To qualify for a piece of the $19 billion being offered through the American Recovery and Reinvestment Act (ARRA), healthcare facilities will have to justify the significance of their IT investments to ensure they are "meaningful users" of EHRs. The Department of Health and Human Services has yet to define what it considers meaningful use (this is on the HHS agenda for December).
Aggregating info to create knowledge
Ideally, in addition to providing doctors with basic information about their patients, databases of vital signs, images, laboratory values, medications, diseases, interventions, and patient demographic information could be mined for new knowledge, D'Avolio says. "With just a few of these databases networked together, the power to improve health care increases exponentially," D'Avolio suggested in the September 9 issue of the Journal of the American Medical Association (JAMA). "All that is missing is the collective realization that better health care requires access to better information—not automation of the status quo." Down the road, the addition of genomic information, environmental factors and family history to these databases will enable clinicians to begin to realize the potential of personalized medicine, he added.
"Much of the information contained in electronic records is formatted as unstructured free text—useful for the essential individual communication but unsuitable for detecting quantifiable trends," such as outbreaks of infections, D'Avolio wrote in JAMA.
Data analysis experiments performed by Ben Shneiderman, a University of Maryland computer science professor and founder of the school's Human-Computer Interaction Laboratory (HCIL), and his colleagues indicate what the future holds if EHR systems are improved and implemented. "If there's enough information available, and it's able to be searched effectively, a doctor could essentially be running a virtual clinical trial for each patient by studying existing patient data," he says. "The real power of [EHRs] comes not from looking at just one patient but rather being able to analyze similar information across millions of people."
And although there is criticism that electronic medical records today are little more than digitized versions of paper forms, National Institute of Standards and Technology (NIST) Director Patrick Gallagher is optimistic that the ARRA money, combined with the $80 million in grants HHS is offering to train health IT workers, will push EHR adoption in the right direction. "The way I've been thinking about it, it simply would not have risen to the level of priority it has if it was simply about digitizing records in a doctor's office," says Gallagher, who took over as NIST director in early November. "I don't think we'd be investing as much as we're investing. This is about using technology to bring health care information together to reduce medical error, reduce the need for testing, put information in front of patients, and put information in front of researchers."
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Reply | Report Abuse | Link to thishttp://ahier.blogspot.com/2009/12/health-it-and-cost-saving.html
Is this another way for Big Brother to spy on us? The Bush adm. Was accused of this. Pres. Bush was tracking terriost, but this seems like tracking everyone probably to weed out the near end of life for the elderly!
Reply | Report Abuse | Link to thisFederal funding may be encouraging a move toward EHR, but there's more to it than just installing systems. How can healthcare data pooling lead to a better system? More at http://www.healthcaretownhall.com/?p=1499
Reply | Report Abuse | Link to thisProbally not good idea because once it entered into the computer, it's most times it's not updated.
Reply | Report Abuse | Link to thisProbally not good idea because once it entered into the computer, it's most times it's not updated.
Reply | Report Abuse | Link to thisI suffer the misfortune of having to use an electronic medical record in my practice. Keep in mind that physical records have been under continuous development since the Sumerians began making accounting entries in soft clay with wooden sticks in what? One thousand BC? Electronic records fell off the turnip truck this morning by comparison. Even considering the current speed of technological advance, I expect that it will take a century or so of uninterrupted work before the electronic medical record begins to solve more problems than it causes, but for now I find that the EMR is a hazard to patient safety, privacy, well being, and ease of care. Employing an EMR results in a HUGE "systems engineering" change in work flow, habits, sources of distraction, aids and impediments, etc. In most cases the altered systems are EVOLVED not designed, so their functional elements are neither well studied nor well understood. The developing changes in interaction between physician/patient/staff/medical record threaten to upset centuries of functional culture. No good will come of the EMR over the short term (decades) except better access to data for research, and for financial controls.
Reply | Report Abuse | Link to thisHoly Sh*t. This completely blows my mind.
Reply | Report Abuse | Link to thisThe entire health care system of the United states still hasn't moved beyond what was it, Sumerian times? One Thousand BC??? Why? Because it would require us to change the way we do things. What kind of lazy excuse is that??? In absolutely every other industry in the world, any company that took that approach quickly finds themselves out of business. Get yourselves together! It's not 1982. Electronic Record Keeping is not a big scary new technology!!!
Privacy my eye. Anyone who wants access can get access to your health records as it is. This changes nothing regarding privacy.
Chasing around after physical records... unreal.
I agree with "hotblack". The only people with a 'privacy' issue is the doctor's and hospital's - you can't hide mistakes in EHR.
