Posts Tagged EHR

Creeping Spread of Electronic Health Records

snailDelinquent, delayed and diverted the electronic health records in the US are missing.   According to the Washington Post two Presidents set 2014 as the target for all medical records to be electronic — so has American medicine hit the target?

According to a study by the Robert Woods Johnson Foundation US healthcare has been very slow to adopt the technology.  RWJF reports 50% of office practices have a “basic” system and 59% of hospitals have at least a “basic” system (25% of hospitals have a comprehensive system).  To give perspective, a “basic” system contains medical reports and medication lists but no physician notes.

Barriers stand in the way of progress:

  1. Medical data is a very valuable business asset.  EHR companies are threatened if such data could be easily transferred to a competitor.
  2. Fear of losing control.  Doctors and hospitals don’t want their data to be too available to insurance companies or regulators.  Quality problems could be easily exposed.
  3. Self-determination.  Health care entities want to make their own systems — the CEO would rather manage than cooperate.
  4. Lack of governmental action.  Doctors and hospitals are licensed by States — just putting the license at risk is all that is needed to make EHRs mandatory.
  5. High cost of building an EHR.  Every office practice and hospital needs a financial system.  But, really, only one EHR is needed in a State or perhaps only one in the entire US.  Hundreds of EHRs across the country is a waste of money — they all do the same thing, and they can’t “talk” to each other.
  6. Failure to embrace a “cloud” computing solution for a large scale EHR.

Ask your doctor:

  1. Please show me my chest x-ray on the computer screen in the office exam room.
  2. Please electronically send all my records to a specialist across town.
  3. Please show me a record of all the prescriptions I had filled this past year and which pharmacies filled them and how much they cost.  (surely you can trust your doctor with that small bit of financial information).
  4. Can I send you a secure email and expect a response?
  5. Can you securely send me the results of my tests?
  6. Can you easily look up the discharge instructions from my recent hospitalization on your office computer?
  7. Do all the doctors and hospitals and pharmacies in town share the same medical record system — why not?  It would be very good from a patient standpoint.

NO answers exemplify the current data problem.  The US has a far better tax system than a medical record system and a far better post office than a medical record system.  Contrary to the story in the Washington Post this is NOT OK.

 

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E-Prescribing — if not why not?

e-prescribing 2011

The above map comes from Internal Medicine News.  State by state it shows where doctors are using electronic prescribing.   A simple question for those doctors in the white states:  why live in the past?  Huge numbers of pharmacies accept electronic prescriptions, patients like electronic prescriptions better than paper prescriptions, prescribing errors are much lower, patients get better care, drug interaction checks can be done BEFORE the prescription is sent (so the pharmacist does not have to call),  and a record of the prescription is available as part of the medical record.

The doctor perspective:  “Just more computer work for me”

The patient perspective:  “I like the idea of fewer errors”

How does it work?
The prescriber needs to have several things in place:

  • An electronic medical record
    (without this much of the advantage is lost)
  • An electronic list of the patient’s active prescriptions
  • An electronic list of the patient’s allergies and intolerances
  • A diagnosis associated with the prescription
  • A record entry to document the thought process for the prescription
  • An internal link to the insurance drug formulary

A very good process is to have the computer screen for prescribing where the patient can see the actions of the prescriber.  That way the patient can see what  is being prescribed, whether it is covered by insurance, where the prescription will be sent, the instructions, the amount and the refills.  If there are problems the patient can comment — it is much better to have feedback at the time of prescribing rather than the patient not take the medication or get phone calls later with questions from the patient or pharmacist.  Physicians who use e-prescribing don’t ever want to go back to the old way!  Pharmacists never liked physician handwriting anyway.

So, if your physician is not using e-prescribing give them a copy of this post!

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