Concerns about the push towards EHRs and PHRs:

I am becoming increasingly concerned about whether the push for national-scale EMR's has created a "gold rush" where prospectors of varied honesty and ability have set out to 'strike it rich' -- by sucking every dollar they can out of an already strained healthcare system under pressure to 'revolutionize care' through computerization.


The strongest point of the VA system is their EHR. I used it extensively during medical school, and really is the only feature that should be copied from the VA system. DB and #1 Dinosaur comment on a Washington Post article.

Another EHR debacle

This time at UC-Davis. The transformation of medicine to the electronic age continues to result in some the biggest wastes of money:

A key observation is that "there's nothing to show why existing staff was not assigned to do what the university paid outside consultants $17 million to do."

Aside from the disruption during roll-out, many EHR programmers don't really ask what physicians want. A typical IT top-down mentality:

Few developers have asked the physicians what they need. Fewer developers understand why they encounter such massive physician resistance. Those who have tried to understand the resistance can not get a straight answer . .

. . . I think the reason is that software developers are ...


The real scoop on EMRs

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 ...


Fat Doctor on EMRs

It makes it easier for the charts to pile up:

When we had paper charts, I'd get freaked out if there were 10 on my desk. I'd quickly scribble out bare-bones histories, ROS, PE findings and plans. Now, it's really easy to get behind very quickly. Part of the problem is the ability to be so darned thorough. I never felt that pressure with paper charts.
Templates are key. ...


It seems so. Many EMRs are template-driven, so you have to work within its confines - rather than the other way around. I also was amused at how the doctor immediately announced how much time she had for the visit:

I was surprised, however, to see this new doctor enter the examining room with a computer on a cart. She didn't greet me or shake my hand. Instead ...


Tips for a smooth EMR transition

And a soothing recipe at the end to boot. (via The Health Care Blog)

Their EMR is a major reason. Although I don't think it works this well:

Most private hospitals can only dream of the futuristic medicine Dr. Divya Shroff practices today. Outside an elderly patient's room, the attending physician gathers her residents around a wireless laptop propped on a mobile cart. Shroff accesses the patient's entire medical history--a stack of paper in most private hospitals. And instead of trekking to the ...


EMRs: Where more is less

Doctor comments on JAMA's recent EMR commentary:

Moreover, EMR encourages everyone to copy-and-paste the notes of everyone else so that notes become the same from author to author as well as from day to day. Even consultants are assimilated into the oneness of the EMR Borg. A cardiology consultant recently copied-and-pasted the intern's note into his own, even including "consult cardiology in AM" in his recommendations. Perhaps he meant ...


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