A cautionary tale indeed.
Chris Rangel details the debacle of his institution’s electronic medical record implementation. Apparently, the IT consultants didn’t work well in concert with the EMR technical people, with Dr. Rangel noting a circle of blame between the two parties.
Indeed, the worst-case scenario happened – a catastrophic loss of patient data:
The backup system was supposed to be saving every EMR database copy but instead it was just backing up the entire hard drive. This meant that as the EMR chewed up data to save space, the backup system copied the files off the hard drive only after the data had been eaten. Then the EMR people decide to remotely update the EMR software which screws it up – of course – and in the process of reverting back to the prior version . . all the records after December 2008 disappeared. Vanished.
And you wonder why doctors are so hesitant to trust their medical records to the current, outdated technology.
We’re currently throwing money at a Windows 95 era of electronic record programs. There’s a real danger that swift adoption of these flawed systems will prevent any meaningful modernization of maintaining patient data.
Related posts:
- Op-ed: Why doctors still balk at electronic medical records
- Paying doctors by the hour will increase the adoption of electronic medical records
- Most hospitals still use paper records, and why money alone won’t solve the electronic medical record problem
- Medical records and Facebook
- Will the benefits of digital medical records only be seen in large, integrated health systems?
- Poll: Will electronic medical records really save money?
- Medical students who are used to electronic records
{ 14 comments }
We do manual back up on separate DVD drives every single day, in addition to an automatic back up on the server and an off site back up. When it comes to medical records be very paranoid!!!
While I am not a physician yet, I am but a young’un preparing for medical school (starting my first year this summer), I can’t imagine why anyone would need anything more complicated than a simple system of 2 excel files for each patient – one for appointments (with a new tab/sheet for each new appointment’s remarks) and one for labwork (one new tab/sheet for each report, with a standard template for each general type of analysis ordered so you don’t have to type in the name of each test ordered a thousand times). You can get a scanner involved, too, and scan in .jpg files of whatever non-electronic documents other facilities send you. No fancy expensive software necessary, no esoteric technology that only a select few inept IT dudes can “understand,” and you can back it up all by yourself by plugging in an external HD and setting it to back up your folder of choice automatically every _ days.
Web based is the way to go. You do not have to worry about backups, as the companies backup constantly to multiple locations around the country. I am not sure what is out there for MD’s, but in EMS web based patient records are great. Things are upgraded & managed by the people that create it. Works much better than having an IT dept try to troubleshoot/manage software that they do not fully understand.
Based on the comments I think we’re seeing a comfort with technology generation gap in physicians.
All that the current EMR’s do is line the pockets of EMR salesmen, help insurance companies decide how not to pay you, and provide fodder for plaintiffs attorneys.
As a 2nd year med student, I totally agree with Matt on the generation gap.
My generation grew up playing with computers in elementary school, and are used to be around it. The last few years I’ve watched my parents (smart people, but only typically tech-knowledgeable) be befuddled by text messaging, blackberries, facebook and other info. Most EMR’s / Databases aren’t much more complex than facebook/myspace, I deal with them everyday.
To ‘EMRs Suck’, can’t you say similar things about the paper companies and their records, or the evil fax machine makers? Sure, I think the med-mal system is broke, and EMRs make things easier for them, but if it can result in better patient care or easier workflow, I’m all for it. What other industry is still stuck on paper records like the medical field is?
The generation gap is hooey, or at least misunderstood. The older generation of physicians are not technophobes–they are the ones who brought medicine from the almost purely clinical art that it was a generation ago to the high tech enterprise that rapidly incorporates all sort of new technology that it is today.
Where there may be a generation gap in is the area of trust. The older generation of docs have seen computer technology develop from it’s infancy. Often they were the ones driving it programming an Apple IIe at home. They know how unreliable it can be, and how all the points of potential failure are not usually predictable up front. Also they take privacy concerns and their obligation to protect it much more seriously than a generation that have grown up in the goldfish bowl world of facebook and myspace. They have more discomfort with “trust me” contracts from venders because they have been burned before and know promises are not certainties.
Look up the career of Dr. Ed Roberts, family doc in rural Georgia before you denigrate the technology aptitude of older docs. It is a really cool story. While you are at it, remind yourself of how text messaging got Mark Foley caught. The electronic technologies cited (text messaging, blackberries, facebook) give the illusion of much more privacy than they provide and therefore have no place in medical care.
