hand written notes.
5. Heaven forbid I have to call in a consultation from cardiology, GI, or some other specialty in the hospital. If I do, then we use our text-based pagers to figure out when the hand-written note has been dropped off because every specialty has to go through steps 1-4. As they follow these patients, they too have to physically recheck the chart since dictated H&Ps and progress notes take time to show up.
6. I can very easily see how a mistake could be made in drug dosing because computers are another step in the way. Plus dosages are selected via a regular dropdown box. All dosages of compounds are rechecked by pharmacy anyway. We can get quite a few calls from pharmacy if something is non-standard or rare.
The EMR is a few extra steps in the management of a patient and does not guarantee that mistakes won't be made. Management plans are checked and rechecked as are drug dosages.
The places where EMR is helpful is getting lab results, radiology results, and study-based information on a computer. However, we have several different systems for viewing different sorts of radiology films that can't be viewed in some types of EMR. Then there is the problem of making sure the COW (computer-on-wheels) we take on rounds has a working battery back and the Cerner database hasn't taken a dive into the deep end. If its all working then it's very helpful that old notes can be looked up without giving medical records a call to haul up a 10 volume chart on a chronic COPD patient we see every other week. Unfortunately, coding for billing is still a pain. The system is so complicated that professional medical coders are needed to maximize profits through proper billing to insurance companies and government agencies.
Another problem not addressed by EMR is the fact that every hospital and practice uses a different system. If I need records from an admission at another hospital then I still have to get a Release of Information form filled out and then hope to god the other hospital can fax over copies of the chart to me. These faxes are huge sometimes, completely disorganized, and at times illegible because notes are hand written. There is no electronic transmission. If I need radiological studies then I better pray the patient or ambulance brought copies on a DVD for us to view. Then we better hope a computer system with sufficient privileges and the right Microsoft Service Pack can run the disk. The NHS system tries to address this but I left long before the system was full operational.
The current crop of EMR systems aren't fitting in with our workflow and our IT teams aren't drawing up a way for us to deal with all the variety of systems we may need to deal with in a streamlined fashion. If a consulting company could come up with a system that worked from point of admission through discharge and follow-up (and billing) of a patient with "it just works" simplicity without forcing me to add tons of different steps then we'd have a reason for EMR. Until then, its just a disaster.
This is one place where a computer alone isn't a solution. We need a solution from start to finish that works with us. A government deadline won't solve this problem. However, if a consulting team made up of a group of doctors, programmers, UI designers, and device integrators/manufacturers got together to attack this problem in an Apple-esque way they'd be billionaires.
This guys rant about the medical system is more just a problem with over-worked health care professionals, and physicians who are used to doing it their own way, and has very little to do with the electronic records system in use.
One we have physicians in place that have used computers their entire lives, and are comfortable with their electronic systems then we will start to see the benefits provided by automation.
There are already organizations that are planning complete open-spec systems, it's just a matter of ensuring that the proprietary systems comply with the specifications (hl7.org)
I think all Slashdot users can agree it would be terrible if Microsoft got in this game. If this might happen, show me where to protest!
I have bad news for you...they already are http://msdn.microsoft.com/en-us/healthvault/default.aspx
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'm a resident physician, and so I've used various EMRs in different hospital and clinic settings, and they pretty much all suck in different ways. EPIC, which is based in Internet Explorer of all things, is the worst, but seems to the the one that's being adopted at the most hospitals.
The UI design is just horrible, but beyond that I had a hard time putting my concerns into words until I read an article somewhere that talked about something called "cognitive support to the physician." That is what most EMRs lack.
As a physician, I want an EMR that lets me rapidly get at important clinical information and give me targeted alerts that I need to make a decision. Instead, the systems are centered around billing and cover-your-ass medicolegal documentation. In the paper chart word, these issues had already diluted the meaningfulness of the chart. (Ever see a hospital chart - maybe 10-20% of it has meaningful clinical data in it, the rest is full of useless legal/billing/redundant crap.) Many EMRs just translate the same troubled paper chart system into electronic format, but then the ease of electronic data entry means that even more useless information is included/required, making it that much harder to find the info you really need to make a clinical decision.
