Posted on 12/23/2010 5:28:33 PM PST by Innovative
The adoption of electronic medical records, or EMRs, in U.S. hospitals has improved the quality of care in only one of three areas studied, and even in that area, the gains are limited, according to new research by the nonprofit Rand published this week in the American Journal of Managed Care.
Not only did the researchers find no improvement in care when hospitals adopted EMRs for the first two conditions, pneumonia and heart attack, but they also found that the greatest improvements in care they saw were for people with heart failure in hospitals using only basic EMRs; where EMRs were advanced, quality scores actually improved less than at hospitals that did not have them at all.
Legislation approved in 2009 could direct upwards of $30 billion in federal aid to hospitals adopting electronic health records. This study serves as something of a wake-up call; it suggests that in order to know whether EMRs are worth the cost, their impact on quality of care must be further investigated.
(Excerpt) Read more at news.cnet.com ...
Health facilities adopted EMRs because the government paid them to do so. The government wants access to health records to try to make criminals out of the people providing the care.
This is all about try to take money back from hospitals and doctors to help pay for Obamacare.
I agree — but Obama and the Dems were claiming that it will improve medical care — another lie, I don’t think any of us here are surprised.
In another article, it was mentioned that $30 BILLION in the stimulus was earmarked for this useless program, which only serves to invade our privacy, increase costs, and force doctors and hospitals to spend more time on bureaucracy, than treating patients.
Study: Electronic records don’t guarantee better hospital care
“Lawmakers included as much as $30 billion in last year’s stimulus act to incentivize the adoption of EHR technology in accordance with federal guidelines to improve quality of care and coordination among providers.
On Thursday, the Department of Health and Human Services announced that registration for Medicare EHR incentives would begin Jan. 3. Registration for Medicaid incentives begins on the same day for doctors and hospitals in Alaska, Iowa, Kentucky, Louisiana, Oklahoma, Michigan, Mississippi, North Carolina, South Carolina, Tennessee and Texas.”
Republicans better hurry up and defund obamacare.
Anyone who thought that EMRs would automatically improve health care doesn’t know much about health care, computers, nor people.
I’m really mixed. I know EMR and there are some benefits depending which ones you choose - some update records, automatically notify pharmacy, insurance, billing and reduces pmt’s to doc by over two weeks.
By verification of doc’s thumbprint lots can be saved by over billing and false records or at least, accountability to doc for what they are billing for and to.
Most EMR do require an actual patient to verify they are getting the treatment. This should reduce the fake patients and simply paperwork as humans have to verify the steps.
Your points however are also valid.
The proponents of these things are always the people that don't actually have to use them.
We have spent millions to implement a sophisticated electronic medical records system across a health care system consisting of over 400 physicians, several hospitals, and numerous outpatient clinics in a large geographic region.
The biggest advantage of the system is the accessibility of medical records throughout the system.
The problems are uncountable and range from increased medication errors to a system that is so user unfriendly that providing medical care has to accommodate itself to the system versus the other way around.
In the past 6 months, we just introduced the inpatient record in a sort of beta testing in my specialty and several others before introducing to the range of inpatient services. It has reduced the efficiency of care by at least twenty five percent.
This is the most powerful and sophisticated system out there and literally millions have been diverted from patient care in order to implement it.
I have been in practice for thirty years and this is, undoubtedly, the biggest and most expensive boondoggle I have ever seen. Let me qualify my comments by adding that I learn these things quickly, have created a number of my own work arounds, and am the most adept at using these devices in our group.
The disadvantages far outweigh the advantages if you actually have to use the things even before you take into account the outrageous costs associated with them.
At our VA here in Maine we have a ‘paperless’ system.
On one visit I was seen by ortho for a cast adjustment, my GP for an ear infection. I had appointments for neither. After seeing the GP info was sent to prostetics,lab, and pharmacy.
Left GP’s office. Went to Prostetics. New inserts were waiting. Went to lab. Had blood drawn. Went to pharmacy. Picked up drugs.
Never saw a single piece of paper.
Was in and out of hospital in under 90 min.
In ten years the’ve never lost my electronic chart.