With a paper record in a quality locking fire-resistant file, you don’t need cumbersome on-site backup plans or risky off-site storage. Remember the company in Florida that cut doctors off from their medical records if they didn’t pay massive new fees that they weren’t expecting? Remember the transcriptionist in Pakistan who threatened to post American patients medical notes on the web in a pay dispute? Just last month, the controlled drug database in Virginia was hacked and extortion demands made! The state of Virginia has access to IT expertise and hardware that practitioners can only dream of and they can’t keep it safe.
As an IT professional with experience in many fields of business, I have to say the IT professionals in the medical field would not cut it in any other business. They don’t due what is considered the most basic of functions – support the business. That means identifying all the various user groups and how they need to interface with the system.
I have heard many older and younger health care professionals describe incredibly bad systems. Make no mistake, the guys creating these systems would be fired in any other field for not doing their actual job!
Medicine is not the only field that has to have 365/24/7 up time. Try running a phone system. Outside of actual computer companies, that’s where the best talent is. After that, the closest you come are those dealing with banking and regulation.
This is, to a large degree, the fault of the medical field itself. They don’t consider non-physicians worthy of pay. The cream of the crop go to where the money is. Until that issue is solved, you are going to continue to see bad systems.
Or, Google really will be the default provider for all medical informatics.
Doc Stone- Sorry, I painted overly broad generalizations about the comfort of generations with technology from limited experience. I was unaware of some of the situations you mentioned, I’ll look into those and keep them in mind for the future. And it is always hard for a generation to recognize the work of the one before, I was too young to really remember the first Apple IIe’s hitting the market. Maybe any gap lies in the “taking it for granted” we both seem to be getting at, with my young generation seeing computers as ubiquitous. I’m grateful for the ways IT has changed medical education, I’m pretty glad I can search the literature from any computer anywhere without having to dig through piles of book at a library, or have access to all of my syllabi and slides on demand without lugging more than an iPhone around. Why can’t we harness more of that power in the clinic? Definitely need keep privacy concerns in mind, but still. Thanks for setting me straight though. The Dr Roberts story was cool btw.
MLO- Amen.
Laina is right. Medical EMR is a database. That’s it. Your grocery store has a database, Wal-Mart has a database, the pizza chain restaurant has a database. And I bet their database was a ton cheaper than the EMR foisted on the doctor.
You can make it more complicated……say…….for datamining. Make it easier for business or government to find out more about you. But if your purpose is just to take care of patients, a fairly simple database or even Excel file is enough. Does the EMR exist to facilitate patient care, or to facilitate government intrusion or drug marketing?
EMR’s are complicated because we MAKE them complicated.
None of the above comments address that backup of a database is not just a simple file copy when systems such as Oracle, Microsoft’s SQL Server or the (superior, open source, free) MySQL is involved. It’s essential to know you can trust the backup, so as a quarter-century IT Pro, please consider taking my advice and do a test of restoring from the backup onto a virginal machine. Only then do you know your backup is actually doing what you need it to do.
I love how people are ranting about the costs and issues with EMR. No doubt there’s lots of issues in that regard. However, the point of this article is that the IT people didn’t know how to do proper backups. This is backups 101 to know that you need a real time system and point in time backups to solve the issues listed above. Not to mention an offsite backup to solve the other 2.
Of course, how many doctors offices try and go it alone and don’t have this in place. Far too many!!
Privacy issues aside, it’s hard to believe that there has not been more integration of electronic technology in the medical field. Paper records are inefficient at best. Patients are spending more time on the Web “diagnosing” themselves; they want access to their records so that they can educate themselves on their conditions. Well-informed patients can only help physicians improve outcomes. And to do that, EHR platforms are essential. Something must be possible.
Another EMR problem occured in our Medinotes/Eclipsys software that has been a headache. We recently added eprescribing, where a prescription is sent directly to the selected pharmacy computer. The software sent a message that my password needed to be changed. So, I changed it at Medinotes website/ Dr. First. Since, then none of my prescriptions go to the pharmacy. I get diagnostic errors that my name and password do not match their records. Do not get eprescribing software until companies work out all the bugs. Wait until 2010.
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