Electronic Medical Records: Hazardous to Your Health?

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Over seven years ago when I mysteriously acquired the iatrogenic neuro disorder of the central nervous system called, "Central Pontine Myelinolysis," those few of you in the public system who truly have very little clue along with most all in the "World of Medicine and Healthcare," who do know of it or can atleast use the Keywords of Central, Pons or Pontine, and lastly Myelin from Myelinolysis. Facts be known, a rather elderly RN gave me here feelings on this last little riddle.
Mr. AC, I'm sure pleased to be able to view these stages of the medical future now coming in memo by memo. I'm not going to take anyones time at this point stating how pleased I am for myself along with those worldly that I continue to assist. Many a time I've heard the expression "A computer can only be as good as those who are punching on it which surely has plenty of room to stretch that answer out.
If you don't mind, I'd appreciate getting one possible feeling out which has bothered me on a daily basis now controlled by medication which is "Much To Sad." Constant missing or changed records, notes, memo's, etc. AC, even this short note (by my standards) is going to stay this way. These last seven years I've been predicted to die even by the Insurance Company Actuaries have been no picnic but as I'm sure you know, my personal work and study that I've been blessed to carry on with so the day will come of my prediction That it will be I that turns it around and fills in the blanks of this 50 year old play that's been made on us, Mr and Mrs John Q. Public. Now after working along with some of the finest families in the world, along with their loved ones, I believe Dr. Hugo Moser who we lost in January 2007 as he stated that all these issues with "DEMYELINATION," such as MS and the rest will truly happen.
AC, I have many a plan that will become a reality to me as a counter off of whatever game continues to be played on my "Iatrogenic Disease." Many of the finest physicians now call CPM by the iatrogenic adjective.
There's always going to be a way to mess with the records but it makes me as one feel a bit better knowing the public fights back. G-d Bless To You All.....
Franky, aka: Franky and WhataBreeze, aka: Breeze, aka: Jeffrey

J. Amitin, Founder of "The CPM Awareness Foundation," and Franky my neuro service companion. of MO 11:40AM April 17, 2009

Indeed, those physicians who choose to override computerized pharmaceutical warnings are not reacting to the supposed impediments of EMR, but are rather persisting in what seems to be a lack of vigilance and responsibility on the part of the individual provider. EMR will continue to manifest these oversights, but you cannot attribute those kinds of errors - which are perhaps more prevalent, though less documented, with the use of paper charts - to Health IT.
Electronic health records isn't a cure-all - that is a false attribution, and inconsistent with the arguments in favor of EMR. EMR can, and will, enable health care providers to achieve the utmost in interoperable, fluid, and unified care - but only if those providers share a common commitment to its success.
-Felicia, IO Practiceware
iopracticeware.blogspot.com

Felicia of NJ 9:02AM April 02, 2009

It is costly.
There is no proven return on investment
There is no proven safety.
The government and insurers want this more than anyone. In medicine, information is power. If I have a patient who is on insulin and a blood pressure pill, your insurer knows that you should be on a statin to lower your cholesterol, that you should have certain tests everyone so often and you are at increased risk of heart attack and stroke. Don't want the statin drug? well maybe your premiums should go up, eh? Not getting your medicines filled in time? Well maybe you are, as we say in the business, "noncompliant" and be penalized.
There are some nice things about EMR's but we will have a price to pay.

A REAL Dr in Michigan doing REAL medicine. of MI 8:19PM April 01, 2009

I am on a medication that I take every three days. So, a normal 30 day supply last me 90 days. However, the computer at my pharmacy automatically renews the prescription and I get a phone call every month asking me to come pick it up.
I now have a year's worth of pills on hand and they'll expire before I can take them (which means I should not take them as they may not be effective).
So, I called on Friday to tell them that I wanted to opt out of the system. The nice person informed me that I had been removed from the system.
9:01 AM Today (Monday) I got a call, telling me that my rescription is ready to be picked up.
This is what happens when people cede thinking and get into the 'the computer said it so it must be true' mindset that we've all experienced from time to time to maddening effect.

