Here is the truth about the so-called “holy grail of medicine”:
Admittedly, other industries have seen large cost savings from computerization, but health care is different. First, the health-care system is hardly a system. It is hundreds of thousands of doctors and thousands of hospitals all practicing medicine their own unique way — and the EMR will not change that. Ideally, the EMR should allow a doctor standing in the emergency room or the hospital to look up the records from the patient’s doctor’s office. To see, for example, what the patient’s EKG looked like a year ago, or to determine the patient’s current medicines.However, each hospital system and doctor’s office today has a unique EMR that stands completely on its own and won’t talk to another’s computers. Each has purchased a system, at huge expense, from a vendor who is in competition with other vendors and unwilling to work from a common language. There is no push for cooperation.
In medicine, our fundamental activity is not stocking warehouse shelves or ordering merchandise from vendors. Medicine involves one human listening to, talking with and examining another. It seems entirely reasonable to expect that computers could improve quality by, say, prompting doctors to order certain tests, or reminding them to update the person’s immunizations. In fact, studies show that when doctors are provided with electronic reminders, 75 percent of the time the reminders are ignored . . .
. . . Adding EMRs to the current broken health-care system could increase costs, decrease quality and push the practice of medicine further away from human interaction. Before we spend more money on these electronic holy grails, let’s first look for data showing that in the real world they can achieve important goals other than simply improved billing.
(via GruntDoc)
Related posts:
- Data entry in EMRs, and why doctors are slow to adopt information technology
- Are poor products to blame for the slow adoption of EMRs?
- EMRs and EHRs
- Newsflash: Sleeping medications are being overprescribed
- EMRs: Not ready for prime time?
- Health IT: Labor shortage
- EMRs and malpractice insurance?
{ 7 comments }
“Each has purchased a system, at huge expense, from a vendor who is in competition with other vendors and unwilling to work from a common language. There is no push for cooperation.”
I hate to suggest government intervention as a solution to anything, but maybe it would be for the best if there was some neutral governing body for future EMR development — like ICANN is for the big 3 TLDs. Maybe that AMA could set up a governing technology body or something?
It almost seems like that unless there’s a standard hammered out by someone with authority — and without a financial stake in a proprietary protocol — this is a problem that will never be solved.
And that is a depressing thought.
I disagree with the conclusions of this article. While it is true that the current state of EMRs is sub-optimal, the principle is valid.
The article states, “In medicine, our fundamental activity is not stocking warehouse shelves or ordering merchandise from vendors. Medicine involves one human listening to, talking with and examining another.”
Medicine also involves doctors attempting to recognize patterns within the prose of a patient’s history, and the course of a patient’s symptoms. Physicians look for order in the chaos of a patient’s life in order to determine the diagnosis and appropriate treatment. Think about how we organize our notes and thinking.
An EMR that follows a national standard allow for us to perform large-scale outcome studies, it would allow for us to save money by identifying therapies that don’t work. It would allow providers to avoid repetitive tests and treatments. It would accomodate the fragementation within our current healthcare system, with the same patient being evaluated by their PMD as well as multiple consultants, hospitalists, etc. It would save time by avoiding the repetative taking of the same history, and by avoiding repetition, it would avoid errors from being propagated.
The bottom line, however, is that until EMRs follow a national standard and until the architects of these symptoms realize that a bottom-up approach (a system that addresses the fundamental necessities first) will be much easier than a top-down (a system that tries to accomplish everything all at once), we will continue to struggle and spend/waste money.
When I review electronc records from another ophthalmology practice in town, I read the same template phrses over and over. Its long and boring, Only a few words or sentences matter. Very strange.
Also, the American Academy of Ophthalmology apparently is working on a system for its members that adresses our needs. Hopefully it will be much less expensive than current systems, be easier to get runnung, have less ongoing costs, and generally address all of the obstacles that small practices have to face in implementing. I am skeptical. I imagine that other prof societies will try to do the same for their membership. An MD in So Cal
The worst kept secret in the DoD is their pathetic EMR called AHLTA. They have spent well in excess of $10 billion on it so far and lined the pockets of many contractors and businesses for producing an EMR that is as effective as the DMV or IRS. A great government solution…
The implication is, of course, that you should not bother with EMR and just accept the quality we have. The quality is fine and the problem is the external forces that interfere with doctors’ attempts to do good. We as doctors should not embrace technology that may enable change to happen, we should shout angrily at the problems and wait until others fix it.
Sounds like a well thought out plan.
While there are certain effeciencies to having an EMR, cost is certainly a problem. An EMR’s disproportionate cost in the background of a poor payor mix and reimbursements has put a significant strain on my practice finances.
I think the value of the “efficiencies” are more dubious for practices that have adequately efficient billing and minimal need for records sharing. In my own setting, I might save a little by having throughput to coding and billing from the exam room but it would end about there. I am generally pretty good at getting the appropriate coding myself. I usually don’t need to get too much from other doctors outside my practice, so the extramural access would not be of much value. The interface with special equipment that is necessary in ophthalmology practice might be nice, but I don’t see that as an improvement in time savings or in chart ergonomics. The costs would be large, however. I really don’t see a point where EMR would ever realize cost neutrality let alone advantage.
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