The President has announced his goal to digitalize our nation's medical record system. If achieved, this wonderful and lofty notion would certainly reduce medical errors, increase the quality of care delivered, bring consistency of care to our citizens, reduce costs associated with delivering health care, and quite possibly drive the physicians who are supposed to use them out of business.
The buzzards are already beginning to circle.
Physicians and nurses are the most pressured of all professionals, with expectations of their performance and its unimaginable responsibilities beyond the comprehension of people who have never made life and death decisions hundreds of times a day. With every decision and action comes the risk of being held liable and losing both their profession and their assets. The very mechanics of using electronic medical records in their current state of development has complicated the lives of many clinicians who use them and have been slow in being adopted for that reason. With luck, that will change.
What few people realize is that using a computer to document every decision, every action, and the assessment of every piece of information that streams to clinicians in real time represents a major change in the way clinicians have to think and work, and an audit trail that has begun the salivation process of every malpractice attorney who has finally realized what is about to be imposed on the medical profession. An electronic medical record system can track how long a doctor looked at a document, if he or she scrolled down to read the entire thing, how long it took a doctor or nurse to respond to an alert or notification of an abnormal result, how long it took for them to answer their email, and the accuracy of their every assessment, thought and action. It can track whether their decisions and actions meet the most recent guidelines or research results in a world where thousands and thousands of new papers and research are published every week.
This may sound wonderful for those receiving care, but how many people reading this article would want to use such a system in their work knowing that their every thought and action could be audited and evaluated by others who make their living suing you for everything you own?
The President's plan calls for rewarding physicians who purchase and install electronic medical record systems through a series of financial incentives over a period of years.
Mr. President - thanks for the thought and the money, but if you really want to see this work - call off the dogs before the kennel doors open.
Instead of pouring still more money into yet another system in an effort to eliminate its problems, get to the heart of the matter. Reduce liability premiums for physicians and hospitals that install and use electronic medical records. Protect physicians who will have their every move, thought and action auditable at the most granular level. (Personally, I might like to know that I can finish dinner or brush my teeth before responding to a real time alert that someone's blood sugar was a little high without someone suing me because I took too long to act.) Establish standards of expectation for clinicians who will be working in a world of real time data that is delivered to them as quickly as it is generated. Place limits on what audited user-activity information can be deposed in malpractice litigation, while still providing the opportunity for those who have been victims of genuine malpractice to seek justifiable compensation. There is a middle road wherein standards and expectations of how to practice in a whole new world of real time data can be established and it must be addressed in order to allow those who use electronic medical systems to do their jobs without apprehension and fear.
We have the technology to do wonderful things in healthcare and reform the system entirely through exciting and innovative technology. Most doctors recognize the wonderful benefits that an electronic medical system can bring to the quality of care they deliver, and want to use them. But what we also need is for our physicians and nurses to be able to use these tools without fear of the foxes lurking around the henhouse looking for the tiniest of opportunities to attack. Otherwise what we will end up with is a very expensive and technologically advanced universal electronic medical record system with no doctors who want to use it, and a lot of very rich lawyers.
PS: Here's a seven minute introduction to the Electronic Musical Record