Reply | Report Abuse | Link to thisIT technology is mature. The only issue for the medical establishment is learning how to use it. The public suffering from enormous medical costs have a right to demand that you do.
Just curious? Under American law, who owns a patient's medical records? The Doctor, the hospital, the insurance company or the patient?
Reply | Report Abuse | Link to thisThis article is a good start, but there's more. As a practicing internist, I see three major barriers to EHR: First is impairment of productivity during startup. Most studies show a 30-40% reduction in productivity during the first six months of use. I can't afford that. Second is that the current menu driven EHRs don't communicate patient narrative well, an important part of documenting the patient history both for other caregivers and for legal purposes. If done as free text, the information is not adequately available for data mining. Finally, not only are there inter connectivity issues within systems, but there is no standard for connectivity between different vendors of EHR systems. We need: 1)A minimally intrusive system that does not interfere with work flow. 2)An open source system that is cost effective and brings an international standard for information transfer. 3) Interpretive software that will scan narrative and offer a palate of likely coding diagnoses that can be used for data mining, with the physician given the opportunity at the time of creation of the patient record to accept or change those diagnostic codes.
Reply | Report Abuse | Link to thisResponse to Bill Case:
Reply | Report Abuse | Link to thisThe patient owns the info. The health care organization owns the paper (or the electronic medium.)
These objections to Electronic Care Records (EHRs) sound remarkably similar to the objections raised by middle management in industry more than thirty years ago. They have the same ring as the objections raised by bureaucrats in government departments 20 years ago. They are less valid now; we have come a long way since then.
Reply | Report Abuse | Link to thisAll that I can share is a personal anecdote. I had a major heart problem when I lived in Toronto and was taken care of by a fully computerized hospital. Everything there -- test results, doctor's records, diagnoses and prognosis -- were filed and shared electronically. It was zip, bam, boom and out. Everyone was used to filling out electronic forms and transferring data. They wanted nothing to do with paper. I could get a test or X-ray upstairs and the results would be available through the doctors computer by the time a got back downstairs to his office.
Now that I live in Ottawa, the local hospital does have some EHR but they run it as a dual, parrallel system. First they write everything down on paper forms and to be later entered into a computer -- I don't trust the system and just think about the waste of time and money. The paper system takes three or more appointments; one for the diagnosis, two or three more a few weeks later for the various tests, and then one even later for the cure.
It is like living in the Dark Ages. I am waiting for leeches and bloodletting to get my humours balanced.
I, too, agree with Hotblack. Doctors who don't like EHRs and CPOE are the kind who don't want to be bothered with too many facts. It's much faster to stick with the standard practice and wait for the patient to return each time the prescription doesn't work - but this is the root of the high cost of care.
Reply | Report Abuse | Link to thisEHR use by itself is an empty tool (as found in the hospital settings studeied), but when combined with changes in the care-delivery system the benefits can be significant. See full blog at http://www.ehrbloggers.com/2009/11/making-sense-out-of-conflicting-studies.html.
Reply | Report Abuse | Link to thisWith respect to Bill Case's question on who "owns" the reocrd, see blog at http://www.ehrbloggers.com/2009/12/who-owns-shared-medical-chart.html
Its easy to be an armchair quarterback and blame everything on greed or laziness. Medical data is complex and very free-form compared to airline tickets. I have used 2 different EMR's in the last 3 years. They add about 2 hrs to your day, make it harder to find the right report, cause a loss in the subtlety of historical prose. It should work better in a large format like a hospital since their data all goes into it. In the office, I cannot get all the reports directly into my EMR from outside sources since EMR's don't communicate with each other. Dictation is still a lot faster way to get data in, but harder to get data out.
Reply | Report Abuse | Link to thisIt should be clear to any physician caring for patients that in order to evaluate patient care, an EMR must be more than a computer copy of a patient's Hx, PE, Dx, Labs, X-Rays, Drug Rx etc. It must be analyzable both for the individual problem(s), reminders of routine studies and also for aggregate studies of therapy, outcomes and for purposes of "data mining" to establish current practices by region and nationally. This will require that all EMRs can talk to each other and that both inpatient and outpatient EMRs are fully linked and accessible to the individual practitioner and consultants. Aggregate data removing individual "private information" must be kept out of these aggregate data files.
Reply | Report Abuse | Link to thisWithout this forward planning to develop meaningful and useful medical records, we will continue to have only legible records without true clinical usability for ongoing patient care and a real evaluation of what is being done for patients in the USA.
These changes are mentioned in this report but need to be repeatedly emphasized to our legislators, politicians, insurance companies, federal agencies regulating Medicare, Medical etc. and the public at large. Anything less will result in continued chaos and unrest.