Jack Friehold of VA 2:00PM March 30, 2009

Try fast food, now that is hazardous to your health.
Attacking EHR sounds a bit like an argument for not using an ambulance to get transported to the emergency room because of potential emergency vehicle accidents.

Jim of IL 12:11PM March 30, 2009

Avery injects a syringe full of skepticism into the dialogue surrounding electronic health records (EHRs). He asks if the time and cost barriers to EHR adoption were removed, would paperless healthcare even be worth the effort?
Let’s consider the growing number of small and mid size hospitals that have found a way around these barriers with open source software. Look at what’s happening in Texas: it took Midland Memorial Hospital only three years and $6 million dollars to become paperless. Compare that to the industry’s average implementation cost of $22 million over the course of seven years. Midland did it with an open source EHR, OpenVista, a commercialized version of the acclaimed open source VistA system from the Department of Veteran Affairs.
After removing cost and time barriers with open source, was EHR implementation worth it? A third party study of MMH’s clinical outcomes after fully adopting the technology reported that central line bloodstream infection rates declined by almost 88 percent.
With these outcomes and the pending federal certification of an open source electronic health record, Comarow’s skepticism sounds more like an unwillingness to accept reality.
Yes, paper has its purposes and in the hands of one individual or practice, paper records can be great. But, quality health care requires collaboration and communication across the continuum of care; from primary care, to a specialist to the hospital. Understanding the effectiveness of care options and best practices to achieve quality outcomes requires standards of documentation and a database. Paper systems are inadequate and have failed in supporting whats needed to fix our health care system.
Ask anyone involved in quality improvement if it can truly be done systemically without an EHR. Ask anyone you know, if they feel they would be better off with en electronic health record.

Edmund Billings MD of CA 6:36PM March 29, 2009

1) I've had my paper record lost more than once, at different clinics
2) My psychiatrist (works in a hospital) routinely does not get her last week's notes put in my chart on time. All the nurses have to do is punch some holes in a sheet of paper and stick it in, but it doesn't get done. It would make more sense to type it in my chart directly.
3) I've once had a doctor order a $2400 test, over my objections (the test had alredy been done). I din't care, as my insurance covered it 100%, but with a 20% copay, I'd be paying through the nose for her mistake. Hopefully, an electronic format would flag a test as recently done. God knows how many tests are repeated for no reason. And once it's done, you can't not pay for it.
4) What IS wrong with electronic records? The only people we really don't want prying are the insurance companies and employers. The employers don't have the right to access and never will. The insurance companies have the right to the information right now. It is also pretty certan now that the insurance companies will not be able to use your pre-existing condition against you in the future, so who cares?
5) Hopefully with electronic records, I will have an easier time accessing my lab results, doctor's notes etc. There will also be some checks for the doctors. Currently the docs write whatever they will, which keeps them from a lawsuit. I've had doctors outright LIE in the records. I've had an OB pressure me into having an abortion, in 3 separate phone calls. When I wrote to complain to the hospital chair, the records said that he recommended to "wait and see". Not true. Maybe there will be a link to "report to State Board". At the very least, you can know the first time the doctor lies, and switch right away.
6) There can be automatic flagging for medication interaction. I was prescribed heavy doses of Advil in the ER, for a sprained ankle. That could have been highly toxic in combination with another drug I was on. I HAPPENED to know that, alert the doctor, and simply tough out the pain, but someone less educated could be in real danger. Amazingly, in the 3 hours I spent in the ER, NOONE took my medical history, nor the current list of medications.
7) What about privacy? I'm assuming your ex-wife is not going to hack a government server to edit your medical info and put in a positive syphilis test just to spite you. The real threath is a) using your account to get health coverage, and b) identity theft. With electronic records, you can catch thiefs early, and BTW, hopefully it will be easier to get insurance in the future, so there's less need to steal. As far as identity thefts, we already have a much bigger threath from all the credit card companies who have their data stolen on a regular basis. It is a real risk, but we live with it, and manage it, and no one is advocating going back to cash payments.

