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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.
They aren't more usable because anyone who deals with them wants to use their own proprietary format, which they of course work with absolutely no other companies to share or interoperate with.
Until the government steps in and actually does its job, digital records are worthless to the patient.
This is what happens when companies lobby for stupid laws like we have now ... things like 'requiring X% of your patients use your patient portal ... which means that I don't have a choice any more about my medical records being online ... because now every doctor basically FORCES it ... so they don't get fined for not having X% using their patient portal ...
Instead what happens is I have fucking spammers calling me about my god damn 2 year old son because my pediatricians shitty web portal had less security than swiss cheese and was hacked, of course it also took involving a lawyer to even get them to admit to the fact they had a damn data breech ...
And all of this has nothing to do with you getting your records easier, it has to do with companies like AllScrip and its ilk lobbying and buying off congress to get stupid laws passed that do no good to patients but make a fuckton of money for some shitty industry that shouldn't even exist in the first place.
The reason medical records in digital form are useless is the same reason that Obamacare is a big pile of shit. Its not about the people, its about how entrenched corporations can make more money faster by making you a customer that doesn't have a choice in being a customer, you are required to buy their service no matter how shitty it is.
Its like your ISP except worse. You can choose to simply not have an ISP. You can not choose to not have your medical records online and you can not choose to not pay for bad insurance.
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The VA figured out a universal export that others have picked up. But you can not import to most of them.
Fun issues like well you only see lab work done by x y or z even though that doctors office has the results in there electronic system. For those of us that detest quest it's fun.
Some you can export calendar events some even have a calendar you can link to. They still insist on robocalling to remind you till you press a button to let them know you got said robocall.
You can send emails etc, one took more than 30 days to notice the message and get back.
Healthcare in this country is still working on voicemail and faxes. If the government wants to provide incentives it should be to connect to the provider of the patient's choice for all medical and related scheduling information the existing va blue button XML format is a good basis to start with. Make it clear under the law that all patient records data etc are the patients property and make not be resold etc without explicit consent every time.
No sir I dont like it.
I've developed an EHR system for a small clinical company, and one of the biggest hurdles is preventing mistakes. The prompts for, "Yes, that's what I meant to do," are almost necessary because of industry standards like ICD9 (and, fuck, ICD10 now).
One digit wrong can mean a completely wrong diagnosis, which means completely wrong tests, and completely wrong results. The patient's life can depend on the right information getting in there.
So, when developing these systems, we have to balance usability vs preventing errors. Once a system becomes too easy to use, people just start whizzing right through it like it's nothing; second nature. That's when they overlook things, like the fact that they entered 129.4 instead of 128.4, which is prettin' similar at a glance.
It's this way for most applications, and not just EHRs.
Having worked for three different health organizations, I find that breaking the task apart is more accurate, but also requires more workers. So, now you have to consider privacy and security into the application design. Doctors require as much info about a patient as possible; RNs possibly less; data entry operators (medical translators, included), require far less. And those people at the front desk, the phlebotomist, who collect pee/oral swabs for testing... need far less.
There are so many factors to consider: reflexes on tests. What to do with positive STD tests (it's required by law in most states that an HIV positive patient is notified directly and almost immediately).
People think developers of these systems are the problem, but the real issue is two fold, and it has very little to do with accounting. What it has to do with is ensuring people don't fuck things up for a patient to the point that cancer is diagnosed as low cholesterol or something far less severe... and then the patient drops dead a year later... all because someone had the incorrect keystroke, of one-fucking-character.
Doctor's don't like to spend their time using EHRs because they already know their diagnosis, recorded it on paper, and need to move on to the next patient. They're already pressured, as there is indeed a shortage of doctors, not just other medical professionals / specialists.
If EHRs are truly going to be fixed, we need a lot more people, and a lot simpler standards and coding systems. The recent ICD-10 standard that was just switched to two months ago... has throw down the fucking gauntlet holding a monkey wrench.
One digit wrong can mean a completely wrong diagnosis, which means completely wrong tests, and completely wrong results. The patient's life can depend on the right information getting in there.
Sure. But this was true before electronic records too. If nobody asked these questions when filling out paper forms - then the questions are not needed for the digital version either. It is the patients life either way - and it worked before.
Next, what idiot thought it was a good idea to enter codes anyway? The patient takes a HIV test, not "test 129.4". The patient may need "valium", not "drug #132667". And so on. Codes may have their places in the system's internal workings, but no need to expose that to users. They can select "HIV test" from a pulldown menu, or start typing HIV and have autocompletion. And red lines, if they type gibberish.
EHR has been a problem for decades. Don't blame this on Obamacare, blame it on the asshole corporations that are more interested in money than patient care. If anything, the problem is that Obamacare lost its public option because Republicans are stupid. The government runs healthcare in most countries, and it can be competently done if people don't fight it based on the fact that their rich CEO buddies wouldn't be able to buy their third summer home should profits go down because they're forced to spend more money on care instead of funnelling it to numbered Cayman Island bank accounts.
Without those mandates, the insurers would be able to continue to abuse their customers freely. Imagine getting cancer, after paying exorbitant premiums for years, only to find your insurer has cancelled your coverage for no other reason than paying for your treatment would eat into the profits. Imagine getting denied health insurance because you used to have asthma.
Companies don't do the right thing unless they're forced to - and it's the government's (read: the people's) job to force them to do it. Health insurance is largely insulated from market pressures, so "free market" principles do not apply. I certainly wouldn't pay $850 out of my pay each month (with my employer picking up the other half of my premium) for coverage that didn't pay out a dime until I've spent $5000 out-of-pocket if I had a choice. Yes, I could go to the exchanges, but I'd lose the money that my employer pays towards what I do have - and I make too much money to qualify for subsidies, but not enough where I can pay $1700 a month for health coverage. Without a public option to drive costs down (or force better behavior), this is what we have. Conservatives tore all the value out of the bill and now they're pointing out all the problems that are caused as a result (which were their own doing.) It's like slashing the tires on a car and then complaining that the ride is bad.
Never underestimate the power of stupid people in large groups.