This is a major step forward in patient care in the USA that will require time and money to accomplish but clearly is the goal of 'meaningful', useful and worthwhile EMRs to improve significantly what we as physicians attempt to do on a daily basis as we care for our patients.
My physician would love to see what results of my prior tests were (e.g., PSAs from years ago), which physicians treated me when, what age I experienced various heath conditions, etc. I can provide very little of this info, since I've moved around every few years and the paper records I've kept don't adequately portray my medical history, or, many times, who the physician was, just who paid the bill and how much I owed over that.
Reply | Report Abuse | Link to thisI would love it if there were a comprehensive 'me' health record on line, accessible by any physician I might authorize. This would of course have to be digital, even if some of the info would be viewable-only (not searchable). Could an insurance company get hold of this info and use it against me? Maybe, but perhaps the Obama health bill will stop the worst abuses. In any case, it's a tradeoff I would choose.
I am firm believer in electronic records. So I made one of my own. Every single record I can get my hands on I scan and save it. When I go to a new provider I carry with me all the information in a thumb drive. Sometimes they look at me with glassy eyes and can't access the information so I print it for them. A few providers were very thankful for the information and some even use a tablet to download my information and upload it to their computers. Everybody could do the same for a few dollars until the medical profession catches up with the 21st century. One major requirement: Single payer so no one would be afraid that their information could cause them to lose medical insurance. Your life and mine may depend one day on electronic records being available.
Reply | Report Abuse | Link to thisLegally, these concepts are a clear violation of Roe v. Wade, which articulates a fundamental right of privacy between a Doctor and patient. Albert's method is a viable and constitutional alternative which preserves patients' rights while making information available when it is necessary. The government can't protect you from identity theft. How can it protect you from medical record theft?
Reply | Report Abuse | Link to thisBack in '98 I had a massive heart attack and a double bypass at Borgess Hospital in Kalamazoo. They were completely computerized. Digital Imaging, too.
Reply | Report Abuse | Link to thisFive years later, when confronted with what I thought was another incident, I went to Borgess again. From my local ER (40 miles away) until I arrived at Cardio ICU, they had a bed, a doctor and my complete history on screen as I was gurneyed in.
I can't tell you what it felt like to see a totally NEW doctor who knew me, my condition, and my history *before* we had said; "hello."
Go! EMR.
So is that why US health care costs twice as much as any other developed nation and gets worse results?
Reply | Report Abuse | Link to thisI started working with an EHR in my primary care setting ten years ago, and it can be tell for sure that it is a top quality improvement, as long as you take the time to start with a good history the first time the patient comes to the clinic; soon the whole system of primary care in the Madrid community will be interconnected by the web.Two problems: 1st, it is a complete loss of privacy, 2nd, sometimes the server blanks all records, and some electronic records have no full legal value, so you have to keep some kind of paper records too, double workload
Reply | Report Abuse | Link to thisSeniors's computerized medical records would improve knowledge, health, security of seniors. Yet since they have medicare there is no fear of an insurance company denying them insurance because of preexisting conditions. Why could not the whole population of the USA benefit from such a simple thing universal health care. We pay for roads we never drive on, schools we certainly will never use why not health care we all need? The fear of some new conspiracy theory pertaining to electronic medical records should be totally overlooked because those people want to live in the 18th century. Most probably think that vaccination is some dangerous plot cooked by "Big Brother." We have to improve education. Particularly teaching critical thinking and some minimal understanding how science work and why.
Reply | Report Abuse | Link to thisElectronic medical records, of course, stop working when disasters like Hurricane Katrina take down the computer network and/or the hospital generator. (As a handwriting instruction specialist, soon after Katrina I found myself teaching handwriting to emergency medicine MDs and other physicians in a Florida hospital which had been busily computerizing everything right before the hurricane arrived.)
Reply | Report Abuse | Link to thisRealities like this -- as well as the other shortcomings of all-electronic record-keeping -- explain why one medical software company (Deep Pocket Series) is now selling a handwriting instruction app, Better Letters, that runs on the iPhone and iPod Touch. Doctors with Better Letters on their cell-phones can gain and maintain legible handwriting -- something they wouldn't need to do, if electronic record-keeping always performed acceptably in real life.
Better Letters web-page:
http://bit.ly/BetterLetters (includes download link)
Video of Better Letters in action:
http://bit.ly/BetterLettersVideo
Kate Gladstone
Founder and CEO
Handwriting Repair/Handwriting That Works -- http://www.HandwritingThatWorks.com
co-designer and content provider for the Better Letters handwriting instruction app
Excellent summary of the EMR challenges and issues. Iwould like to be interviewed on a story about the Personal Health Record. Iam a SME and recently delivered a White Paper in DC.
