We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
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Thursday, May 23. 2013
Or, for that matter, in the hands of the IRS?
I can report, first-hand, that electronic medical records double the doc's time doing "paperwork," and thus halve their time with patients. There is only so much time in a day. As a private Psychiatrist, I have thus far been able to avoid it. Who would speak freely to me if my notes went into the cloud? I was offered a $40,000 check by the government to go to electronic records linked to the hospital and thence elsewhere, and I refused the offer even though the money would come in handy.
Obama’s Medical-Records Crony - Electronic medical records are being heavily subsidized — to one Democratic donor’s benefit.
If you have a problem with this government-subsidized trend, ask your doc whether he, she, or it - or they - puts your records on the internet. Most hospitals require it, nowadays, as it is required of hospital-employed physicians. FYI, you may not know whether your doc is a hospital employee or not because many are selling their practices to hospitals in anticipation of Obamacare. Times are changing.
Ask, just so you will know.
By the way, I am not stupid but I cannot understand this: Yet Another Obamacare Design Flaw
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I install and support EMR systems in Canada so the situation may be somewhat different. It is an Open Source EMR called Oscar McMaster, developed at McMaster University.
Since it's Open Source, the only cost is the (optional) support.
There may be a learning curve initially, especially for physicians who cannot type. Voice Recognition software can be used (eg. Dragon Dictate).
There are many advantages: No paper charts to find, file and pay rent for. Some of my clients had no more room for new charts. That space is now empty.
No appointment books. Automated reminders.
You can find out which patients are on what medications in seconds.
You can read your notes later.
Prescriptions can be sent to the pharmacy electronically.
You can access your information remotely (if you want).
Automated tracking of critical measurements (from Lab results).
BUT, I would agree that there is little or no time savings within the examining room. The immense advantage is before and after the patient visit.
The benefits for some specialties may be different.
Typing notes while talking to a patient may not work in your situation.
The data can be stored in your own office, not the cloud.
..so just because the government is recommending something, doesn't mean that there no alternatives.
The government should not be telling physicians (or others) how to operate their businesses.
The advantages you list assume that everything goes correctly. But it is likely that some percentage, lets say 5% of the records will get lost, mis-filed, lose data, not be linked or associated with specific files that directly relate, etc. The error rate and types are not too dis-similar from the manual filing system. But the primary difference will be that if a record doesn't exist or isn't retrieved properly in an automated system everyone will swear up and down it never existed. Whereas in a manual system where the people doing the actual filing and retrieval of the data are so accustomed to errors they develop a system to find misfiled and lost records. So I'm suggesting that with the automated system we will still have all the same problems and fewer solutions to those problems.
Furthermore the new automated system will cost billions, it will be delivered late, probably years even decades late, it won't work as designed, the cost overruns will be 200%-500% and the probability of it being scrapped after years of effort and lost files and system failures is about 50:50. This is the norm, the standard for very large automated systems funded by the government.
But it gets worse. To the extent the system works it will be hacked, misused and exploited. Make no mistake if you are famous or infamous everyone using the system will read your records. People will read their spouse/friends/relatives records. Information will find it's way into tabloids maybe even wikileaks.
A 5% error rate filing documents is unacceptable. I have never seen anything close to that number.
A properly designed computer system has audit trails, so that misfiled documents can be found and refiled. Try doing that with a paper system.
So I'm suggesting that with an automated system you will have fewer errors and the ability to track down what went wrong.
Billions? Perhaps a system designed by the government. The NHS in Great Britian has transferred over £7bn from taxpayers to IT companies with poor results.
Oscar was designed by physicians and is being used in clinics across Canada. There is no charge to download it and try it out. There are numerous demo sites online.
The problem is the government, not the system.
Can't disagree with your last statement.
Probably 5% error rate is too high. Whatever the error rate I would expect it to be the same as a manual system. The problem with an automated system is people believe it. The computer says it so it must be true. A manual system is one that people intuitively understand. A misfiled record can be found placed under a first name vs the last name or in a file of a similar name or some other intuitive place that humans place things when they are talking about what they did last night. The problem with an automated system is once the data is filed or changed etc, right or wrong there is no reason "look" for it anymore. The system provides you with something when you make a query and to the user it is gospel. I'm still looking for some X-rays taken in 2003 that magically disappeared. How many X-rays disappear but we don't have a reason to discover the error? I have read that over 100,000 people die in the U.S. every year from medical mistakes. How could that possibly be true. Is that error rate 5%? Is that error rate "unacceptable"? Is it even accurate? It could be higher and unknown. Do we even know the correct error rate for existing automated systems? We ONLY know the errors discovered we don't know the unknown unknowns.
The system you describe appears to designed for "clinics" and not nations. Will it work flawlessly for 350 million people in a country where high school graduates (who would be the people entering the data) typically read at the 8th grade level?
And none of this even addresses the major flaw with such a system; the risk of misuse. China has hacked into every computer system in the free world. Israel (or someone) put a trojan into Iran's computers to destroy their nuclear bomb making systems. A bunch of thugs recently stole huge amounts of money from ATM machines around the world with a simple computer hack. How do you protect the data once it is in the system and how do you discover problems that are created in a way to prevent discovery?
I am not opposed to clinics or doctors or hospitals automating their record systems. I am opposed to the federal government mandating such a system. I am opposed to it because of the history of big government IT projects, because of what is happening right now with government misuse of power and information and because I know it will cost billions and in the end fail at some level and to some degree.
"ask your doc whether he, she, or it - or they - puts your records on the internet"
Thanks for the heads-up. I intend to ask that question at my next appointment. Kaiser Permanente, my health care provider, has spent a fortune developing its extensive electronic medical records system. I can use the Internet to access my recent test results, make medical appointments on-line, send email to my doctor, and do a few other simple tasks, but as far as I know I cannot access my full medical record on-line. My entire digital medical history is obviously open to Kaiser's internal intranet, but it didn't occur to me to ask how much of my complete medical record is actually available to Kaiser medical and administrative personnel over the Internet. The fact that I can't access that information over the Internet doesn't mean they can't. An Internet-based system is obviously less secure than a closed intranet one. It's also important to know who else aside from the local Kaiser personnel has the authority to access my records. I will be sure to ask that question as well.
Why are people okay with personal information on "the cloud", when they would never agree if it was still called a "shared drive"?
I am interested in Freud and psychoanalysis. I see You are freudian psychologist and political right-winger. This is rare connection.
In my country, Poland, I meet some kind of ignorance on the "right" - which thinks Freud wad deviant and destroyer of our Civilization. On the other hand "left-wingers" treat Freud as ideological father of their "sexual revolution". This is very sad and confusing.
I would like to recommend to You and Yours readers some interesting papers about Freud, his connection with vopn Mises, anti-connection with Marx, leftism and commonalities in freudian psychology and traditional teology:
1) Mises on Freud and psychoanalysis: http://mises.org/daily/4542
2) Mark Sunwall article on political and philosophical resemblance of Mises and Freud: http://mises.org/journals/scholar/Sunwall3.pdf
3) Traditional catholic on freudian and traditional psychology:
Best Regards from Poland:-)