Tuesday, February 12, 2013
EHRs, and how sometimes common wisdom is incorrect
I have the wonderful opportunity to speak with many physicians across the country. Recently in Omaha, I had breakfast with some academic internists. The recurrent theme these days involves the unintended consequences of electronic medical records (EMR) and especially the challenges imposed by the meaningful use requirements.
Once again the government imposed a regulation without understanding the unintended consequences. Since time is the most important attribute of an internist's day, anything that slows their daily activities means that they cannot spend as much time with patients.
I am a big fan of EMRs, but (and this is the key point) they must be designed and tested by practicing physicians. EMRs should make writing notes easier. EMRs should enhance sharing of data amongst physicians.
Unfortunately the promise of EMRs is failing. In order to accomodate "meaningful use," the screens and clicks seem endless. The EMR does not look right in most circumstances.
Our EMRs don't talk to each other, partially because of HIPPA and partly because each vendor uses proprietary databases.
EMRs could possibly improve care in the future, but today they have become a nuisance. From the New York Times articleIn 2nd Look, Few Savings From Digital Health Records: "Many experts say the available systems seem to be aimed more at increasing billing by providers than at improving care or saving money. Federal regulators are investigating whether electronic records make it easier for hospitals and doctors to bill for services they did not provide and whether Medicare and other federal agencies are adequately monitoring the use of electronic records.
"Technology 'is only a tool,' said Dr. David Blumenthal, who helped oversee the federal push for the adoption of electronic records under President Obama and is now president of the Commonwealth Fund, a nonprofit health group. 'Like any tool, it can be used well or poorly.' While there is strong evidence that electronic records can contribute to better care and more efficiency, Dr. Blumenthal said, the systems in place do not always work in ways that help achieve those benefits."
We need a "time out", but what will we get?
"Federal officials say they are drafting new rules to address many of the concerns about the current systems."
AAARRRRGGGHHHHHH!!!!!!! New rules--that should solve the problem (please read this sentence with great sarcasm). The rules are the problem. New rules will only create new problems. Get real practicing physicians to help you. Not computer geeks, not wonks, but real docs in small private practices.
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.
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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 Iowa City, IA, 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).
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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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.
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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.
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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.
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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.
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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.