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Answer to: A Major Glitch for Digitized Health-Care Records

September 19, 2012
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Based on a WSJ Opinion piece EMR software is “is generally clunky, frustrating, user-unfriendly and inefficient.”

Based on a WSJ Opinion piece EMR software is “is generally clunky, frustrating, user-unfriendly and inefficient.” Although I will not disagree with this “generalization,” I do take exception with the articles naïve view that Health IT systems have not improved patient health.

This article sites studies designed to compare investment versus cost savings. They do not address clinical quality improvement.  Anyone that has looked at studies by the Leapfrog group and others, know that just having the ability to data mine clinical analytics opens the door for developing key quality indicators. Physicians are now able to do side by side comparisons of their patient population metrics versus their peers. How is my asthma patient’s control metrics compared to my peers, in a specific age group? What about my diabetic patients A1C scores compared to my physician partners? How do I tweek my protocals? Try that with paper charts. Do we think that we would get anywhere near a "Patient Centered Medical Home" without some form of Clinical Healthcare Information Technology?

So is this a data game? Not for our patients. As a patient I want to know that my physician is maintaining my problem and medication list. I want to know that he can review all my lab tests and trend them while I am sitting right there with him. Was he able to do this before he had an EMR? I was lucky if he flipped through the top five pages of my paper chart. I would have to fill in the blanks every time with the same information. What do we have you on? How often do you take that? What was that for again? Believe it or not, those were common questions pre-EMR.

You get no argument from me that the cost savings hype for EMRs did not live up to reality. The promised Return on Investment (ROI) always came in the form of paper savings, process improvement and FTE savings. The reality is that productivity took a hit. But wait, let’s stop there. Why is productivity down? Well now you have to document with a step by step process and review certain lists with the patient. Again, from the patient perspective I hated spending one hour in the waiting room and 3 minutes talking to my doctor. Now my visit is fully documented, e-prescribed, labs orders sent, and I can get a summary of the visit if I want one. Isn’t this what it’s all about: Patient satisfaction and improved outcomes? Yet we want a fully justified ROI or we might as well do what? Stay on a paper chart?

You can tell that the article touched a nerve. Not just as Healthcare Information Technology guy that has seen technology leaps and bounds in just a few years, but also as a patient that now feels much more empowered in my healthcare decisions.  The authors of the referenced article fail to realize (obviously coming from an academia point of view), that in order to achieve interoperability and compliance across health systems, the government has to step in and make mandates. That is the only way to develop standards. Talk to a healthcare provider that had to change jobs and went from an EMR office to a paper office. They will tell you that paper---“is generally clunky, frustrating, user-unfriendly and inefficient.”   



It seems you have completely missed the point of the article. no one is suggesting that we return to the stone age of paper charts. They are making the case, rather strongly and based on actual research not just anecdotal evidence, that usability is a key success factor missing in today's EHRs. They certainly have a point...

The article states, "With a few isolated exceptions, the preponderance of evidence shows that the systems had not improved health or saved money." Yet all their studies site costs savings. They mention physicians alerts overridden by doctors as reason that it has not improved health?
Again, they should have focused on the cost issue. I called out the weakness in the argument that EMR's has not improved patient health (Quality of care).

As a provider in a 19 doctor integrated eye care group complete with ASC, retail optical and optical surfacing laboratory as well as a member of HIMSS, I read the WSJ editorial and the above comment with great interest. However, in spite of tremendous advances in the IT arena, there is still much lacking when carefully comparing the desired result of using EHR to what is actually happening. EHR implementation is more expensive than ever imagined, the ongoing maintenance costs exceed what was anticipated, the potential liability from "cloned notes" is in its infancy stages, and the measurable improvements in outcomes are still minimal at best. With good data that has been captured for two or three years, I agree you can measure some specific trends, but outcomes still require compliance by the patient and a desire by the patient to improve, and paper vs EHR still have no impact on compliance. There are a whole new list of potential errors with EHR that no one ever mentions, and most commentary is from those speaking of theoretical advantages and not from those that are in the trenches. One example of potential error is the real chance of clicking on a medication from a drop down menu that is alphabetically similar to the one desired but not anything close to the same medication...or the next one in the list that is simply a different strength (100 mg vs 50 mg). The choices of EHR continue to improve, but it is nothing like the hype presented for several years about instant clinical benefit and costs that will "pay for themselves". Anthony Johnson, MD Greenville, SC