“The ability to drop a bill more quickly has nothing to do with quality of patient care.”
that is a people issue, technology will never fix that unless it rids itself of people. Care what you ask for.
“before you take into account the outrageous costs associated with them.”
Not sure your system but the average cost is 30,000 per medical office.
Our system involves five hospitals, at least 30 outpatient clinics, and over 400 physicians. We are talking, start to finish with support and all the phases implemented, over one hundred million dollars.
We have had the EMR for about one year. It has caused a drastic decrease in efficiency and morale. Now every O.R. requires two RNs, one for the computer and one for the patient. I now refer to the nurses as “data entry technicians”. Our nursing turnover rate is about 10% a month, and the ones that remain are the poorest clinicians. Good nurses didn’t go to school to do billing, inventory, and risk management.
The EMR creates reams of useless information. I can find out that the patient lives in a two story house but to find out their allergies takes ten minutes. Everything is a chore with this system. Instead of doing 24 cataracts a day, now we do 16. The nurses spend about 90% of their time at the computer and about 10% with the patients. One nurse told me that with the computer it’s like taking care of two patients; to which I replied “maybe, but only one is ALIVE”. The EMR is to health care what ethanol is to energy. Anyone who speaks ill of the EMR in a hospital should watch her back.
Not sure what you are referring to here but I assume it is the quality of care issue.
If that is the case, I would argue that the technology can increase the complexity of care and result in increased errors. This is based on personal experience. Before purchasing, we compared vendors and bought the most powerful system we could thinking toward the future. This has been an ongoing process of over 10 years.
The systems interface with the user are clumsy, create a number of make work exercises, and increase the opportunities for errors.
Again, there are some advantages, namely accessibility across the system to medical records and faster access to lab studies, etc.
The benefit does not outweigh the problems and cost in the system. Again, money spend on these systems are dollars drained from patient care and no one is ever willing to consider in the analysis.
I’ve worked in healthcare (Radiology/hospital setting) for 34 years and have worked with EMR and paper charts. My experience has been with the elimination of x-ray film and the emergence of all imaging being digital. We no longer spend $450,000/yr on film, our images are all on spinning hard disks and located in 2 different locations. Does that matter? Well, in June of 2008 when our hospital was hit by a devastating flood that washed away the remaining 20,000 patient files in our basement file room — yeah, it matters.
It also matters when you are transferring a gravely injured patient to a trauma center and you can send you CT images electronically so that the MD at the trauma center has them to review and plan 30 minutes before the patient arrives by helicopter.
For those of you that think this is a conspiracy, this started decades ago, long before Obama was scheming to take your healthcare away. Digital imaging in Radiology (PACS) has been a works in progress for a couple of decades. We installed it 6 years and were in the first 15% of hospitals to do so. The imaging center in our community just put it in 2 years ago. And I’m talking about Radiology only — just a fraction of the medical record requirement we deal with.
For those of us in healthcare it is about right information on the right patient at the right time.
Did any of you notice they only measured outcomes of 3 different clinical conditions? Want to know why? Because EMRs are not in every hospital, every clinic, and every MD office -— they are in a lot but they don’t necessarily talk to each other. There is a lot of work to be done on the implementation and standardization side but it will work and it will make things better — maybe not on cherry picked studies for someone with an agenda.
Is there opportunity for abuse, yes — is that a reason to not proceed? I don’t thing so. I guess we could go back to writing letters and crank telephones — it makes just as much sense as continuing to mess around with basements full of handwritten records, or maybe we should get rid of all of our industrial automation — how many of you remember the first automated manufacturing machines? I worked in a factory in my early 20s and I can tell you they were anything but efficient.
This is no different than any other emerging technology, it takes time and we are early (relatively speaking) in the evolution of EMRs But if you want to think this is to let Obama see if you have herpes -— go ahead and kid yourselves.
We are only now starting to integrate this into our ORs.
Yes, the EMRs have been developing for some time now. However, if you think the government has no interest in mining this data to try to impose arbitrary standards of care or to judge the care provided by physicians for financial reasons, your head is buried in the sand.
