Fun with electronic medical records

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Tuesday, December 31. 2013

Fun with electronic medical records

It is true. Docs who use electronic records spend more time on the computer than with their patients. Even worse, the treatments are increasingly done by prescribed protocols instead of designed for the individual situation. Case in point: When treating a patient with dementia, electronic health records fall short.

Furthermore, those records are not private. This is what you get when government gets more involved with medical care - and anything else.

My patients know that they are not on an assembly line, and I'll keep it that way until they make it illegal. Doing things my way, however, requires that I take no government insurances. Just pay me for my time at around the same fee as a master electrician and below the rate of a fancy lawyer.

Posted by Dr. Joy Bliss in Our Essays, The Culture, "Culture," Pop Culture and Recreation at 16:11 | Comments (9) | Trackbacks (0)

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We've been using the same family doctor for 30 or 35 years. This year, when I went for my physical, and he brought his computer into the examining room, it was clear that his attention was on the gear, and not me. The EHR part of Obamacare will be a disaster for patients and doctors alike.

#1 Randy on 2013-12-31 17:10 (Reply)

My internist has been using a laptop for years, and by years I mean it's a now archaic 4.5 lb. Toshiba M200 tablet running XP. He weaves his use of it into the visit to make contemporaneous notes, and to look up info on past visits, lab work, medications etc. It's not nearly as distracting as the doctor thumbing back and forth through a 3" thick set of paper records looking for something.

#1.1 BillH on 2014-01-01 12:53 (Reply)

Electronic medical records are good for only three parties, the developers who license the technology, the government and the insurance payers and also perhaps also the pharmaceutical companies.

#2 phil g on 2013-12-31 19:57 (Reply)

I have mixed feelings about this. On the plus side I see multiple doctors and specialist and they all know what my tests and treatments have been even the ones that happened hours to days ago. On the other hand I do fear government involvement in this and everything else in ur life.

#3 GoneWithTheWind on 2014-01-01 11:55 (Reply)

EHRs utterly dumb-down medical reasoning and communication. Check-boxes, indeed. They are the perfect tool for a government which sees us not as individuals but units for whom they can design a system of living. And if we don't quite fit the check-box, they will of course change US rather than the box. My curse on them and those who designed and legislated them.

#4 Khornet on 2014-01-01 13:19 (Reply)

These blanket generalizations are wrong.

I install an Open Source EMR for physicians in Canada called Oscar.
There are no developers getting rich. It's a cross-Canada community of programmers and physicians who want to use computers to improve the delivery of health care. Some of the most active participants are physicians who are looking for ways to give their patients better care.

Advantages: Legible prescriptions. Automatic warnings for medications with interactions. Simple renewals of prescriptions. No paper - the Rx can be faxed directly to the pharmacy. Immediate graphing of important lab results. Error-free calculations. Instant visual plotting of growth curves for children. Remote access to patient information. No room full of paper charts to pull and file.

The list goes on and on.

Suppose there is a warning about a medication that you have prescribed in the past. How long would it take you to locate all the patients to whom you have prescribed the drug? With paper charts would it even be possible? With a computerized system it would take minutes to get a list of all patients, their contact information and the date of the prescription.

EMRs are not suitable for all fields of medicine and not even for some physicians... but a blanket condemnation is wrong and I will comment every time you do it.

If you are even in Canada, I can introduce you to dozens of physicians who love their EMR and would not want to go back to paper charts.

If the government insisted that from now on you were forced to use a government approved tool to get into your car, would you blame the tool manufacturers?

The problem is your government and it's blind insistence on computerization.

#5 EarlW on 2014-01-01 15:08 (Reply)

"I would happily do this on paper or using an EHR that created a logical note within the same amount of time. But that is not an option."

The problem is the EHR that he has and the related billing issues.

He would probably be happy with an EHR that allowed him to enter his own notes.

#6 EarlW on 2014-01-01 15:25 (Reply)

there's pros and cons.
Privacy is at risk, and doctors spend more and more time looking at their screens rather than their patients.
But in clinics where ever more you're handed from doctor to doctor to nurse practitioner, them having all your combined records at their finger tips at any moment rather than having to dig through dusty file cabinets organised with someone else's system and written in near unintelligible scribbles, it's a gods' end.
And with the pharmacy having access to all your prescription history as a side effect, they can check whether what you got prescribed isn't contra indicated by something else.
And that can save lives, as doctors do sometimes prescribe the wrong things either out of ignorance or simply by making a typo in the prescription (and in the past by a pharmacist misreading the handwritten drivel of a doctor who's handwriting is so bad he can't even read his own).

#7 J.T. Wenting on 2014-01-01 15:39 (Reply)

It's amazing just how many players are allowed to input data -- which is often staggeringly WRONG.

The ER admittance nurse changed my oral testimony about where I felt pain -- and pretty much all the rest.

I strongly suspect that he simply ticked off a diagnosis box and the computer auto-filled the rest. No-one could be that daft. He was all thumbs at the keyboard, too. You'll see a lot of that. Digital systems now require everyone to be his own typist, yet typing classes are now passe. (!)

I only learned this hours later -- walking out the door.

It was the best explanation as to why everyone else took matters in an unexpected direction.

This is the unforeseen problem with GIGO.

The 'system' does not let the patient check on the accuracy -- of even their own testimony! It's privileged, of course.

And, of course, the rest of the planet gets courtesy copies.

#8 blert on 2014-01-02 03:32 (Reply)

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Tuesday, December 31. 2013

Fun with electronic medical records