Simple question for Mac OS using medical people
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From: Mark Conrad on 8 Jan 2010 07:42 Question: Does the blog below reflect _your_ feelings about why EMR forms are not widely "implemented" in the USA? Some estimates mention only 10% of medical people in the USA use EMRs, the rest use just plain word processors to fill out all required paperwork. I am assuming Mac OS medical users, at least in spirit, if not in actual practice. The Blog: ************ <http://www.thehealthcareblog.com/the_health_care_blog/2008/12/emr-use-o n-the.html> Reason I ask is because our knee-jerk politicians may be getting ready to force adoption of some sort of standardized EMR upon the long-suffering medical industry. That would be just ducky if EMRs worked, but a lot of the medical community seems to think that EMRs are flawed in their present incarnations, and will send medical care back into the dark ages if they are forced upon the medical industry. I dunno either way, because I am not a "medical guy", which is why I am asking this question. Mark-
From: Tim McNamara on 8 Jan 2010 16:46 I was just discussing this at work today. A little about me to create a context. I am a licensed psychologist and work in nursing homes. I go to 11 nursing homes, usually two a day, either weekly or every other week. Because of the complexity of the cases, I see about 25% fewer people than I would see in an outpatient practice- I see about 1000-1200 "patient encounters" per year. In the course of this, I have developed a set of templates on my Mac (using NeoOffice) for writing reports and tracking cases. I plug into one of the printers in the nursing home, print, sign and on to the next thing. People don't have to decipher my handwriting, wait for dictation to be typed and mailed, etc. They've got the report that day. I type about 2500 pages a year, I would estimate. I work with several different EMRs at different nursing homes. Some of them are Web-based like Matrix or PointClick. The advantage of these is that they can be set up to allow remote access, so I can have reviewed the chart before even getting to the building which streamlines service delivery quite a bit. Others run locally on a server over a network and typically require Windows (e.g., Care Organizer). I don't know any nursing homes using EPIC but that seems to be in use in most of the hospitals around here. A few of these have an client that can be installed on consultants' laptops- assuming one runs Windows- and others can only be accessed from terminals hard-wired into the building's network. In all of the non-Web based cases, there is little to no provision for consultants having access. There are always a limited number of seats available, so the consultant is taking up a computer that one of the nursing home staff needs. Or the consultant can't get to a computer because they are all being used. Consultants going to multiple sites probably have to know how to use multiple EMRs. Since they operate very differently, it is difficult to use them efficiently through lack of enough screen time for developing expertise. There's all kinds of stupid bullshit with passwords and user names that are suitable for secure military installations and massive overkill for health care settings. These things are designed by computer programmers for the way they *think* healthcare providers think about, store and organize information. The better ones are probably designed with input from the very first stages of development. Another problem is reliability. Every nursing home I go to has had problems with the EMR going down in some way, whether a remote Web-based system or a system on a local server. This just happened this morning (hence why I was talking about it). That particular nursing home uses Matrix and scans all their documents into the EMR (done by faxing the document to the service provider), not keeping a paper backup. That means that there is no access to the information while the EMR is unavailable. Keeping paper charts at the nursing home, on the other hand, defeats the purpose of having an EMR. In my experience, using a paper chart makes access to the important information much, much faster than a computer. Flip a page, there's the new info. On a computer, click a button and wait while the system queues the request, finds the file, displays it on the screen- I can be almost halfway through a printed page by the time this finishes in many cases. EMRs are supposed to save money overall but my experience is that they drastically show down the process of getting access to information about my patients. I expect that this will change as EMRs improve. As they stand now, most of them are pretty awful to use. -- "I wear the cheese, it does not wear me."
From: JF Mezei on 8 Jan 2010 17:50 Tim McNamara wrote: > Another problem is reliability. Every nursing home I go to has had > problems with the EMR going down in some way, There are non-Windows solutions which provide proper redundancy. VMS used to be a big player in this market because of its clustering and failover capabilities. (used in large hospitals). But HP has de-emphasised this solution. IBM has servers running AIX with similar capabilities. EMR makes sense when it is interconnected (or centralised) because in systems where you have a choice of doctor/hospital (not restricted to one insurance company's hospitals), when you go to another hospital, they can access the records created at the other places in seconds instead of hours/days to have the stuff faxed to them. But there are very serious security issues associated with allowing any hospital/doctor access any information from any person without some security controls. You don't want every doctor in the USA accessing Angelina Jolies's PAP smear test results and revealing them to the National Enquirer. But if you have an accident and are wheeled into some hospital unconscious, having access to your complete medical history would be extremely valuable.
From: Tim McNamara on 8 Jan 2010 20:49 In article <0140b265$0$20798$c3e8da3(a)news.astraweb.com>, JF Mezei <jfmezei.spamnot(a)vaxination.ca> wrote: > Tim McNamara wrote: > > > Another problem is reliability. Every nursing home I go to has had > > problems with the EMR going down in some way, > > There are non-Windows solutions which provide proper redundancy. VMS > used to be a big player in this market because of its clustering and > failover capabilities. (used in large hospitals). But HP has > de-emphasised this solution. IBM has servers running AIX with similar > capabilities. Competition rather than cooperation. > EMR makes sense when it is interconnected (or centralised) because in > systems where you have a choice of doctor/hospital (not restricted to > one insurance company's hospitals), when you go to another hospital, > they can access the records created at the other places in seconds > instead of hours/days to have the stuff faxed to them. Those things are true, but at this point because those hospital systems tend to be competitive rather than cooperative (and since AFAIK there is no standardized data format for interchanging information between different EMR systems) that is mostly a theoretical rather than practical benefit. > But there are very serious security issues associated with allowing > any hospital/doctor access any information from any person without > some security controls. > > You don't want every doctor in the USA accessing Angelina Jolies's > PAP smear test results and revealing them to the National Enquirer. Data security is an issue. Even within the system there are issues with people accessing information they shouldn't. > But if you have an accident and are wheeled into some hospital > unconscious, having access to your complete medical history would be > extremely valuable. Absolutely. But there'd also have to be some foolproof way to identify you (e.g., you are found unconscious without ID). -- "I wear the cheese, it does not wear me."
From: Mark Conrad on 8 Jan 2010 22:11
In article <0140b265$0$20798$c3e8da3(a)news.astraweb.com>, JF Mezei <jfmezei.spamnot(a)vaxination.ca> wrote: > EMR makes sense when it is interconnected (or centralised) because in > systems where you have a choice of doctor/hospital (not restricted to > one insurance company's hospitals), when you go to another hospital, > they can access the records created at the other places in seconds > instead of hours/days to have the stuff faxed to them. Yeah, that is why it is not practical to go back to paper records, in this day-and-age. As regards electronic fallibility, if I were running the show, I would make sure we expanded our underground glass-fiber networks to all major hospitals in the USA, so we are not so reliant on satellites, which are vulnerable to all sorts of problems, such as terrorists, solar radiation, collision with space debris, etc. Mark- |