millie of IL 4:46PM March 27, 2009

A lot of doctors don't want it. A lot of patients don't want it. A lot of hosptials don't want it. So why is it being rammed down our throats?
Those who want it are welcome to use it for themselves, but MANDATORY digitalization will drive a lot of people away from current healthcare, to cash-on-the-barrelhead, back-alley, unlicensed health practitioners, homeopathic remedies or no care at all.
We've heard the arguments for this system for over 10 years, and have rejected them. We have good reasons for doing so. Nothing more needs to be discussed.

Rich of CO 1:24PM March 27, 2009

As a nurse who worked with old fashioned written charts, as well as electronic medical records, I much prefer the old fashioned charts. If someone writes an important item in the old one, it will be there next time someone looks. The electronic files sometimes get lost, things drop off, or are written in the wrong place never to be found.Many doctors I knew did not like to use electronic files, and demanded their History and Physical be in written paper form, along with the Doctors Orders and Progress Notes. If I wanted to learn what was wrong with a patient, I would always know the H&P was available, thank goodness, along with orders, & progress notes. Nurse's notes would be a "checklist" and absolutely worthless. Any patient in the place had the same checklist, and almost all the checks were in the same places. I would be very concerned about passing medication using entirely electronic medical records and computer dispensed meds. I can't understand why they think it saves so much money. It makes staff go to computers instead of spend time with their patients.

Nancy of IN 11:14PM March 26, 2009

I have been implementing EMR projects including numerous interfaces among systems (clinical,labs,ADT,transcriptions,etc) and patient identity management. There are lots of dangers, as of today, in using any type of comprehensive EMR from the top vendors out there. I will throw an example which just has not been resolved by any vendor that I can think of. If any vendor says that their system does handle these situations involving merges/unmerges correctly, it would be prudent to have an independent expert test that workflow and determine if the vendor's claim (as usual) carries any merit!!
Here's a serious example that directly affects patient care. Medical records team at hospital XYZ determines that two patient patient records A and B are duplicates in the system and that they need to be merged. They merge the records and determine that B is the survivor. Obviously, all systems from then on need to use/refer to B for all transactions among the various ADT and clinical systems (including any downstream systems). 2 years later, patient A shows up in the hospital and indicates to the registration clerk that he is the twin of patient B. Medical records is notified and they determine that the merge was incorrect and that the patient records need to be separated.
Here starts the problem. For 2 years, labs,transcriptions,blood tests, medications,etc all ended up on the patient B's medical chart (A no longer exists technically since it was merged into B). There is no vendor that can claim that their system or software can detect and separate the two patient records cleanly. I say this because only a nurse or an expert needs to look at all the transactions for the various labs,visits,etc and determine which one goes where? Is this really feasible? Will any nurse remember all she did in 2 years on this patient? Even if you bring together various clinical folks from the various clinical systems in the hospital and brainstorm as to what goes where, there is no way any of them would even know which lab,visit,etc belongs to which patient (A or B). Unless there are paper charts that were documented at the time the patients were treated, the electronic medical records from all the interconnected systems were messed up. You can see how one system can easily corrupt data in the other systems and that no one system can say with 100% certainty what data goes on which patient's medical chart. This situation can get out of control when there are more than two patients that were incorrectly merged and now need to be unmerged. Ask any nurse or clinical user and they will indicate how messy this situation is and why the EMR's today are very dangerous.
Why do we end up in this situation to begin with?
- Legacy systems that the hospital cannot get rid of for many years (usually 12-20 years!!) Integration can only be done so much.
-Insufficient training and expertise in the new EMR system.
-Old policies and procedures

Naga K of WI 5:29PM March 26, 2009