EHR myths

Its still very expensive for small practices, with ongoing expenses too. When the investment goes down, I am in, but not before. EYE MD

“As a lawyer who’s worked on both sides of medmal, I suspect that the difficulty of altering electronic records after the fact might play a role in their slow adoption . . . .”

Yeah, I’m laughing my ass off. What a dumb statement.

I’m shocked! Vultures circle Kev’s blog. Leave it to the deviant mind to assign nefarious, criminal motives to a discussion of changing practice in the medical field.

My employer is currently working to integrate all of their electronic records into one seamless working page. I can’t wait. When I speak to a patient, I have immediate access to most of their history. The system is cumbersome right now, we have to tab through different applications, including an old DOS system. Physicians are encouraged to receive emails on their Blackberrys to book appointments. Patients are demanding we communicate with them the same way they communicate with everyone else, instantly.

The price tag? Mulit-millions.

This is very frustrating, all the way around–from the author of the article implying he doesn’t care what percentage of his diabetic patients are meeting goals for a hemoglobin A1C to the lawyer suggesting implementation is slow because EMRs would be more difficult to alter.

I don’t understand how physicians could think they can use 1900s technology (i.e. pen, paper, manilla folder) to manage the information involved practicing modern medicine. In my experience, even using an extremely cheap, bare bones EMR (ie Amazing Charts) represented a quantum leap in enabling me to focus more on practicing the art of medicine rather than spending so much time laboriously writing notes, prescritptions, etc. that even I would have a difficult time reading.

I agree with the the original post. I have used a couple of EMR in large institutions and use paper in my private practice. In the large clinic, the good EMR was good in fascilitating communication and data sharing. Despite costing 100 million dollars, it did not provide any useful population measures. What it did was give me everyones notes instantly and all the lab was there from the large multispecialty system. Even the good one took a little longer to document. The bad record system was totally useless so I stopped using it.

In the private practice, I see no net value. I have database programing experience and really wanted to set one up, but restrained myself as the benefits do not exceed the disadvantages. I only have about 500 active patients at a time and their files do not take much room. I devised efficient paper templates long ago. The advantages are outwieghed by costs and security risks. If I back up offsite, I create security risks. If I do not, paper is less likely to be lost. I have used computers since the mid 70′s and have gone through several generations of hardware and data formats for my hobby data. I learned that keeping data in uptodate formats is a chore that must not be ignored. Paper data cans sit on the shelf for 20 years and be picked up and read without a problem. I promise you that any data file you crreated in your home or business 20 years ago and set on the shelf–forget accessing it, you will have long ago gotten rid of the obsolete hardware and software to do so. It can be done, but with hassle.

I agree that the physician has absolutely no professional need at all to know how his population of patient is doing with their glycosolated Hb. His job is not to achieve a population target but to get the best results he can with each patient. His population average is going to depend a great deal on what patients he has. Does he struggle to work with a lot of non-compliant or very ill patients that other PCP’s ease out of the practice? Or are his patients highly compliant and motivated more than the average? Those are likely major factors driving the average.

It is truely pitiful what is happening to the profession, what it is doing to itself. One patient at a time guys. I don’t want my internist to know what the average BP is in his patients when he is seeing me. I want his mind on MY BP and what the proper target is for ME.

In my specialty of psychiatry, given the security risks, I am not interested in seeing a shrink with a EMR. I want one copy of my oh so private psych file to exist, and that to be barely legible. I want it in the sole possession of a rabid privacy curmudgeon doc who feels a moral obligation to me–not digitized and shoved here and yon by an IT manager. When he dies, I want his executor to burn it.