Electronic medical records will not cure what ails you
posted at 10:11 am on April 29, 2009 by Pundette
[ Healthcare ] printer-friendly
Most people assume digitalized medical records would be a significant improvement over low-tech written records. But, as we’ve touched on before, studies have shown that computerizing medical records will not save money or improve care, and may in fact be harmful to patients.
Here’s a telling anecdote:
The Data Model That Nearly Killed Me
The law [the stimulus bill] also explains how to test systems built with federal money but it does not explain how to measure semantic validity of information – garbage in garbage out! Good luck with all of that Mr. President.
During the last week of January 2009 a faulty electronic, networked, health information data model nearly killed me despite its vaunted status as a component of two state-of-the-art, health information systems at two of the world’s most advanced medical facilities. This will come as no surprise to healthcare IT experts because health information is inherently complex, medical science develops extraordinarily rapidly, patient interactions are intensely personal, and the number of data types and sheer volumes of healthcare data explode prodigiously with new tests, instruments, and treatments. . . .
My near-death experience at one of the best tertiary medical centers in the world, with modern electronic health information systems, illuminates the chasm between the President’s NHIN vision and its reality.
If you don’t like horror stories or are prone to nightmares, skip this. The patient lived but with no thanks to the multiple doctors and nurses who dutifully took his history (11 times, and he could hardly breathe), entered his information into their laptops, and did little else. One nurse stood out in her efforts to correct errors, pull his records together, and try to obtain ordered medications. Thank goodness the patient’s wife was there as his advocate. She had the foresight to bring his own meds along and finally gave him what he needed on the sly. He believes that this saved his life.
An excerpt:
I was in ER for 20 hours before being admitted to the intensive care unit (ICU) where I spent another 28 hours. Throughout my stay, I was hooked to network attached monitors that incessantly sounded alarms to which no one responded. I was asked 11 times to repeat my medical history, medication, and allergies to as many different medical professionals. I was seen by seven doctors each of whom asked me similar questions. Five doctors were never to be seen again. All doctors mumbled something about putting their findings into the hospital’s electronic records system – most did not according to ICU nurses. No one read my allergist’s detailed report about my condition and health history.
As I moved from ER, to an ER holding room for admitted patients, back to ER, and to and fro other departments for tests, and finally to ICU, I was visited by nurses and technicians who pushed laptops mounted on wheeled sticks. They checked my vitals; asked me questions about my history, medications, and allergies; and entered findings into the hospital’s electronic medical record using the laptops mounted on wheeled sticks.
I asked every nurse and doctor who met me, and I was told that I would receive medication to relieve the intense pain from my lungs. Each claimed they would note this in my electronic medical record. No one did until about 14 hours later, during the middle of the night, when one thoughtful ER nurse finally found a doctor to authorize giving me the oft approved but never delivered pain relief medication.
There’s a lot more where that came from.
What follows this hellish anecdote is an analysis that smart, analytical types like Pundit (husband) will breeze through. I did not attempt it. I’ll ask him to give me the Cliff Notes version later. (It’s one of the perks of marrying a genius.) But I gather it explains why merely digitalizing records are at best not helpful, and finding a solution that deals with the extraordinary complexity of contemporary medical practice is not on the horizon.
And there’s no way that Obama or any of his brilliant team has any inkling of this. But this change has been mandated anyway. Cuz it sounds good.
h/t: Slashdot via Pundit
Cross-posted at Pundit&Pundette
Blowback
Note from Hot Air management: This section is for comments from Hot Air's community of registered readers. Please don't assume that Hot Air management agrees with or otherwise endorses any particular comment just because we let it stand. A reminder: Anyone who fails to comply with our terms of use may lose their posting privilege.
Trackbacks/Pings
Trackback URL
Comments
What does the Surgeon General have to say about this? Oh, that’s right, we don’t have one yet.
qestout on April 29, 2009 at 10:20 AM
This past winter while visiting my Mom, 95, we had to take her to one of the better hospitals in the DC area..chest pains, edema, difficulty in breathing, and a few other symptoms, all severe. The EMT’s took a history and entered all of it into a laptop in the ambulance as we headed to the ER.
Got to the ER, had to provide proof of her TriCare, and all her personal data, and re-enter her acute medical conditions. Transferred her to a exam room in the ER. Had to re-enter personal info, and her current medical condition into yet another laptop. One resident, three nurses…tubes placed, wired her up to EKG and other monitors…laptops well in hand. 4 hours into this thing.
Mom started to have severe problems, had to intubate her…and then in comes an administrator with a laptop and tries to obtain personal and medical info from my mother…while she was intubated.
After nine hours, my mother was taken to a critical care department, and cardio-vascular specialists descended on her room…armed with…wait for it…each one had a laptop.
Mom survived. Had a short in her pacemaker and early onset pneumonia.
More laptops do not improve medical treatment…and doctors and administrators and even ER techs and nurses apparently do not communicate to each others’ laptops let alone talk to each other.
Add that to the susceptibility of any data system, laptop or your blackberry to your computer at home to intrusion…hacking…and it is surely nice to know that all my medical information will one day be available to some kid in his basement hacking for giggles, or government trying to decline my treatments because a glitch told them that I was already deceased.
coldwarrior on April 29, 2009 at 10:25 AM
So … your point here was that technology is bad because people won’t use it? Sorry, but this comes off as an indictment of the people, not the tech. Tech is a tool that be used effectively to provide targeted information.
If you really can’t see the value of targeted information I’m not sure what to tell you beyond asking if you really think a paper in a file some place is better than a file you can download from any location in seconds.
