Govt push for electronic medical records-part of stimulus pkg consider

[rudywoofs (Pam)]

Quote:

The Government Push for Electronic Medical Records

Posted 02/24/2009 Medscape Today

by Nancy R. Terry

The economic stimulus plan currently being considered by Congress allocates $20 billion to health information technology such as electronic medical records (EMRs). Recent postings on Medscape Physician Connect (MPC), a physicians-only discussion board, offer frank opinions about the utility of EMRs in clinical practice -- opinions that are decidedly mixed.

"EMR is the worst thing that has happened to me professionally in over 25 years of practice. My care of patients is impeded and the quality of my care is worse as a direct effect of the introduction of EMR," says a MPC contributor who championed the installation of an EMR system for his physician group.

"I absolutely love our EMR," says a nephrologist. "It has improved the quality of our practice immensely. I spent a lot of time customizing for our practice, but it was worth it. Everything is point and click. To improve care and cost, all patients need a Web-based collection of medical records that include hospitalization, lab reports, x-rays, as well as office notes. That would be the ultimate care."

Physicians who are dissatisfied with EMR systems cite loss of productivity, the negative impact on patient care, and high maintenance requirements. Physicians who have embraced EMRs cite the increased efficiency the systems have brought to their practices. EMRs tend to get high marks from subspecialists and low marks from primary care physicians.

Some of the MPC physicians least satisfied with their EMR systems are those practicing at large healthcare companies or medical centers. "My hospital solicited medical staff support for EMR," says one MPC contributor. "After implementation, administration took over and now EMR is solely for the benefit of medical records as a storage device. To hell with the medical and nursing staffs. RNs are input clerics rather than beside nurses."

"The very few efficiencies were all on the administrative side," says a regional medical director who helped bring an EMR system to a nationwide healthcare company. "A good sales pitch with nice graphics and testimonials sell it, then the clinical staff is left to suffer."

"EMRs need to address work flows and clinical efficiencies and not seek to provide administrative support," says a general practice physician. "Unfortunately, the administrators are the ones with the time and energy. The rest of us are seeing patients."

In smaller practices, issues of EMR maintenance and support infringe upon patient care. "In my clinic," says a family medicine physician, "provider meetings are completely dominated by EMR issues and problems. There is virtually never time left for discussing topics pertinent to improving patient care."

In speaking about their day-to-day experience with EMRs, primary care physicians complain that entering patient information is cumbersome and time consuming, often because of a template-based system that does not reflect the patient encounter.

rest of the article

[Pockey]

EMR is a great thing, although I can see how a lot of the older docs don't like it. The problem with Barry's "vision" of everyone on EMR: there are so many different EMR platforms on different operating systems. So basically none of them can communicate with each other. If you end up in a hospital at another city, there's no way to look up your chart even though your records may be sitting on someone's hard drive in the "EMR".

The only way to go around that is to have a web based EMR. But then you run into the problem of having to be online to access those records. If for some reason the internet is down, then one couldn't access those records.

[Gregory Matthews]

EMR is a great thing, although I can see how a lot of the older docs don't like it. The problem with Barry's "vision" of everyone on EMR: there are so many different EMR platforms on different operating systems. So basically none of them can communicate with each other. If you end up in a hospital at another city, there's no way to look up your chart even though your records may be sitting on someone's hard drive in the "EMR".

The only way to go around that is to have a web based EMR. But then you run into the problem of having to be online to access those records. If for some reason the internet is down, then one couldn't access those records.

FYI: There is a standardized, nationwide, system of EMRs. It is not web-based as the records reside in the servers of the providing hospitals. So, access does not require being on the Internet. Yes access by a clinical provider located in California of records on a server in Colorado do require Internet access. Software and hardware protects the transmission of data over the Internet just as your financial transactions are protected over the Internet.

This is the system maintained by the Department of Veterans' Affairs. It has been in opperation for several years, is well developed and quite successful. It is incomplete in that access between seperated institutions is being accomp;lished on an ongoing basis and is not fully implemented at this point in time.

Privacy is protected by a comprehensive set of software, hardware and privately developed certification systems. As this is developing these issues are more confined to people at a local institution accessing records without a valid reason to do so. These protections are being developed and put in place. When they are brea ched they may be identified and corrective action taken.

I am both a clinical provider with access to patient records that allows me to both read and to post. And I am a patient who recieves clinical care at the institution where I work.

As a patient I can recieve a listing of every person who accessed my clinical records for whatever time period that I specify. Taht listing will tell me when they were access, when, how long and what they did in my records. Periodiclly I obtain such a listing.

As a clinical provider my access of patient records is tracked, where, when and what I did. I am subject or quetioning as to my access of patienet records. In addition, I am prohibited from certain access.

It is the general thinking of the clinical providers that use our system that it provides much better care for the patient.

[Gerr]

Greg, I have worked in three different facilities where EMR is used. They have nothing in common

and can't communicate with each other.

[Pockey]

This is the system maintained by the Department of Veterans' Affairs. It has been in opperation for several years, is well developed and quite successful. It is incomplete in that access between seperated institutions is being accomp;lished on an ongoing basis and is not fully implemented at this point in time.

Yeah, VA's use the VistA system. But like you said, they can't even communicate between VA hospitals yet. Even if they did, that's only the VA system. Not everyone is a veteran. And what is Barry going to do, force every hospital, clinic, and medical office to use VistA? I don't think so. Kaiser just spent 4 billion on their EMR. No way they'd switch to VistA. Also that would put a lot of companies out of business and more unemployment. So yeah, it'll be nice to have every office on EMR, but they still will have problems communicating with each other being on different platforms.

[Gregory Matthews]

Originally Posted By: Gregory Matthews

This is the system maintained by the Department of Veterans' Affairs. It has been in opperation for several years, is well developed and quite successful. It is incomplete in that access between seperated institutions is being accomp;lished on an ongoing basis and is not fully implemented at this point in time.

Yeah, VA's use the VistA system. But like you said, they can't even communicate between VA hospitals yet. Even if they did, that's only the VA system. Not everyone is a veteran. And what is Barry going to do, force every hospital, clinic, and medical office to use VistA? I don't think so. Kaiser just spent 4 billion on their EMR. No way they'd switch to VistA. Also that would put a lot of companies out of business and more unemployment. So yeah, it'll be nice to have every office on EMR, but they still will have problems communicating with each other being on different platforms.

A couple of responses to your post:

1) Yes comunications between VA hospitals is not fully imlplemented yet. But, it partally in operation and communicaiton is possible between some hospitals.

2) The VISTA system as a tax-payer developed system is in the public domain. As such it is open to be used without cost by anyone who wants to use it and/or anyone who wants to take VISTA, make software changes and sell it as their own system.

3) That is exactly what is being done by some private companies. They have taken it, rewritten some of the software parts and are selling it to hospitals as thier own system. Due to the fact that they have rewritten some of the software parts compatability with the VA version, as well as all other versions, is not known.

4) Yes, there still are significant issues in regard to talking to each other.

5) My point was simply that EMR is here on some level. It has advantages. It also has some problems. It cannot simply be brushed off due to its present problems.