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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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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.
The models [tomwoods.com] where so-called insurance has been abandoned are where the costs are lower and the care level is higher.
If you're going to link to a long podcast without a transcript, you ought to at least summarize the point you are trying to make so people don't have to suffer through it. Are you promoting a single-payer system there, or do you have something different in mind?
"First they came for the slanderers and i said nothing."
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.
The study described in the web page accessible from the login-protected link (which is not the primary source) has been published on the Journal of the American Medical Association: http://jama.jamanetwork.com/ar... (protected too, but at least is the real thing).
Here the AMA news release about the results, sufficiently informative: http://media.jamanetwork.com/n...
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.
There is a standard for transferring medical information between and within medical facilities called HL7, or Health Level 7. It's a fairly simple text protocol with fields designated for particular types of data separated by pipes ( | ). Those fields are sometimes then further divided. This standard is meant to ease the flow of data between disparate systems. Within a hospital you may have a radiology information system (RIS), an EHR or EMR, practice management software, scheduling software, PACS archive, lab software, interface engines, emergency department systems, and a whole host more. These are systems are made by niche companies you've never heard of, and large corporations that everyone's heard of. All of these systems need to talk to each other to some degree.
Here's the dirty little secret that makes my job more difficult...
NO ONE FOLLOWS THE STANDARD!
Seriously. Here's how a call between me and a vendor might go (simplified):
Me: Where is the scheduled datetime?
Vendor: It's in field C.
Me: But that's where the observation datetime should be. So where's the obs time?
Vendor: Oh that's in field A.
Me: Field A is for completed datetime. So where that then?
Vendor: We put that in field B.
M: Are you messing with me?
Vendor: Uhhh...no?
Me: Grrr. Field B is where the scheduled datetime should be!!! Why is it built like this?
Vendor: Mmmm...not sure. I'll have to check with one of the engineers and get back to you.
Me: You may want to give them the HL7 specification while you're at it. It's published. Online. Freely accessible. You want the link?
It'd be like every web browser and web server all agreeing upon a standard markup language, HTML for instance; then each rolling their own version anyway. So Chrome looks for a HEAD tag, but IE calls it the TOP tag, Apache calls it the BEGIN tag, and IIS uses a FRONT tag. You may be thinking, well since IE and IIS are both from Microsoft they wouldn't do that. And my answer would be, you obviously haven't delved into the world of SharePoint.
I'm sorry, but your opinion seems to be wrong.
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.
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
Or when the Dems get hold of them and all your records go into a central medical database in Washington. Oh wait, they did that already!! The only solution is never to visit a doctor.