Posted Thursday, June 24, 2010
Electronic medical records are supposed to be central to the future of health care reform. The theory is that doctors will become more efficient and doctors, patients and insurance companies will exchange information effortlessly. Two Case Western Reserve professors say that rosy future may come with a fair number of complications: privacy concerns top the list, and they could lead to a spike in the number of malpractice suits. Thursday morning, we'll look at the potential and the potential pitfalls of health care's brave, new world.
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CCF has experimented with Google to keep health records. Is this “cloud” environment something that is being investigated for universal records? Who would create the format or protocol?
I was reluctant to switch to Kaiser Permanente Insurance 1 year ago because I had heard their system was all computerized and at UH that meant doctors who made almost no eye contact during the visit. BUT, I have been reformed! It is WONDERFUL. I have 3 kids and my own health to keep track of and the electronic component keeps things coordinated and consistent, and easily accessed from home. My ONE complaint is my daughter’s specialty care at the Cleveland Clinic, though organized within each department, is not efficiently shared with primary care providers at Kaiser, and in my experience, between departments at the Clinic. Is it possible for the numerous hospitals and clinics to agree on ONE system? And, are privacy laws in need of revision for sharing information?
I’m a former IT worker. I’m a registered nurse and have worked with several types of emr. Healthcare informatics development is crucial to the future of healthcare in the United States. One example is the cost savings involved in not duplicating expensive tests such as Ct scans, and you spare the kidneys of your patients by not giving them extra iv dye for imaging for these exams if you can download outside hospital results. We love radiology informatics!
I’m sorry you didn’t have time to take my call since I am an expert in this area. It seemed to me that your panelists were a bit luddite. I also worked in medical informatics for several years at the NIH before I moved to the University of Virginia.
As a software engineer I helped implement one of the first systems at the University of Virginia Health Science Center in the mid 1990s. We used SMS (Shared Medical Systems, Malvern, PA) software. Our system was extremely successful.
As for privacy, we fired about three workers who attempted to hack into the medical record for the actor Christopher Reeve who was admitted to our hospital after his spinal cord injury following his equestrian mishap.
Furthermore, it is often essential to force a person entering data to complete one screen before navigating to the next. We sanity checked everything. Many medical errors are caused by people simply fat fingering numbers.
My physician in the 1980s spent much of his time shouting on the telephone at medical labs who were incomprehensibly ignorant. They would do a test for magnesium instead of manganese because they started with a “M.” They would also return results which were clearly so far off base that they were utterly impossible to believe.
I had a couple nursing and medical technology students who were lab technicians when I was in college. These people were ignorant. One day I walked into the lab and found that there was all this white powder spilled all over the countertop near the sink. I asked her what this was and why it wasn’t cleaned up. It turned out it was mercuric chloride. I asked her if she was aware how toxic that was. She answered she didn’t know it was toxic. I ordered her to immediately pull out a hazmat kit and clean it up.
This is the biggest source of iatrogenic injury in medicine. The majority of these medical technicians are ignorant. That’s why we don’t let them go on to the next screen when entering data if anything is wrong. After all, data entry is not the same as treating a trauma patient in the ER. Then you just forget the computer and treat the patient. This is just common sense. Sadly there are just too many ignorant people in medicine.
Very truly yours,
James W. Adams
If you follow the money, you can see that hospitals and doctors have spent big dollars already on their in-house computer systems and don’t want their “installed base” to become a loss. So each hospital system wits to see if its competitor will abandon its expensive proprietary system first. Meanwhile big systems hope to sell their programs to smaller hospitals and practices, so they will turn a profit on their investment. All of this makes a good argument for a national or even worldwide system, for the sake of patients who may need care anywhere they go.
Though I am not in the medical field professionally, I have experienced the use a number of different databases and user interfaces and I have a question and comment.
As a professional who has used a variety of databases, I find that there are two major issues.
1. Poorly designed databases and interfaces are the norm.
Design of the database is usually accomplished by management hiring an outside firm to design and implement the database and human interface. This often involves questionnaires given to the employees who actually use it, but those are designed with questions created by someone who does not use the database. As a result, the database is usually awkward, does not have the information where you want it and when. It often requires excessive clicking and typing of information not relevant to the particular activity of the user. Feedback and confirmation of information entered or actions requested is poor to nonexistent. In other words, when a database is designed without the needs of the user in mind, it meets contract specifications but can waste an enormous amount of time, require extensive training and create new problems. These institutional interfaces are also different than those encountered in regular life, e.g. defaults and shortcut keys are totally different that Microsoft conventions, and so fail to build on existing skills and processes.
Questions: In the implementations being discussed in this program, what testing or measure of successful design is being done in the context of an actual user environment?
2. Database in Concrete
My second experience with a database or interface is that once created, it is impossible to change. The creation process usually involves an outside contractor and the institution that uses the database is not able to tweak, improve or modify the end result. Changing anything is a major operation and so even fairly gross errors or deficiencies go for years without correction. Once implemented, management takes a bow and takes credit and then departs, leaving the employees and users without a way to fix or improve things.
Question: Is the a process for the evolution and improvement based on real world experiences that will take place in the database scenarios being discussed.
I have noted the problems are particularly severe in hierarchical organizations where users and employees are not really given the opportunity to assess the development or success of a project. Needless to say, Government organizations can be among the worst in this regard.
Success for a database mean having more information and having is easier and more accurately so life and work are better. Just having a database or any compute system does not automatically achieve this.
Thank you for entertaining my questions and comments