The more homogeneous the outcomes people try to make medicine, and the more that doctors are pushed to follow predefined treatment paradigms instead of being thinking medical scientists, the worse medicine will become. Guaranteed.
“The systems interface with the user are clumsy, create a number of make work exercises, and increase the opportunities for errors.”
Everything I see and point people too are GUI’s. All point and click no different then you use here. What were you using?
If medical records are electronically accessable then there will be no privacy. Are you kidding? Look at wikileaks. All it takes is one person with access and an agenda and everyone’s medical records will be made public.
As most people who work in the healthcare IT know (and I do) there are at least three major factors in whether a system will improve care or not:
1.) Can the system be made to communicate effectively with other systems. Most hospitals have multiple pre-existing systems, and getting them to speak to each other in meaningful ways is very difficult. Most vendors will blithely say "Yes! Our system uses the most up-to-date HL7 standards!" As Captain Queeg said, "There are mistakes, and there are mistakes..." There are standards and there are standards. Everyone has their own version, slightly different. If you want to get systems to speak to each other, it is quite easy for vanilla transactions. But if you really want to make a system work and be useful, it requires migrane-inducing interface customizations and application customizations, both of which vendors will charge an arm and a leg for, and both will not only increase the possibility of electronic errors, but will make the upgrade processes extremely painful, because the vendor will often have to do a huge amount of the rework again. And you better have good interface and applications people on your team, because if you depend on the vendor, you are screwed. Not to say vendors don't often make a good effort, but you are often not their only customer, and there is no way on God's green earth they will know your workflows and particular institutional peculiarities the way you do.
2.) Can you make the right compromises in the implementation of the system? Every single implementation I have ever seen is an exercise in compromise. No EMR or HIS system can do it all well. Some do certain things well, and other things crappy. Some do the exact opposite things well and the opposite things crappy. They always say that you cannot take your current square workflow and use a big effing hammer to beat it into the round hole that is your new system. They say that you should rework your workflows to fit the capabilities of the new system. To be fair, that is what you end up doing anyway, but that is a long, protracted battle with healthcare providers, everyone from doctors, through nurses all the way to dietary specialists who have needs that must be met. There is no monolithic application that does it all equally well, and most of the time, not even a single specialty is uniformly good. Certain tools that doctors have to use may be great, and other equally important tools they need simply suck. Again, it all comes down to compromise, ESPECIALLY when it comes to integrating different systems. And, irritatingly and surprisingly enough, even if the SAME DAMNED VENDOR MAKES THE TWO APPLICATIONS THAT NEED TO WORK TOGETHER, THERE IS NO GUARANTEE IT IS POSSIBLE. It is maddening beyond belief. If you get two vendors, often times they simply point at the other vendor and say "We work fine. They need to find a way to work with us." Then you get three or more, and it becomes damn near impossible. The way you have to often make things work is to implement manual, human intensive workaround processes. And if you don't make the right compromises, any additional efficiency benefits from a new electronic system evaporate like an ice cube on a hot asphalt driveway. So you better make the right compromises and workflow adjustments.
3.) Will the users participate in the process, contribute in the the decision making that is critical towards making the best compromises, and accept and adhere to the training. This is a leadership issue. I have seen places where the users actively and passively sabotaged the implementation of a new system. Actually, nearly every implementation has some amount of that (it is human nature) but it can be mitigated by figuring out how to get people to buy into it, what is in it for them. But if not accounted for, it can be a disaster. I have been lucky, I have only seen small amounts of that. I have a lot of second-hand knowledge of horror stories from other institutions where an implementation was a disaster because people refused for a variety of reasons to give it their all. I have heard of multi-million dollar systems being ripped out by the roots and teams having to start over with a new product from a different vendor. Disaster.
Bottom line, when I hear dopes like these people in the Obama administration wax poetic about how EMR's are the cure for all the ills in healthcare, I know that very few of the stupid bastards have ever implemented one. An EMR is a tool, and just as a hammer can be used to break windows or build a beautiful table, an EMR isn't going to improve healthcare just by mandating people install them. It is all in how they are installed and used.
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