Reply | Report Abuse | Link to thisGerald Theis,LCSW
Excellent EMR article that describes the challenges and issues ahead. I have developed a Personal Health Record system that will co-exist with the EMR . Innovative because it was designed for the consumer. I recommend an article be written about this emerging industry as well. My PHR sytem is interoperable and will protectively transmit vital medical information during a personal medical emergency On Demand anywhere anytime! Now that will save lives and avoid unnecessary duplicate diagnostic testing while avoiding medical errors! Consumers will finally be empowered as they navigate throughout the daunting health care system.
Reply | Report Abuse | Link to thisGerald Theis, LCSW
In England, if the aged are taken into care, their medical records (in the possession of their family doctors), are not available for consultation. Therefore it is just nurses who evaluate the old people, for which they are not qualified! It is clear that computerising old people's medical records would avoid a lot of current mis-diagnosis and errors of medical and psychological treatments.
Reply | Report Abuse | Link to thisIf everyone was actually honest and looking out for the best interests of the patient, it is a very good idea. However, what about the records where the doctors actually misdiagnose a patient and then that patient is denied some coverage or care because of that? Then what? Can't wait for a time when there is no more sickness and no need of doctors and health care insurance, etc.
Reply | Report Abuse | Link to thisQuinn's experience really highlights the immediate advantages of EHRs. Albert highlights the advantages of creating a PHR. Most people, and their physicians, are working with an incomplete picture of the patient's health record. The power of digital health records is evident: when a doctor has access to vital data that can help with a diagnosis, the result is significantly better. I created a PHR in HealthVault and I recommend that people who want to take control of their health do the same.
Reply | Report Abuse | Link to thisI believe that EHR is a necessary step forward to improve our healthcare system. However, the privacy of those records is paramount. Would you want a prospective employer to be able to review your EHR, showing your physical and mental history of treatment? Privacy and security must be ensured...EHR standards have to be developed and adhered to by those developing the tools to build/maintain EHRs.
Reply | Report Abuse | Link to thisI think emr services will greatly help out. I have been using the <a href="http://www.drfirst.com/">emr system</a> at http://www.drfirst.com for a while and it is one of the most convenient things I've ever used as far as hospital trips and I highly recommend it.
Reply | Report Abuse | Link to thisIt is just another way to make us IT geeks busy but it is an interesting field. We are managing informatics work in the big hospital chain in Pakistan and privacy is not a big issue. We all know that when doctors write report on paper, the registers could get stolen etc. Here we have computer coded system. So, don't worry atleast IT section is a bit on a more safer side. Sharing of medical reports, database and most important of all Drugs consumptions are very important issue. This has reduced higher numbers of drugs thefts.
Reply | Report Abuse | Link to thisMedical/Health Informatics is a better solution and is very dynamic in nature.
IT guys should get a good knowhow about it prior to doctors. Atleast their (Doctor's) stiff necks would get under someones feet ........
I was wondering where you heard that Madrid was installing a universal electronical medical records system. I want to learn more. Any info would help. thanks
Reply | Report Abuse | Link to thisFor years the federal government has been holding meetings on a weekly basis to determine a lingua franca that would make medical records be able to speak to each other such that the terminology of one system would have the same meaning in another. This occasional luncheon meeting method which hasnot yet yielded the results after upwards of 20 years of attempted development is pathognomonic of government intervention in healthcare innovation. Without the lack of a common language any hope of meaningful use of medical records is a fantasy of government bureaucrats.
Reply | Report Abuse | Link to thisThe terminology they have been working on is an XML based language called HL-7. The veterans administration does have a HL-7 universal language across all of their platforms worldwide. This is a lingua franca the federal government already owns but rather than translate that over to a standard in the private sector they insist on the ridiculous weekly luncheon meeting method as an alternative solution.
Furthermore, the structure of medical records was well described by a genius of electronic medical theory, Dr. Larry Weed, MD, the inventor of the problem oriented medical record. The structure includes active problems and inactive problems and whether those conditions are better,worse or unchanged. The allowance of only free text allows the ongoing scribble that leads to meaningless documentation for billing purposes that contributes nothing to patient care.
God help us with all of the other concepts contained in the affordable care act that are even more complex, are outside the management skill set of government bureaucrats and their usual academic appointees, for whom common sense is rarely if ever present, and who will most likely spend trillions to avoid useful solutions to the real solvable problems of improving an individual clinical malady.
Electronic Medical Records deliver time, productivity and cost benefits across the practice in the long run: http://www.technicaldr.com/tdr/ehr-selection
Reply | Report Abuse | Link to this