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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.
This is another example of government not doing their job. We have needed a single, comprehensive standard for the form and format of Medical Health Records (MHR) for a long, long time. They needn't mandate specific products, but those products should all comply with one, universal and constantly-updated standard. But, nooo! We have to let Republicans exercise their fantasy that government can't do it, it has to be the "private sector" (in other words, reward the people who pay them to sit on their hands instead of solving problems). What was once a rich and vibrant marketplace of products has narrowed down to one industry leader who does NOT have patient information reliability and quality on their list of priorities.
We should have seen thermometers and scales and manometers and oxygen-level gauges (all standard tests on any pnysician visit) automated to send the information to the currently-opened patient record in the examining room over secure WiFi a decade ago...insofar as I can see, there are still no such products. These Electronic Medical Record (EMR) software products (especially from the "leader") are designed to impose the maximum load on professional staff, because it's easier to code them that way. I'm surprised they aren't designed to require staff to use green-screen, text-only monitors!
So, yes, lawyers are making money. And, I'm glad those lawyers are starting to attack the EMR system providers. But the Department of Health and Human Services (and, truth be told, the Republicans who think that underfunding government agencies to cripple them is a good idea) are a root cause of the problems..
Army hospitals too. My father worked in the records department of a 13 story giant Army medical center in the '80s and '90s. While the records themselves were fat paper folders, much of the patient information was kept in a database (which I think by the '90s was an AS/400) - and part of the job of the record keepers was to take the new information from the doctors and update the patient files in the database. So while the historical record was all on paper, the most up to date stuff was in the database where it belonged. They had about 30 people doing this kind of data entry full time for a hospital of 100 doctors.
Occasionally living proof of the Ballmer peak.
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.
This is one of those rare instances where the Feds CAN make a difference by mandating specific medical record formats, import and export of data, standard reporting functionality, etc.
Many EMRs are in "island" systems that you can't easily get the data out of or bring data into, stranding important information and raising the costs of moving from provider to provider. How many fucking times have you filled out the stupid medical history forms?
Where the data is kept is up for discussion, but the format and content should be standard across all systems.
When Fascism comes to America, it will call itself Anti-Fascism, and tell you to give up your guns.
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.