TheUnrepentantGeek on April 29, 2009 at 11:47 AM
Not so much the technology…but the reliance extremus on that technology.
I’ve seen this in the classroom, hours and hours of a teacher trying to teach the kids how to use computers and the internet to learn history, for example, and after a few weeks, the kids are computer-savvy enough to find a way to get porn past the filters, but still can’t tell you one darn thing about American history.
Take it back many generations…teaching kids Spencerian Script, as a school standard after it came about in 1840.
Did the teachers spend endless days doing nothing but teach kids how to write proper cursive…or did they spend more time teaching history, reading, math and such, and expecting the kids to write and read Spencerian along the way, each lesson reinforcing both handwriting and content.
Seeing one of the most modern hospitals in our Nation’s capital in action…the only thing I can tell you is that they certainly know how to use a laptop.
And from the frequency of those who kept asking the precise same repetitive questions all day long, each one dutifully clicking away on their laptops, at any point was anyone consolidating information? Or was no information being shared? Or, were the input devices, i.e., doctors, nurses, tech, administrators, so incompetent that what they inputted was useless or irretrievable information?
No Luddite here…but if we have these wonderful tools, perhaps we’d better figure out their proper and full application before we start down a road where we cannot read the signposts nor communicate to others behind us the birdge is out?
coldwarrior on April 29, 2009 at 12:05 PM
Your first scenario illustrates an abuse of technology not damage resulting from reliance on it. Again, the people are the problem, not the tool. This is the same reasoning gun banners use.
Bad design is the fault of the designer and constitutes an implementation problem. It doesn’t repudiate the concept of electronic medical records in the slightest.
The complaints here boil down to two things:
1. People using the technology improperly, which is the fault of the user. This calls for better training, performance management, and hiring practices
2. Poorly designed systems, which are the fault of designers and requirements providers failing to communicate and implement ideas.
Train better and design better. This isn’t a repudiation of electronic medical records but of lousy staff and bad implementation.
TheUnrepentantGeek on April 29, 2009 at 2:30 PM
True, both points.
If we were dealing with engineering issues, issues not having an immediacy, we could do both, re-program/train people…and through pilot programs and lab experimentation design the technology around the actual needs, and the weak point…the user.
Right now, seems the announcements before the product is readily useful and users understand that product is getting the cart before the horse.
Similarly, it makes no difference how efficient, how cutting edge the technology, if when it comes to actual usage, and successful usage, as we are dealing with human lives, if the technology is of the highest order…and it cannot be used or is used improperly, perhaps graduating down the scale a few steps would seem prudent.
Fewer bells and whistles…until the users learn to handle the technology successfully..and then graduate upwards in defined steps so that the technology does not outpace the user.
Think in terms of the development of the Saturn V. Exact same principles as the V-2. But, from a technology standpoint, it took a couple decades to get it right.
Like I said, I am no Luddite, but if technology is misused, or causes serious ruptures in the field it is intended to advance, then what good is it?
Lastly, whatever can be invented by man, can be perverted by man. When it comes to personal medical information, or life or death transmission of vital information, I’m not one to jump on board readily until that little bit of human nature can be addressed.
coldwarrior on April 29, 2009 at 2:44 PM
Couple this with Kid from Brooklyn’s post above for an extra dose of justifiable paranoia.
Disturb the Universe on April 29, 2009 at 5:50 PM
here is what worries me about the medical records plugged into every computer in the world: some hacker can go in & say that i have every sort of illness thereby making me ineligible for many treatments should i ever need them.
kelley in virginia on April 29, 2009 at 8:08 PM
The comments are far, far better than the linked blog post.
This person had an unpleasant health care experience, but very little of it was due to the data model or the concept of electronic medical records. This blogger, I’m afraid, is one of those folks who has a hammer, and to him everything looks like a nail.
Bartrams Garden on April 29, 2009 at 10:36 PM
Electronic Medical Records are pretty new, and will have snafus of course. Reading the article, though, it appears that the problems aren’t just with computerization.
This is a tool, which medical practitioners use to accomplish their task of medical treatment. If the information isn’t in the chart, there’s also this ancient technology called the “telephone” that every MD I’ve ever interacted with is pretty good at using. Doc-to-Doc phone conversations happen all day, every day, and should have helped here.
Much more to say about this, but I’ll stop with the ancient observation that the plural form of anecdote isn’t “data.”
cs89 on April 30, 2009 at 1:51 PM
EMR systems are dependent on several things – not just user training, but system and network security, reliability of database structure and linking, proper identification of the patient, and the medical professionals actually entering the data.
It also depends on the medical professionals knowing how to access the data for the specific patient.
I work in IT at an Army hospital and our EMR for outpatient med records is AHLTA. We have a separate one for in-patient, called Essentris. We also have a legacy program called CHCS. From what I understand, each was developed independently (though AHLTA was originally CHCS-II, and holds a close relationship with the data sets in CHCS).
But even when all the people entering and accessing information do their data entry/retrieval functions flawlessly, and the network stays up, the database is perfect, etc., we still run into the chance of incompatibility of the EMR systems themselves.
And there’s the incompatibility of the EMR programs themselves.
AHLTA is sufficiently flawed that, although a Windows application, it is compatible only with XP, not Vista. So the entire Army Medical system cannot use Vista. And for XP, it can’t use the current service pack. And it can’t use any version of Internet Explorer newer than 6 (IE is up to version 8 now).
AHLTA is also so user hostile that the Army Medical folks have started a whole new program – MAPS – to get Providers to use AHLTA properly.
Feel free to look up AHLTA and MAPS in your favorite search engine. You’ll see stuff that will curl your teeth.
Dan. on May 2, 2009 at 2:06 PM