Friday, September 7, 2012
My struggles with our EHR
My group purchased our electronic health records system (EHR) about 5 years ago. We had four clinical practice locations (soon to be five-and-a-half) with one administration office. None of these sites are close to each other. A major reason for purchasing an EHR was, and still is, to collect and analyze all data from our entire practice for the purpose of determining outcomes of our treatments.
In other words, we wanted to know how our patients were doing in all of our offices, which treatments were working and which were not, and then use this information to refine and practice the best medicine we could. This was the promise of an EHR.
And so my nightmare began. Some of my patients define nightmare as something you didn't wish for and it never seems to end. Volumes could not fully describe my experiences. I'll just mention one "glitch." I noticed that some of my notes were disappearing into the "ethernet" on a seemingly haphazard basis. Sometimes I could locate them in another section of the chart; other times I wasn't so fortunate.
Despite my staff spending weeks trying to find the defect, we had no success. Our vendor monitored my work processes for two weeks. Again, clueless.
To add insult to injury, I was told that I was the only one experiencing this problem which, of course, I took personally. Turns out the problem occurred only when I started my note before my medical assistant entered vital signs. So we had the explanation, but no fix. As a result, I wait for my assistant to enter her data, which frequently delays my ability to see patients on time. Recently, we have added two physicians to our practice. One of them asked me what he was doing incorrectly that caused some notes to disappear. This time I had the answer!! What's more, I was now informed that it was a system wide problem for which there was still no fix.
When I was a kid, there was a TV show called the Naked City. When episodes ended, the announcer said: "There are 8 million stories in the Naked City; this has been one of them." I do know that my story is just one among many. But it's still so annoying.
Because of the flawed design of this particular EHR system, we have been burdened with huge financial costs resulting from lost time, the need for extra IT support, and the hardening of my right carotid artery. I don't need the added stress in this era of decreased reimbursements for providing clinical care and chemotherapeutic agents.
One of my partners has gone back to hiring a transcriptionist rather than using the EHR. Another is chronically behind in his data entry. To this date, we are not set up to pool and analyze our data for outcomes. Soon, we are beginning the gut-wrenching process of converting to a new, and hopefully more user friendly, system.
A few weeks ago, I had the pleasure and honor to have a conversation with Eric Topol, M.D. on "this week in oncology" radio show. We were both intrigued by two articles that recently appeared in the New England Journal of Medicine on this subject. The first, entitled "Escaping the EHR Trap--The Future of Health IT," discredits the myth propagated by EHR vendors that health IT is different from industrial and consumer IT. The authors suggest that vendors have alleged this to be fact "in order to protect their prices and market share and block new entrants."
The second article is also quite enlightening: "Unraveling the IT Productivity Paradox--Lessons for Health Care." In the 1970's and 80's, many industries adopted computers with the expectation that they would increase productivity. To everyone's surprise, digitization resulted in a significant reduction in efficiency. This was called the productivity paradox. Subsequent research revealed that productivity attributed to computerization was underestimated due to defects in measurements, mismanagement of processes (such as summarized in the "glitch" in my system above), and poor usability. Most systems, including mine, don't have spell-checking capability. Unbelievable!!
In chapter 7 of his must read, "The Creative Destruction of Medicine", Dr. Topol discusses the benefits and challenges of electronic health Records and health information technology in detail. Despite the fact that digitization initially can be associated with an increase in errors, which doesn't ease my pain, and many other challenges, he concludes: "While some may consider the topic of electronic medical records prosaic, it should now be abundantly clear that their ultimate adoption and full interoperability will prove fundamental to the future of medicine. Only via full electronic convergence can all the tools of digital medicine be in sync and immediately useful. With the torrent of individualized data flow that is coming from whole genome sequencing, remote physiologic monitoring, and medical imaging, electronic information storage and processing will become more essential than even envisioned today."
I have to agree with him. While this current transition period can be a frustrating, even painful experience, the alternative of a failed health care system is unacceptable.
This post by Richard Just, MD, ACP Member, originally appeared at JustOncology.com, a joint publication of Richard Just, MD, aka @chemosabe1 on Twitter and Gregg Masters, MPH, aka @2healthguru on Twitter. Dr. Just has 36 years in clinical practice of hematology and medical oncology.
Contact ACP Internist
Send comments to ACP Internist staff at email@example.com.
- Five reasons why research into eggs is scrambled
- QD: News Every Day--High mammographic breast densi...
- Insurance coverage leaves patients feeling naked
- Get legislatures out of the office and away from t...
- QD: News Every Day--Kidney stones associated with ...
- A plague upon unneeded antibiotics
- Practicing medicine isn't like ordering from a men...
- QD: News Every Day--Nine of 10 with uncontrolled h...
- West Nile Virus cases reach 8-year high
- QD: News Every Day--One-third of internists won't ...
Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.
David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.
Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.
Reflections of a Grady
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.
The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.
Technology in (Medical)
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.
Peter A. Lipson,
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.
Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.
Other blogs of note:
American Journal of
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.