I have to say that the best EMR I have used is still good ol' CRPS at the VA. It's not as slick looking as the newer ones, but the data is easily accessible and I have never had to waste my time looking up a billing code. It's been chugging along for over a decade, sharing data between hundreds of sites across the country. (And the issue in the first article about the EMR causing more deaths because you can't put in orders while the patient is en route - not an issue in CPRS, we do this all the time at our VA.)
My understanding is that the code for CPRS is open and free to anyone who wants it. I would gladly choose CRPS over the ability to type my notes with colored fonts in EPIC. They were considering adapting it for the large county hospital system where I work now, but in the end went with EPIC because... wait for it... it was easier for billing.
Here's how an admission would go in the middle of a typical call night: I'd get called at, say, midnight to admit a patient from the ER. I'd go down there to examine the patient and admit them, which means find out what's wrong, formulate a plan of action, and stabilize them for the night.
We actually did have a primitive EMR, which held any recently (within a year or so) dictated discharge summaries -- those are a lengthy summary of what brought the patient in last time, how it was handled, what meds the patient was sent home with. Those were available to us about 1/4 of the time, and were a goldmine of information.
The remaining 3/4 of the time, we had nothing except the patient's memory (they're ill, it's the middle of the night, majority of patients don't keep track of their long lists of meds and dosages). So I'd request the patient's chart to be found. Usually, I'd hear the following from medical records:
A) The chart will be here in the morning: they're understaffed right now (they'd have 1 clerk in there at night)
B) The chart is off to some doctor's clinic from a recent visit, and hasn't come back yet. It'll be a couple of days
C) We have no idea where the chart is.
So I'd have to rely on the patient's recollection of what meds they are taking, what their medical history is, what their allergies are, etc, etc. If you've ever had to go to the ER in the middle of the night, you know how hard it is to remember that stuff about yourself, and how annoying it is to be asked the same questions by the clueless medical staff over and over again.
When I saw patients in my own clinic, it was just as bad. The records were often gone -- to the hospital for a recent admission and still being processed, to another doc or clinic, etc.
I bought a Vaio subnotebook and as an intern kept my own notes on my patients, and carried the notebook with me everywhere. I was ridiculed a lot, but I always had critical info about my patients at my fingertips.
Then I went to another hospital system for residency, and spent some time at the VA, which had an early EMR called VISTA. It was just fantastic! It had usability problems, and required a lot of typing, but it was amazing to see a patient's current medications, list of major problems, past history, etc, all instantly, integrated over hospital and clinic visits, and even across different VA systems across the country if the patient recently moved. It revolutionized care, in my opinion.
So no, it's not a panacea, but a damn sight better than what we have now in many instances!
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.
Brazil seem to have an amazing electronic healthcare system using Java. Maybe that pushed oracle to buy sun. http://java.sun.com/developer/technicalArticles /xml/brazil/index.html
Just from the number of organizations involved, it reads like "We like standards so much we're collecting all of them!".
A single standard would permit patients to move from hospital to hospital easier than it is currently. Multiple tests for the same condition wouldn't be required.
Which is why it seems the health care industry is against it.
Patients which leave don't provide more funding. Redundant tests can be a way to increase billing as well, so eliminating those cuts down on hospital income.
A Human Right
In Oregon, the number of new nurses accepted every year is severely limited to "ensure only the best candidates" are accepted. This is decided upon by a panel of nurses, who benefit from the shortage driving up wages. I know of people with 3.8GPA's, that were not selected for the nursing program, and told to apply next year, two years in a row. Yet the state screams about how much more it needs to pay nurses, to attract more, while it is turning them away.. Talk about either a scam, or just plain stupidity.. (or both)
What are we going to do tonight Brain?
I've looked through the VA's code for VISTA. What unreadable garbage. MUMPS has supported functions and variables with names longer than a few characters for years now. The spaghetti-code logic is terrible. It's pretty apparent that the software was developed by multiple contract agencies over several decades when, quite literally, the left hand didn't know what the right was doing.
