Cutting Through The Crap

Saturday, December 6, 2008

Sounds Good



Actually, looks good, too. Wonder what those books are, and who's in the picture. Ovoid office, is the gestalt.

To my economically deficient mind, the idea of a massive government investment in infrastructure of all sorts makes sense. As a physician (as I recall), I like the generic concept of electronic medical records, but I think we're a long way from being able to get them into every office and clinic and hospital and to have the kind of interconnectivity Mr. Obama implies. This is for two reasons: the perfect software doesn't exist; and even if it did, lots of doctors would resist it. In my experience, it's a huge step forward; but I understand the reluctance.

I guess I had the best of both worlds: not long before I left, my clinic switched to entirely electronic medical records. But, unlike the systems today, back then what it meant was digitizing all info for instant accessibility. We still dictated our op notes, our office records, but they were instantly transcribed, by human beings, into digital form. The benefits were immediate: no longer did my office have to search for the records of the patient arriving for consultation: they were online. As were the most recent notes of the doc who sent that patient to me. Lab data were available within moments of finishing the tests; as were Xray images and (in theory) the reports of the radiologists. And since the hospital had dedicated computers linked to our clinic, all of the above was available there as well, any time of day or night. It's impossible to exaggerate what a boon that is. So what's the problem?

This: the electronic medical record (EMR) systems now are aimed at eliminating the middle man (or, more likely, woman.) No longer can the doctor dictate his/her reports: they are to be entered electronically, using various algorithms and pre-packaged phrases. Likewise the ordering of labs, onto which are often imposed various protocols for confirming the necessity and/or appropriateness. The results, too often, are the forcing of square pegs into round holes; and dramatically to slow down the process. Op notes, for example, which I could roll out of my head as if a CD had been inserted, may -- depending on the particular program being used -- require several extra minutes to finish, and that has an obvious cascading effect on all subsequently scheduled operations and all the people involved therein. The better the software, the more familiarity with it, the less this is an issue. But it's still significant.

Nor is there any standardization. I could be wrong, but to have perfect communication between providers across the country, there'd need either to be universal acceptance of a single program (investors, anyone?) or some pretty brilliant intercessory software (more investors, anyone?).

It's been a while since I've been deep into the medblogosphere, but I think it's safe to say the majority of doctors are unhappy with their experiences with EMR. Mine, before the square peg/round hole era, was nearly perfect: it was nothing but a vast improvement over paper records. And it's absolutely certain that universality is inevitable. Mr. Obama's aim is highly worthy. But much of the pie remains airborne.

1 comment:

Ellen Kimball said...

Sid, you brought back memories for me. I worked in a marketing/PR job for MedAccess Corporation in Lexington, Massachusetts in 1995-96. They were using venture capital to try and get the medical profession up to speed on computers.

The job involved convincing doctors to enter their office notes on a small computer. Most of the older doctors I met at trade shows couldn't even use a keyboard. Doctors were still dictating their notes for medical transcription personnel to enter at a later time. Xrays and computer tomography scan inputs were still in their infancy. There wasn't enough pixel resolution for actual diagnoses, as I recall.

Even today, Wikipedia indicates that there are many competing computer programs vying for this marketplace. There is probably less standardization than there was thirteen years ago.

As Senior Advantage members, we've ended up in the Kaiser Permanente system. They seem to have a workable system here in the Pacific NW. At least, I am able to email my doctor!

However, this doesn't account for the LONG wait times when I try to get a telephone call to go through to the local office.

Oh, well, I know you are DOCTORS, not MIRACLE WORKERS!

Warm regards,

Ellen K.