Digital Health Record Problems

[tjscott0]

This article reinforces that patients need a loved one to monitor every aspect of the patient's care.

Digital Health Records

>When Scot Silverstein’s 84-year-old mother, Betty, starting mixing up her words, he worried she was having a stroke. So he rushed her to Abington Memorial Hospital in Pennsylvania.

After she was admitted, Silverstein, who is a doctor, looked at his mother’s electronic health records, which are designed to make medical care safer by providing more information on patients than paper files do. He saw that Sotalol, which controls rapid heartbeats, was correctly listed as one of her medications.

Days later, when her heart condition flared up, he re-examined her records and was stunned to see that the drug was no longer listed, he said. His mom later suffered clotting, hemorrhaged and required emergency brain surgery. She died in 2011. Silverstein blames her death on problems with the hospital’s electronic medical records.Electronic health records are supposed to improve medical care by providing physicians quick and easy access to a patient’s history, prescriptions, lab results and other vital data. While the new computerized systems have decreased some kinds of errors, such as those caused by doctors’ illegible prescriptions, the shift away from paper has also created new problems, with sometimes dire consequences.

Dangerous doses of drugs have been given because of confusing drop-down menus; patients have undergone unnecessary surgeries because their electronic records displayed incorrect information; and computer-network delays in sending medical images have resulted in serious injury or death, according to a study published in 2011 based on reports submitted to the U.S. Food and Drug Administration.

Hmm looks like digital health record keeping opens new avenues for lawyers to sue hospitals & software designers of such systems.

 

[Tadpole]

Who runs the central node? People are afraid of government and we don't need competitive node services to exasperate the problem. Perhaps the insurance companies but, wait, no there is Medicare and there is primary and secondary insurers.

Doctors should not rely entirely on electronic data until there is an agreed upon, totally interoperable, all the kinks worked out data system.

But, don't you imagine there were even more delays and mistakes in data transfer before electrons? It seems to me that a totally interoperable system almost assumes competence at each node of information input. As an orchestra in my mind it is pure music; as a reality it is probably more like discordant sounds.

A bit off-topic. All my doctors rely on me to give them a list of the meds I take each time I visit. And they all get to charge my insurance for reviewing and updating my electrons from my list. This happens even if I see two doctors on the same day. So my records are supplied by me from my medicine cabinet. In fact I've increasingly noticed that doctors are waiting for the patient to self diagnose and recommend their own course of treatment. (an Internet thing or a "ask your doctor" thing; I don't know)

So are central nodes and interoperability a problem and, if so, is there a reliable solution?

 

[ERhoosier]

More evidence that electronic records still have serious potential flaws. Not to mention how much time they take distracting docs away from their patients. Too bad these electronic records are not as advanced as today's video games. But heck, it's only people's LIVES we're talking about here

Despite the promise of these electronic databases, everyone should still keep their OWN personal written records of major issues of their health history, or at least current list of all medications/dosages they are taking, allergies, etc. Old saying that 'knowledge is power' applies to health care too.

 

[bUU]

Paper records had their own set of serious potential flaws. Only the form has changed, not the risks.

If anything, the risks that have changed are those associated with the drastic changes in the nurse-to-patient ratios, destined to become more critical as the average age of nurses continues to increase.

 

[rbmrtn]

I don't see how the EMR was the problem. Someone changed the prescription, that is the problem. With the EMR, he was able to find the problem ( you can also find who made the change ) . Good luck doing that with current paper mess. The problem is compounded with multiple Drs with multiple scripts and none of them cooridinating with the other. One of the problems with EMRs is the Drs just flat refusing to learn how to use the system.

 

[Brat]

A Dr. who refused to learn how to use the system should be denied admitting privileges. If s/he can't learn the system they shouldn't be practicing IMHO.

That is not to say they are perfect, one of my physicians complained that she can't schedule her children's checkups and she has provider privileges.

 

[Gatordoc50]

More evidence that electronic records still have serious potential flaws. Not to mention how much time they take distracting docs away from their patients. Too bad these electronic records are not as advanced as today's video games. But heck, it's only people's LIVES we're talking about here

Despite the promise of these electronic databases, everyone should still keep their OWN personal written records of major issues of their health history, or at least current list of all medications/dosages they are taking, allergies, etc. Old saying that 'knowledge is power' applies to health care too.

+1

 

[obgyn65]

This is very likely the correct answer.

I don't see how the EMR was the problem. Someone changed the prescription, that is the problem.

 

[ERhoosier]

I agree EHR's are the future. But it's interesting that published studies of change to EHR's have not shown consistently better patient outcomes, but rather mixed results.
Electronic Medical Records Not Always Linked to Better Care in Hospitals | RAND
Nor has the huge, gov't 'encouraged' investments in EHR resulted in the promised cost-savings.
More Changes in Health Care Needed to Fulfill Promise of Health Information Technology | RAND
And BTW, RAND has been a big proponent of EHR's since the beginning.

There's always "good" software and "bad" software in any field, inc EHR's. I know several docs who like their EHRs, and some who find them a complete PITA with clumsy, illogical, time-wasting interfaces and frequent gliltches/crashes. And even when the EHR works well, there's the chance that a bad entry can populate a patient's entire record. For example when practitioners just cut & paste existing EHR data to do their own notes/orders/etc. Just like using mail merge for mass mailings, it's great that you only have to enter an address once--- but enter the address wrong and it can mess up many, many future correspondences. Not saying EHR's are bad, but there needs to be better safeguards (e.g. improved human interfaces, software cross-checks, etc.) to prevent tragic incidents like the one in the OP's link.