Some of that I won't dispute (the spaghetti code - I still have dreams^Wnightmares about a 'three slash stuff'). At the time, the issue was there were still VMS systems from the '70s that were still in use and had limited features.
That being said, the coding standards that were used were first-rate. I learned a lot about proper coding and code review at the time. I'm not a coder by trade anymore, but I almost never see code to those standards anymore.
There was a facility for getting payments from insurers (it was a revenue source for them at one time). It's been 15 years since I did any work on it, so a lot of my memory on it is a bit fuzzy now. Then again, perhaps some of my code still lives on.
Although having more doctors would help, the problem is insurance. Because it's a tax-free benefit, we press our employers to provide the best possible health insurance. When we need health care, we have no incentive whatsoever to shop for price. It's an all-you-can-eat buffet and we have season tickets.
The insurers have the system rigged so that uninsured people get screwed. They negotiate price very effectively, to the extent that non-insured people are expected to subsidize the discounts that the insurers demand in exchange for a steady flow of patients that keep utilization rates high. The government plays the same game with Medicare and Medicaid.
Example: 10 years ago, I had inpatient surgery that resulted in an overnight stay in the hospital. The bill was $5800, of which insurance covered all except the initial doctor's visit co-pay of $10. But the hospital accepted $1500 from the insurance company as payment in full. If I could get the same type of pricing, I would be thoroughly tempted to go self-insured.
Market forces are the ONLY way to reduce cost. But we have to be careful to avoid a system as dysfunctional as the airlines.
For starters, health care expenses (except insurance premiums) should be 100% tax-deductible. There are some tax breaks available, but the government tries really hard to make this more difficult than it needs to be. It should be as simple as the mortgage interest deduction. Every dollar that is spent outside the insurance industry is helpful to the system and should be encouraged. Current policy does the opposite.
Next, there should be a universal price policy for health care providers. Let them charge whatever they want, but they should offer the same price to all. Individuals should be able to pay the same price as the insurance company. They might have to require payment upfront to avoid collection hassles, but it would be cheaper than playing the reimbursement game with "managed" care providers.
Insurance should be mandatory, but limited to big-ticket expenses with high deductibles.
Getting prescription prices under control is as easy as opening the door to Canada, India, or wherever. God knows, the pharmaceutical companies are quick to go with offshore outsourcing when it serves THEM. Why should the customers think differently?
Any solution that leaves the insurance and pharmaceutical industries unscathed is not a solution at all.
The administration either has an undisclosed agenda or no idea what is really wrong with the health care industry. I work for a large medical institution in their IS department and I spend most of my time moving medical data around. In the short time I've been here, I have run across several roadblocks to providing efficient, safe and effective medical treatment.
The most detrimental entity in all of health care has to be the private health insurance industry. Insurance companies have spent a great deal of time and money developing strategies to MAKE MONEY. They are not in the business of making people well, they are constructed to make profits and protect those profits at all costs. They have nearly perfected the art of delaying or denying treatment for sick people all in the name of the almighty dollar.
The lack of standards is truly astonishing as well. There are dozens of large companies vying for stimulus money to develop electronic medical records. Do you really think they'll be working together to provide a single solution that can be transported all over the country? These companies are also out to make a buck and it better serves their interests to develop the one standard format and be the holders of the golden goose than to work collaboratively on a solution that fits all (or most) needs. See: Blue Ray vs. HD-DVD or VHS vs. Beta-max. I would estimate that 9/10s of the stimulus money directed to these companies will be an utter waste, and the remaining 10th will got to produce fortune for a single organization.
Whenever a format *is* declared the winner, it will likely be so inadequate that it will be routinely altered and hacked to fit the specific needs of each institution. It will be rendered nearly useless. HL7 is great example of this. It's designed as the de facto format for transmitting health care information from one site to another, however, I have yet to see two institutions or vendors do it alike.
