Healthcare computing and the use of the electronic health record has been a difficult roll out.
I worked for a very fine bunch of Portugese medical system computer experts for a time. They wanted to break into the electronic medical record market in America. They had some paperless hospitals they developed in Europe.
Fascinating to see what a big deal computing has become. I am not a good nerd, worked for them to advise them on medical care and medical risk management content, have no software or hard ware expertise at all. I use computers when I work for the Army and the computer is my typewriter and search/email engine at home, but computers in health care are intended to create a seamless digital record, nursing and physician notes and orders sheets, reports, consultations, operative and anesthesia records, recovery room records, medication records, therapy records, dietary, respiratory therapy, social services reports, vital signs records and more. on and on. a lot of stuff.
Read a computerized hospital record and it can easily get to hundreds of pages for a short stay, much, much more for a long one.
Now we find out that implementation is still going slowly and there are lots of problems. Sometimes commitment to electronic records still doesn’t gitterdun. One example is a famous 100 million dollar dud in a major California healthcare system. They just shutterdown when the docs threatened a revolt.
We have a big computer commitment in the DOD but people are not happy with how it sucks a lot of energy and time from patient care.
Computers are tools. I think they take up too much time and energy from the nurses and physicians.
They eat you up with all the screens and questions to be answered and medical care is pretty burdensome to think about , much less to document compulsively.
30 years ago my father, a physician, kept his patient records on 3 x 5 inch cards.
http://www.ihealthbeat.org/articles/2014/2/13/study-finds-hospitals-unprepared-for-full-cost-of-ehr-implementation
In my book, the most important use for the EMR is the record of medications and sensitivities/allergies. If these are up to date the others arent nearly as important. We have good computer programs these days that can identify dangerous medication interactions, as well as identify when someone has been prescribed a medication they are allergic to. If these two critical areas are current and in the computer system, and new prescriptions go into the system immediately, it doesnt really matter if you keep the rest of the data on stone tablets or the latest in electronic storage.
Here’s another part of the problem, if you have a program that does a default, it would put in stuff that isn’t true.
the default stuff for a Kurzweil set up became a real problem a long time ago.
i say nothing about a chest exam, it puts in a chest exam that makes it sound like i did a complete, more than complete exam and everything was normal.
So, as a risk manager, i had to tell people not to be a victim of their computer and it’s ability to put up all kinds of verbiage that means nothing.
one problem i’ve seen in the EMR’s i’ve reviwed is that they appear to use default entries in parts of the chart, which i figure someone thought would save time.
unfortunately, nurses being nurses, many forgot to make the necessary changes as their patient’s conditioned changed. for example:
charting that the patient’s skin is “dry, warm, elastic, intact” when you are also charting wound care of the blisters and ulcers on their thighs & lower back is a fail, and a failure to meet JC standards as well…
Holy cow, Greene, you must have strong bull genes to make these kids such successes.
I get these techies, but you know, it still has to happen between the ears.
Amazing how they have so much access to info. Amazing how they are fascinated to watch an old guy walk in and figure out what is going on. Some of them think I am a Shaman or VooDoo priest and they are right–one has to set up the therapeutic milieu. I know the secret.
Actually I know what I know and what makes sense and I tell the patient the truth, from experience. You would hate practicing medicine Greene, you’re such a scientist–i am more like a priest with some real knowledge and a censer that burns my own particular form of incense.
I also am allowed to use suggestion and empathy and friendliness/paternalism to get results. I have a tremendous advantage because I am old and grey all over but frightfully handsome considering my advanced years. I tell the residents that if God came to earth and wanted to be an emergency physician, he would look like me. My luck, I had nothing to do with how I look.
I do really like to teach emergency medicine. I really do, and i teach it from a position of fascination and uncertainty and limited knowledge–the nature of what we do is uncertain and we try to bring more certainty to it.
Make sense?
How much of the problem is implementation? Bon Secours (Richmond) computerized several years ago. It works quite well from a patient standpoint. I can do non-critical by email, fill out the awful, repetitive questionaires on line. The downside is I’m in an examining room with the Doc or Nurse talking to me while staring at a screen. Dougie Hauser has figured out if he isn’t looking at me, I don’t talk.
How much of it is generational? The kiddies don’t know from pen and paper. My No. 2 daughter is an ER nurse in Anchorage and wants everything on an Ipad. My niece is grinding her way through med school and is aiming toward ER. She is totally computerized.
If you get the data management right, and make the interface intuitive, it should work well. The problem with IT types is they generally don’t listen to the client and give him what they think he should have and needs. I’m not sure if that’s genetic or beaten into them in school. I’ve fired a few consultants who didn’t get the message.