The Obama healthcare plan hinges on savings achieved through the implementation of electronic medical records (EMRs) and pays doctors $44,000 over 5 years for hardware and software to embrace this evolving technology. Let us not forget however, that garbage in produces garbage out, for instance, information not suitable for medical decision making.
In reality, data entry is daunting and by far the most expensive aspect of converting to electronic records. Huge amounts of patient data resides in the IT “silos” of insurance companies, hospitals, pharmacies and laboratories. It could pre-populate EMRs, should the principles decide to share it, which largely they have not. Some of the data is accurate, some certainly is not.
Currently, data can only be entered on a patient by patient basis. Unless the relevant medical decision making data is properly vetted and reviewed by the patient, with one on one help by a clinician, it becomes garbage in. An experienced primary care clinician who knows the patient best and has all medical information flowing through their office is the best person to input and screen new information important for medical decisions. They would also potentially shoulder the lion’s share of the burden of data input responsibility and therefore cost of implementing an EMR. These are the same practices that are the most financially insolvent, many on the brink of shutting down. Should specialists get the same stimulus if their input is limited to one organ system?
One of my patients was recorded incorrectly at the hospital as having reported a reaction to x-ray dye, and a breast cancer history. Whenever he goes to the hospital, these continue to be reported on his computer record. The odd times I have had to order a test that required x-ray dye, my staff and I waste hours in order to convince the facility to do the study. I have repeatedly told the hospital IT department that this needs to be corrected, only to be told that there is no current mechanism to correct this.
Interconnectivity is also still a major stumbling block. National standards are far from established. Currently, office based EMRs can get info from the lab and the hospitals, but cannot communicate back to these entities, or with other doctor’s offices. Any interconnected central repository that could communicate effectively in a standard medical decision based format is still many years away from being a reality, and who will pay for this?
To implement an EMR carries a real cost of well over $100,000 per doctor and much more for primary care practices. There are currently scores of vendors. Each vendor stores information on their own proprietary software. Only half a dozen vendors are expected to survive. If your vendor goes out of business, you go back to square one.
Consider these issues the next time you feel like your doctor is slow in adopting health information technology.
Winslow W. Murdoch is a family physician.
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