Tag: "EMR"

What If the Exchanges Aren’t Ready?

This is from my column today in The Wall Street Journal.

The Obama administration wants something the federal government has never done before: a computer system that connects HHS, the Internal Revenue Service, the Social Security Administration, Homeland Security and perhaps other departments as well. This is a herculean task with unclear benefits. For perspective, consider that the Veterans Administration converted to electronic medical records in 1998 and the VA and the Department of Defense have been unsuccessfully trying to share records ever since. Even though they have spent millions of dollars on the effort, it now appears that the two agencies are abandoning the goal altogether.

May 20, 2013 | 12 comments | by

Why Doctors Hate Electronic Medical Records

Unsent letter to the Tech Department:

So today I’m doing anesthesia for colonoscopies and upper GI scopes. Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution. I’ll probably do 8 cases today. I will sign into a computer or electronically sign something 32 times. I have to type my username and password into 3 different systems 24 times. I’m doing essentially the same thing with each case, but each case has to have the same information entered separately. I have to do these things, but my department also pays four full-time masters-level trained nurses to enter patient information and medical histories into the computer system, sometimes transcribed from a different computer system. Ironically, I will also generate about 50 pages of paper, since the computer record has to be printed out. Twice.

No wonder almost everyone I know hates electronic medical records! I don’t know anything about computers, and I don’t know what systems other hospitals have. I may be dreaming of a world that doesn’t exist or that world is here and I haven’t heard about it.

HT: Jason Shafrin.

May 07, 2013 | 11 comments | by

Headlines I Wish I Hadn’t Seen

Email tells feds to make sequester as painful as promised.

AMA: taxpayers have no right to know how much the government pays doctors.

Medicare Trustee: the federal government is unlikely to keep its Medicaid promises.

Caesarian births range for 7 percent at one hospital to 70 percent at another.

Nearly one-third of doctors using the EHR system reported having missed or failed to follow up on key electronic alerts about patient test results.

Mar 07, 2013 | 11 comments | by

RAND: EHRs Are Not Saving Money

The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.

More on the unmet expectations for electronic health records in the NYT.

Jan 14, 2013 | 8 comments | by

Why EMRs are Backfiring

Doctors used to have to fill out a checklist for every step in a physical exam. Now, they can click one button that automatically places a comprehensive normal physical exam in the record. Another click brings up a normal review of systems — the series of screening questions we ask patients about anything from nasal congestion to constipation.

Of course, you shouldn’t click those buttons unless you have done the work. And I have many compulsively honest colleagues who wouldn’t dream of doing so. But physicians are not saints.

Hospitals received $1 billion more from Medicare in 2010 than they did in 2005. They say this is largely because electronic medical records have made it easier for doctors to document and be reimbursed for the real work that they do. That’s probably true to an extent. But I bet a lot of doctors have succumbed to the temptation of the click…

And then there are the evil twins, copy and paste. I’ve seen “patient is on day two of antibiotics” appear for five days in a row on one chart. Worse, I’ve seen my own assessments of a patient’s health appear in another doctor’s notes. A 2009 study found that 90 percent of physicians reported copying and pasting when writing daily notes.

More on how electronic medical records make some things too easy.

Nov 29, 2012 | 7 comments | by

The Down Side of EMR

Tasks that once took seconds to perform on paper now require multistepped points and clicks through a maze of menus. Checking patients into the office is an odyssey involving scanners and the collection of demographic data — their race, their preferred language, and so much more — required by Medicare to prove that we are achieving “meaningful use” of our EMR. What “meaningful use” means no one knows for sure, but our manual on how to achieve it is 150 pages long…

When the clicks don’t get me what I want, I naughtily handwrite a prescription. I skip ordering certain tests I might want because it takes too much time — I’ll do it next visit. I dreaded the arrival of this season’s flu-shot supply — now there were more orders to input!

Anne Marie Valinoti’s editorial in the WSJ.

Nov 02, 2012 | 6 comments | by

How Kaiser Manages High Blood Pressure

Kaiser used its electronic medical records to identify 88,000 members in the Denver area with hypertension and created a registry to track those whose blood pressure was still too high. It contacts them to come in for hypertension checks annually. And it uses teams of skilled professionals to help patients with lifestyle changes and medications. Kaiser also offers patients home blood-pressure monitors at cost, or about $35, through its pharmacies and provides free blood-pressure checks on a walk-in basis.

Some 83% of Kaiser Colorado’s hypertension patients now have their blood pressure under control. That is up from 61% when the health system launched the program in 2008.

Source: Wall Street Journal.

Oct 19, 2012 | 11 comments | by

Verdict on EMR: Not Good

The first national coordinator for health information technology, Dr. David J. Brailer, was appointed in 2004, by President George W. Bush. Dr. Brailer encouraged the beginnings of the switch from paper charts to computers. But in an interview last month, he said: “The current information tools are still difficult to set up. They are hard to use. They fit only parts of what doctors do, and not the rest.”

Based on error rates in other industries, the report estimates that if and when electronic health records are fully adopted, they could be linked to at least 60,000 adverse events a year.

Entire article is worth reading.

Oct 18, 2012 | 8 comments | by

Personalized Medicine is Right Around the Corner

Later this year, a Boston-based company called MC10 will offer the first of several “stretchable electronics” products that can be put on things like shirts and shoes, worn as temporary tattoos or installed in the body. These will be capable of measuring not just heart rate, the company says, but brain activity, body temperature and hydration levels. Another company, called Proteus, will begin a pilot program in Britain for a “Digital Health Feedback System” that combines both wearable technologies and microchips the size of a sand grain that ride a pill right through you. Powered by your stomach fluids, it emits a signal picked up by an external sensor, capturing vital data. Another firm, Sano Intelligence, is looking at micro needle sensors on skin patches as a way of deriving continuous information about the bloodstream.

Source: NYT. More on this in future posts.

Sep 17, 2012 | 8 comments | by

Too Much Freedom?

Want to monitor your blood pressure and sugar level? Eat healthier meals? Screen yourself for depression? Find out if you need glasses? Now you can do it all with apps on your smartphone. In fact, there are 40,000 medical applications available for download on smartphones and tablets — and the market is still in its infancy…Some even replace devices used in hospitals and doctors’ offices, such as glucometers and the high-quality microscopes used by dermatologists to examine skin irregularities.

But so far, the market has been something of an unregulated Wild West; for doctors and patients alike, it is difficult to know which apps actually live up to their health claims or provide accurate information. Last year, the FDA began to lay down the law. The agency released a first draft of guidelines that require mobile apps developers making medical claims to apply for FDA approval for those applications, the same way that new medical devices must be proven safe and effective before they can be sold.

Source: Kaiser Health News.

Jul 10, 2012 | 6 comments | by
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