Big federal push for electronic medical records

by Walter Olson on January 22, 2013

According to Mickey Kaus, it may not be having the intended results. More: Hans Bader.

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{ 14 comments }

1 Ron Miller 01.22.13 at 11:29 am

As this article indicated, the jury is still out on the long term impact. I can’t imagine it won’t eventually be a good thing for all of us. (But the law of unintended consequences can be brutal. )

2 No Name Guy 01.22.13 at 12:40 pm

Like so many things dictated from on high, a one size fits all, inefficient, crap-tacular system that actually impedes what it is that you’re trying to do* is what you get.

Thanks but no thanks.

* – well….actually since Obama is trying to take over health care EMR is one step in the process.

3 Allan 01.22.13 at 1:26 pm

Let’s see, what technological improvements were supposed to have no long-term beneficial impact, and, indeed, in the short-term did not make much of a difference?

1. Electricity?
2. Automobiles
3. Cleaning the water.

4 Doug 01.22.13 at 2:15 pm

maybe increase EMR will allow fewer doctors and more mid level
providers. The docs will spend more time overseeing charts done by the mid levels and less time seeing patients.

5 gasman 01.22.13 at 6:05 pm

“maybe increase EMR will allow fewer doctors and more mid level
providers. The docs will spend more time overseeing charts done by the mid levels and less time seeing patients.”

Problem with this is that the docs lose skills, judgement, and clinical acumen otherwise acquired through practice, while mid-levels have peaked in their skills due to being mid-educated. In this scenario, docs become another layer of the bureaucracy intent upon denying care, as opposed to being advocate for individual patients.

Well into our second decade of electronic records, the stark contrast is there to be seen by anyone on a ward. Once the chart was a clip board on the foot of the patient’s bed. The chart brought each member of the team to the patient’s bedside. Now the chart is bolted to a central desk. Patients are a barrier to the delivery of health care because one has to leave the chart and walk to their room.
Some day well designed user interfaces will exist in medical charts, and these will again be back at the bedside. We need the boys from Google and Apple to design something comprehensive from the bottom up. Current systems are fragmented, do not intercommunicate, and have terrible user interfaces.

6 OBQuiet 01.22.13 at 8:23 pm

I just ran the EMR Gauntlet.

I had an annual check up with my doc. It had been a while so for some reason, I was a ‘new patient’. I had to fill 6 pages of paper work.

One of the test he wanted was a colonoscopy (hurts getting old). That meant a referral to another office associated with the same hospital. They send me ANOTHER packet asking for the same information. “Can’t you use the records I already gave to Dr G?” I asked. “Nope”

Sigh. OK. Another half hour of paper work for what ends up being a 5 minute preview of the procedure.

Now I am told to go online and enter all my data a third time for the benefit of Surgical center it will be performed at.

Wasn’t the big idea that there would be easy access to this info by the doctors that needed it?

No wonder the profession had to be forced and bribed to do this. And business that tried rolling out this sort of time wasting as part of an internal procedure would not do well in the marketplace.

7 OBQuiet 01.22.13 at 8:27 pm

Gasman,

I have to agree. I cannot understand how something so obviously ill suited to the actual needs of doctors and patients ever made it to the market.

8 boblipton 01.22.13 at 8:43 pm

These systems stink because they are designed by people who have no idea of how items are used in reality. Thirty years after spread sheets became commonplace, I still use ledger sheets and double entry bookkeeping because spread sheets don’t work the same way. I suspect these forms are designed by people with no idea of the actual work flow. A series of forms of the type that a doctor uses could be transferred to an Ipad app, and a doctor could sit with a patient, ask the questions, gauge the reactions , make appropriate notes and then wifi the results to a central server. However, that would call for some bureaucrat to admit they have been doing things wrong and start from scratch; it would go against the companies in the medical “industry” who make money selling and maintaining the current idiotic system. It would also require a government bureaucrat, one likely with little understanding of how a doctor actually works in the field but has achieved a high pay grade through seniority and politics, to challenge other senior bureaucrats. Ain’t gonna happen.

Bob

9 gitarcarver 01.22.13 at 11:49 pm

There is something else that has me skeptical of this – the storage medium of the records.

For example, 10 years ago NASA started to panic and pulled people out of retirement because they no longer had the machines or the people with the expertise to repair the machines (such as align heads) of computers that used magnetic tape. Much of the data for the Apollo missions was on the medium of magnetic tape, but there wasn’t the expertise to read it.

In my life I have seen cards, magnetic tape, 8″ floppies, 5 ‘ 1/4 floppies, 3.5 ” floppies, CD’s, flash drives, solid state drives, etc. (Not to mention the various interfaces of something simple like a HD. (Anyone want a 30 meg RLL drive? I have one.) )

My point is that in a lifetime, a person will see a myriad of storage devices for records and the conversion from one media to another media to be able to read the data has to be a factor in the costs of something like this.

10 Melvin H. 01.23.13 at 2:08 am

Toss in HIPAA which requires you to fill out a form at EVERY doctor or specialist, every year, to say who and what has access to everything from records to a simple call for an appointment; each Privacy Act form asks for different things. None are uniform, none are portable, none are permanent…and none are online.

11 William Nuesslein 01.23.13 at 8:09 am

I was hospitalized in Dec. 2010. I observed how the staff interacted with their computers. Each staff member had a laptop on a feeding cart. Not once did any of these people swear at the computer.

I also asked my pharmacist about computer generated prescriptions. “They’re legible”, I was told. And my urologist was able to get my unnecessary CAT scan at his desk with a few clicks. It was amazing as our my dentist’s x-rays.

We need to have computers do diagnosis as doctors cost too much for routine care.

Computers in medicine are working well. Lawyers on the other hand are disasters.

12 aaaa 01.23.13 at 6:01 pm

@boblipton Sending medical data over internet (and wifi will qualify) is patented. You can not even write a system that would send those data over e-mail, because apparently that is an invention worthy of patent protection.

Well, you can not write it unless you want to a.) risk a costly lawsuit or b.) pay absurdly high fees on that patent. Do not expect such systems to become cheap anytime soon.

13 Bumper 01.23.13 at 9:35 pm

aaaa,

I don’t know where you came up with the idea that you can’t send medical data over the internet, my clients do it every day. The reason you can’t send it via email is because by HIPAA email is not considered safe, while FAXes are, although there are systems that use email to send the FAX.

As one who works in this arena everyday I have found this discussion interesting but flawed. The average mortal has no idea of the train wreck that is soon to become of medical care in America and EMR are just the tip of the iceberg.

14 aaaa 01.24.13 at 4:15 am

@Bumper Writing computer system that sends medical data over internet is patented invention. I bumped into that a while ago. It is not impossible to do it, as long as you do not sell enough copies of your software to caught attention of patent owner. It is not illegal, just patented.

One of those millions patents out there covers also this and have been used to stop competition in the market already. That is where I took the idea.

Btw, you could encrypt those data and send them safely through an unsafe channel (mail). Dunno whether that passes said regulation.

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