Pricing and billing are two other concerns. Both are seemingly completely arbitrary and vary widely from one facility and/or patient to the next. A simple lab procedure, let's say a white blood cell count (literally counting white blood cells), could be done in one location for X while in another location for 6X. The worst part, you have no way of knowing what that charge will be until you are billed. Then, if you have insurance, they get to choose whether to pay all, part or none of the bill based on what loopholes are available to them.
My personal opinion, I represent no one other than myself, is that the single most effective action that any government can do to help solve the health care problems is to do away with privatized health insurance as we Americans know it today and replace it with a system that is much more socially responsible. A standardized digital medical record will be a good thing, but it will likely show very little impact on patient care.
You make a good point that simply making charts digital is not enough. A good system detects errors, supports reporting after-the fact, and allows for good auditing. Our healthcare system has had an EMR for nearly a decade, and I've had a chance to see the growing pains and thrills over that time. Here are a few benefits that come to mind.
Auditing. I help an audit team look at who's pulling up whose records. With paper, this would be nearly impossible, but with electronic records it's quite easy to see that user X is pulling up the medical records of their ex-wife or the visiting famous person. Though this has been hard for some, I think it's made our organization much more respectful of a patient's privacy.
Moves. We moved our hospital recently and I got to write the system that tracked each patient as they went through the various staging areas to their new bed across town. Our EMR made this like tracking packages in FedEx and it worked great.
Widespread Communication. On a more practical note, this is the big one. It used to be very difficult to move charts and images around town or even to other cities. Now people anywhere in the sprawling healthcare system can see the latest on your medical condition.
Reporting. We have a massive data warehouse that lets us see the effect of our various health improvement efforts and gives us the ability to more accurately report quality data (e.g. are we giving asprin to everyone who comes in with chest pain?). Evidence based medicine is big in our organization, and it requires good data to support it.
Fixing Errors Before They Happen. This is the most challenging one, and I think we're still in our infancy. I helped make a lab cross-reference system whose purpose is to make sure nurses know what lab a doctor really ordered. If they ordered something vaguely cryptic, they can key in the lab name and it will give them the different names in different electronic systems, in addition to hand-entered names that some doctors use.
EMRs alone aren't going to improve healthcare greatly, but they open up a lot of other options that most certainly will.
"Clearly, the networked monitors with alarms sounding so frequently no one believed they meant anything is a serious design problem"
This isn't just applicable to this system. I can't tell you how many places I've been were network and system alarms were ignored and the answer was "that's one that we don't worry about". It leads to a really bad place. It always ends up that a real problem got missed because "app02 always has an alarm".
"Fighting the underpants gnomes since 1998!" "Bruce Schneier knows the state of schroedinger's cat"
How it breaks down is this:
HIPAA is very specific about how data is to be handled and audited from end-to-end, and includes specifics on how data can be properly de-identified. As a systems and network administrator at a major trauma center, HIPAA has been a nightmare to implement and a security officer's dream come true. That said, the focus on personal accountability and the high level of monitoring and enforcement leads to an environment much different than a credit card processor or company.
I think what he was snarking at was the fact that HMOs are essentially a privatized form of socialized medicine, and that as the system shifts toward state-run socialized medicine, the problems we already see thanks to HMOs (where billing and CYA and HIPAA rule, while patient care takes a back seat) will magnify. Take my experience and expand it -- that's what Obama's programs will do.
I remember back before HMOs, when it was easy to find a doctor when you needed one, and when one doctor or set of doctors stayed with you for the duration. Now, it's all broken out into billable hours for the insurance companies, and appointments in the distant future even for urgent problems.
~REZ~ #43301. Who'd fake being me anyway?
Interoperability is handled by HL7 http://en.wikipedia.org/wiki/HL7 interfaces.
"But really with all the crap, legacy systems held together presently by silly string...you really almost need to start OVER."
Many hospitals are starting over. They're scraping their old, cobbled together systems (seperate Lab, Physician Practice, HIS vendors) and going with a single vendor. Epic, Cerner and the like have seen a lot of interest in going with single vendor installs.
No battles to the death are recalled. Mumpsman can hit to attack and cause brainsmashing.