Personally- At this point I would MUCH rather go to a doc who continued using paper records rather than one of the worse EHR systems.

 

[bUU]

And I would MUCH rather go to a doctor who used a good EHR system than continued using paper records. The ability for the doctor treating me at the affiliated hospital to review my GP's records right there-and-then, cannot be overstated.

 

[martyp]

What I like about EHR is that much of my health history is on-line for me to access and look at. I can also easily communicate simple questions to my Dr. and get answers. The problem of incorrect data entry exists whether you are using paper or EHR. The problem of reading the records also exist whether you are using paper or EHR. The details may be different but the problems are similar. EHR may magnify the effect of a mistake. On the other hand, paper records make it that much more difficult to correct a mistake.

 

[pb4uski]

I suspect that in the long run that the benefits of EHR will exceed its detriments but there will be some growing pains along the way.

 

[ERhoosier]

And I would MUCH rather go to a doctor who used a good EHR system than continued using paper records. The ability for the doctor treating me at the affiliated hospital to review my GP's records right there-and-then, cannot be overstated.

Basically agree. However you can accomplish the same by hand carrying copies of your paper med record. Unfortunately, I think many folks assume the current EHR systems are better than they too often are. And assume they are clearly better than paper, for which the supporting data presently are rather weak & controversial- esp considering the huge cost of implementation. The health system I generally use has had integrated EHR for some time, and it's one of the top-rated EHR systems in US. Unfortunately, errors are still too common. Last yr I had my long-time primary doc begin to chastise me during office visit for not getting the scheduled screening colonoscopy he had ordered. The EHR had NO record of my c-scope being done. 'But' (pardon the pun) I had it done weeks before by a GI doc at a GI office within the system, and NO I was NOT going to have it done again because their EHR had (pardon the second pun) 'purged' the result. Fortunately I had brought paper hard-copy printout with me (as I requested from GI doc at the procedure). My PAPER record of result was then scanned back into their EHR system. Doc tells me he still sees this kind of frustrating glitch (dropped data) every few days. So even though I use a health system with among the best of the current EHR's, I still make it a point to keep PAPER copies of all my most important records (as I have for many years).

IMHO- If EHR's were as advanced and integrated as the better on-line video games, the data supporting better patient outcomes would be truly overwhelming. Until then, I believe there is still a valid argument to be made by those who prefer to go to a doc who still uses paper records while investing the $$ saved on IT into more direct patient support instead (e.g. more nursing hours).

 

[bUU]

Basically agree. However you can accomplish the same by hand carrying copies of your paper med record.

First, no in an emergency. And second, as a DDD patient, I'd rather not subject my films to the inexpert storage of my home.

Unfortunately, I think many folks assume the current EHR systems are better than they too often are. And assume they are clearly better than paper, for which the supporting data presently are rather weak & controversial- esp considering the huge cost of implementation.

While I agree with you that many people make assumptions, there reality is that there are many problems of hardcopy records that some folks are underselling, so it's a wash.

 

[Midpack]

Yes, by all means let's hold on to the old way (paper records) that has brought the USA on average twice the health care cost per capita with almost third world outcomes (except at the very leading edge of care maybe). While many industries have gone online and mobile, the medical profession still relies on massive piles of paper records that aren't reliably passed from one physician to another and aren't easily decipherable when passed. In our experience, many times our doctors have told us, 'I am running my own tests (and charging you for it), I'm not using another doctors results.'


Small data set, but I know more practicing physicians who while very bright and hardworking, are hopelessly computer illiterate...

 

[MichaelB]

There is no doubt digitizing records and applying some good old fashioned IT to health care would improve productivity. I don't think it has much to do with our excessive cost structure, as paper is used everywhere in the world. Despite much higher prices, new tests are ordered frequently here and not all healthcare providers embrace the work of others or share their own tests. It is also more common in the US for providers to own much of the testing equipment.

 

[ERhoosier]

Small data set, but I know more practicing physicians who while very bright and hardworking, are hopelessly computer illiterate...

And unfortunately I know many doc's who will tell you that their EHR's seem to be designed by the "computer illiterate" In fact, the doc I know who is most outspokenly upset with his hospital's EHR system has an undergrad degree in IT.

There is a big difference between the best & the worst EHR's- at least from docs' point of view.
Survey ranks electronic health records physician satisfaction | Medical Economics

IMHO- We need to move to EHR's but also need to hold these IT companies more accountable for better systems so doc's are not spending more time with their $$$$$ EHR's than they are with me- the patient.

 

[Midpack]

There is no doubt digitizing records and applying some good old fashioned IT to health care would improve productivity. I don't think it has much to do with our excessive cost structure, as paper is used everywhere in the world.

Electronic records aren't a panacea, but it's hard to imagine improving productivity without any cost (and performance) benefit...and examples from other industries abound.

 

[Gatordoc50]

This article reinforces that patients need a loved one to monitor every aspect of the patient's care.

Digital Health Records

Hmm looks like digital health record keeping opens new avenues for lawyers to sue hospitals & software designers of such systems.

I have no doubt that the attending physician will be named in this lawsuit. Reliance on the electronic record won't absolve him from responsibility. In fact will probably be used to show an act of omission. Not confirming medications with the patient/family/family doc.