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Kludgey Electronic Health Records Are Becoming Fodder For Malpractice Suits
Lucas123 writes The inherent issues that come with highly complex and kludgey electronic medical records — and for the healthcare professionals required to use them — hasn't been lost on lawyers, who see the potential for millions of dollars in judgments for plaintiffs suing for medical negligence or malpractice. Work flows that require a dozen or more mouse clicks to input even basic patient information has prompted healthcare workers to seek short cuts, such as cutting and pasting from previous visits, a practice that can also include the duplication of old vital sign data, or other critical information, such as a patient's age. While the malpractice suits have to date focused on care providers, they'll soon target EMR vendors, according to Keith Klein, a medical doctor and professor of medicine at UCLA. Klein has been called as an expert witness for more than 350 state or federal medical malpractice cases and he's seen a marked rise in plaintiff attorney's using EMRs as evidence that healthcare workers fell short of their responsibility for proper care. In one such case, a judge awarded more than $7.5 million when a patient suffered permanent kidney damage, and even though physicians hadn't neglected the patient, the complexity of the EMR was responsible for them missing uric kidney stone. The EMR was ore than 3,000 pages in length and included massive amounts of duplicated information, something that's not uncommon.
I don't think the VA is a model other healthcare providers should be trying to emulate.
We're going to make information free Mr. Anderson, whether you like it, or not.
The problem is not just that, it's that those companies don't actually pay that well, either.
Writing safety-critical code is not hard - there are plenty of guidelines on what you should and shouldn't do (e.g., memory allocation is verboten). It is a specialized skill, and the job should really be done by people who have the requisite training and knowledge and often even certifications (e.g., engineering certifications).
The problem is this is very specialized, and it costs a lot of money because those people know they are taking on professional risk (not unlike many other engineers - civil, mechanical, etc., who design stuff that could fail and take lives). Of course, the IT companies behind it all? They're not willing to pay for that enhanced risk - they're going to pay market rates.
Well geez, if I'm going to be paid market, I'm not going to put my name on anything to certify because that's a specialized skill that gets paid for. (hence, things like "approved drawings" which mean some engineer actually reviewed it all and put their stamp and certification on it).
There's a reason why NASA's software for the space shuttle costs 5+ times what a normal software project of similar size and scope would cost. It's not incompetence on NASA's part, and it's not just the extensive documentation and paperwork that goes along with it, but the fact that writing safety-critical software is hard, specialized, and for every line of code, probably generates a book's worth of documentation proving it fails safe, who wrote it, who changed it, who reviewed it, etc.
Yeah. Most IT companies for health don't even come close.
If physicians have to keep updating the patient's age, then something is wrong. But good news! We have these new fangled things called computers! These computers can calculate the patient's age on the screen at the time the record was entered (by doing this patented new thing called date subtraction to get number of days and thus the age!).
I'll see your senator, and I'll raise you two judges.
In other words, shitty software strikes again. Civilization won't end with either a bang or a whimper, but will be taken down by an avalanche of garbage software. Hardly a day passes where I don't want to club some moron that couldn't program their way out of an open paper bag.
Legitimate court rulings that demonstrate real harm as a result of bad software design are a means of achieving change; the alternative is that the providers get to hide behind the claim that they are complying with all the regulations - despite providing a product that doesn't work. Whilst much lawyering is unhelpful, the reality is that SOMETIMES it does enable good things to happen!
It's not limited to electronic medical records -- it's the insane user interfaces in modern software that were obviously coded by a developer who never has to use the systems for work.
I'm not a doctor, but know many. Most of them are not happy at all with the shift to EHR, for the reasons cited. Most of the doctors I see for actual visits are attached to the large state university hospital nearby, and so they all use the same EHR system (I think it's McKesson.) The doctors often spend half the visit clicking through mandatory screens and cursing the computer. The insanely complex workflow is the problem. I work in airline IT, and the main reservation system providers do absolutely everything in their power to eliminate duplicate keystrokes and actions when booking a reservation or doing a check-in. It's optimized so much that agents trained on the system can do the entire transaction in real time while talking to the customer, with very few pauses. The real expert agents can eliminate any delays by using the terminal provided they've memorized the insane commands to do various tasks. The main reason for this is that airlines are insanely stingy, low margin businesses. Any delay for the agent decreases customer throughput and increases the chance they will need to put more agents on a shift.
In the IT world, I can't count the number of crappy end user applications I've integrated, where I've just shaken my head and thanked $deity that I don't have to use them for my job. And also, don't forget the ITIL-driven service desk and change management applications. The big vendors (Remedy, CA, etc.) will sell a company the "cheap" out-of-box package that implements _every single feature_ but charge them millions to customize it. Most companies don't bother, and you end up with systems where you spend almost an hour filling out a change request.
I'll bet most of this problem stems from that "out of box" deployment syndrome...where you get a product that technically functions, but is suicide-inducing unless the customer pays for customizations, in the "light a bag of money on fire" realm. How many hundreds of integration points does an EHR product have? Prescribing systems, records storage, insurance company connections, etc, etc, etc... Doctors must hate it because they can't just order a PA or nurse to do their transcriptions for them like they used to.
Really? And let's say that instead of a normal adult visit, we're talking about a pediatric visit for a child or infant with a congenital heart defect. Will the oxygen-level gauge transmit whether the reading was from a finger or a toe? Will the manometers also transmit: 1) what side the pressure was taken from, 2) whether the pressure was taken from the arm or leg, 3) whether the patient was sitting, standing, or supine?
Yeah, that's the thing. When the /. crowd starts saying there should be a "single standard" for medical records, those of us who actually work in the industry just roll our eyes... You have no idea of the complexity of the problem, nor of how fast things change on the cutting edge of the specialties.
Oh, the Feds have made a difference all right. Not the good kind. Yes, they've mandated that the systems 'talk' to each other but then watered things down to where all they have to do is talk to some third party reporting system. Sometimes. But mostly the Feds have spent their time and dime making sure that EHRs collect all sorts of useless data and follow clinically irrelevant workflows. Then they spend their time changing the rules in mid stream.
So the vendors, especially the smaller ones, spend the majority of time trying to keep their systems in compliance and avoiding doing anything clinically useful. The big systems (Epic, GE, McKesson, etc) have their own issues but generally have the resources to deal with the idiots. Even amongst the big guys there is very little work done on how to integrate all of this fancy data into something useful for the clinician and patient. It's mostly just capturing everything that every happened.
And printing it out on paper.
Faster! Faster! Faster would be better!