EMR exuberance

EMRs are being promoted as the Holy Grail. But, no one is willing to put money where their mouth is. Another example of sticking it to physicians:

Also, one wonders, say, why airline pilots are not forced to purchase, out of their own pockets, computers in their cockpits designed to prevent pilot error or collisions, but that in testing actually often doesn’t work, or just makes piloting a plane harder without strongly proven benefits.
Oh, wait … pilots could just refuse to fly until the systems worked!
Oh, wait … pilots can just go to their union steward and complain, and then the union can call a strike and shut down the airlines!
Oh, wait … pilots can just leave and go fly cargo planes in the Caribbean!
But to doctors, the government can make an “offer they can’t refuse” with impunity.

Comments

Better Health Future
First of all, this is a really bad analogy. If you worked for a hospital, like pilots work for airlines, then yes they are making investments in systems that are saving lives and reducing medical errors that SO many Doctors seem to make today. I myself choose to have my entire family see physicians that use EMR systems to track our health. I myself, have 2 chronic illness’s that where never given the attention they needed since those physicians were buried in paper that was not reportable. My presciptions used to take as long as a week, now a couple of minutes.
To the patients that wish to use Doctors that are in the ice age of technology: WOULD YOU USE A BANK THAT KEEP TRACK OF ALL OF YOUR MONEY IN A PAPER LEDGER AVAILABLE AT ONLY ONE BRANCH? – I THINK I KNOW THE ANSWER.
EMR’S HAVE BECOME AFFORDABLE (I AM NOT A DOCTOR AND I CAN AFFORD ONE!).
My physicians uses Misys and I know they just came out with a new system that is even less expensive than the one my Doctor uses. Less than $20K for one Doctor. Small price to pay to save a few lives and give better patient care.
Not to mention better physician reimbursement!
Anonymous
AS a cost of business, physicians should pass the price of a new EMR onto the insurance companies. But that’s not allowed, right? That’s too bad.
MedInformaticsMD
My presciptions used to take as long as a week, now a couple of minutes.
Now that’s a really bad analogy. (I stand by my metaphor – its major meaning was to demonstrate the political marginalization of clinicians. It seems the concept of clinicians exerting themselves politically really firghtens some.)
ePrescribing fulfillment and electronic medical records/clinical decision support systems/CPOE are quite different in scope, complexity, and nature of the deliverable.
True, computers were used to reach the moon. However, the deliverable was very concrete – a rocket to do so.
Clinical IT is a very un-concrete entity, however, an amorphous, poorly-defined series of ever-changing products trying to automate the clinical environment.
The true nature of clinical settings and the major fault in the management model for healthcare IT is captured quite pithily in the article “Hiding in Plain Sight: What Koppel et al. tell us about Healthcare IT” (Nemeth & Cook, Journal of Biomedical Informatics 2005;38:262-263):
On the surface, healthcare work seems to flow smoothly. That is because the clinicians who provide healthcare service make it so. Just beneath the apparently smooth-running operations is a complex, poorly bounded, conflicted, highly variable, uncertain, and high-tempo work domain. The technical work that clinicians perform resolves these complex and conflicting elements into a productive work domain. Occasional visitors to this setting see the smooth surface that clinicians have created and remain unaware of the conflicts that lie beneath it. The technical work that clinicians perform is hiding in plain sight. Those who know how to do research in this domain can see through the smooth surface and understand its complex and challenging reality. Occasional visitors cannot fathom this demanding work, much less create IT systems to support it.
MedInformaticsMD
LEest I be thought of as a clinical IT detraxctor, I forgot to mention my website on the downsides of clincal IT, especially at the organizational and national levels.
It is at this link.
I am a strong proponent of clinical IT, but only good clinical IT.
I expect the same rigor in the clinical IT world as people expect of clinicians.
Better Health Future
My comment on prescriptions was not a all an analogy. It was simply a fact that came out of our physician using an EMR system. They are able to better communicate internally and short cut the long process’s of “sticky notes”. It’s important to me for my family to have the best care possible. I believe that the technology has been around long enough to prove it’s keep and success. All three of our families physcian groups have EMR and rave: Internal, our OB, and our Pediatrician. Ironically, they all have the same system. Must be something good about that Misys system!
MedInformaticsMD
Better health future wrote:
I believe that the technology has been around long enough to prove it’s keep and success.
What if what YOU believe is wrong?
Why do you not address what the references in my post and website on health IT difficulties indicate? Do YOU think the experts are wrong? (You did read those links and references, didn’t you?)
And if you didn’t but still hold on to your opinion based on your personal experiences, do you recommend that strategy for medical decision making? Why, or why not?

EMR exuberance

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