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Why Electronic Health Records Aren't More Usable (cio.com)
itwbennett writes: There are plenty of things wrong with Electronic Health Records (EHRs), writes Ken Terry. Among them: 'The records are hard to read because they're full of irrelevant boilerplates..., [a]lerts frequently fire for inconsequential reasons..., and EHRs from different vendors are not interoperable with each other.' But those are all just symptoms of the underlying (and unsurprising) problem: '[T]hey are designed to support billing more than patient care.' A recent study (login required) found that, of 41 EHR vendors that released public reports, fewer than half used an industry-standard user-centered design process. This despite a requirement by The Office of the National Coordinator for Health IT that developers perform usability tests as part of a certification process that makes their EHRs eligible for the government's EHR incentive program.
I am my no means an expert on EHR. However I have dated a couple of RN's and have several in the family.
What I can say is that who ever develops this crap does not seem to ask the Doctors or RN's how they do there job.
There was a different 15digit code for every procedure, option, action and the RN had to key each in for every step and often had to click a "yes that is right" box or have a Dr come over and acknowledge that yes that is the correct prescription, etc. Im not talking about new prescriptions, Im talking about standard daily doses given in a care facility.
In every case it took 3x longer for them to do the computer entry than it did for them to do the job and add written notes to the charts. Every RN I know complains that it is cumbersome, time consuming, and takes away from their time caring for the patients.
It really reminded me of some of the time keeping systems I have used. Ones where Accounting laid out the system so you had to enter the time code for each task in no smaller than 15min increments and you had to make sure every min of your day was accounted for.
Resident MD here and use EHR extensively. They are a royal pain in the ass for even daily users like me to read, due to things like:
1) Lack of standardized reporting format. There is extensive variability between records from not only different hospitals, but different departments within the hospital. Different companies uses different formats, which of course aren't interoperable (probably by design).
2) Lack of streamlining for user experience. There is a lot of "unnecessary data" that a user sees, whether you're a physician, nurse, patient, lab, lawyer, etc. Imagine your car's dashboard spewing every OBD sensor data on the dashboard. Is it important? sure or maybe. Does every one need to see every bit of generated data? certainly not.
3) Lack of instantaneous access. Patients have the right to see their data more easier than: figure out the process for records at each provider > submit a records request at each provider > receive 10-1000 papers > sort through #2). Physicians deserve be able to access their patient's data relatively fast even if the patient went to a different hospital system (say traveled to a different state for thanksgiving), without having to call the office > find out the fax number > fax a request (find the patient to sign the request) > wait for 6 hours to several days while the recipient processes the request. What do you tell the patient while they are waiting in your office? Banks manage to do both #1 secure financial data and #2 make instantaneous transactions, but healthcare IT is lagging.
The way it currently stands, EHR system is a net negative experience practices, and in some cases outright dangerous (think of missing important information with data overload). The hope among physicians is that as the technology matures, the problems will get worked on and turn EHR into a net positive.
It wasn't rammed through, no matter how much spin is spun to portray it that way, the fact is, it was highly debated and discussed over decades. And it was full of compromises and such, and didn't differ greatly from the plans proposed by numerous others. The Republicans just took political cover and refused to stand up and vote for it, so almost all the Democrats did instead.
Except that, at the last minute, they passed it under reconciliation because Massachusetts elected Scott Brown to the seat that had been held by Ted Kennedy on the platform of being the vote that would block it being passed. The Senate bill did not exactly match the House bill, so the House had to go back and pass it again. I forget the exact shenanigans, but in order to get it passed the House inserted a rider into the bill they voted on that "deemed" part of it as passed without ever voting on that part.
If that is not ramming the bill through, I am not sure what they would have to do for you to consider a bill rammed through (I am guessing that you would only consider a bill rammed through if the Republicans were putting it through).
The truth is that all men having power ought to be mistrusted. James Madison
OMG, someone else that knows HL7!!!
Yes, pr0t0, I've been doing this for over 25 years and I have to agree with you for the most part. However, in my line of experience, I've seen some more variations to this example than the one you gave.
One example is: What is HL7? That's right. Companies with programs that are NOT even familiar with HL7, or an API
Another example is the different forms of medical practice. When we think of medical, we typically think of a clinical/hospital setting. But there are more cases than that: such as screening, per-screeing, preventative medicine, and mental health.
A third issue I've run into is the practice of the clinic itself. In other words, they may or may not follow what the HL7 platform dictates, and that makes API and medical meetings very interesting. You don't want to tell a Masters or Ph.D employee that they might be, "doing it wrong." I've ran into this with immunizations, labs, exams, and screenings so many times I've had to just throw my hands up in the air and let the staff fail in order for them to discover the fore-seen problems I tried to warn about prior.
Personally I'm thankful to have been introduced to HL7 as far back as in the late 90's. It's helped me to not only understand the medical community, but it's helped to shape my programming skills from thinking statically to always thinking dynamically.