Electronic medical records and the VA

If the government adopts a universal system that competes against private medicine, we will have adopted the British system of the average citizen expected to use the NHS and its delays, shortage of specialists and GPs alike. We will have a two tiered system and through natural selection the lower quality docs will dominate the public system because of the lower incentives. The VA system may work better from a doctor’s point of view now than 35 years ago, but it still has many deficiencies: to begin with, eligibility for care is determined by the VA budget. Not all veterans can use the system, a point that ALWAYS escapes the attention of the network news reporters and obtuse politicians who marvel at it. If all veterans were made eligible for care the system would collapse under the weight of the demand. Think of the Walter Reed situation multiplied by 1000.

There problems with the VA EMR that will likely be universal.
#1 cutting and pasting- unfortunately sloppy inattention to detail gets alot of redundant and uneeded information in a record. This leads to problems when JAHCO looks at the chart and views what you cut and paste for example from the radiology report as your interpretation of the film

#2 if a note is unsigned it cant be seen. Residents have to have their notes cosigned by an attending. Until that happens no one can use that note to care for the patient. this happens alot!

#3 The patient only has one record now. That seems like this would be a good thing and it is except from a quality assessment standpoint. I often get “dinged” for BP control when the BP was fine when I saw the patient but when they go to another clinic a week later and its high i get nailed for it. Under a paper chart system I would be fine.

#4 Lack of thinking- I truly believe EMRs lead to less doctor thinking. Everything is a template and you dont have to think as much as when you had to hand write the note. Its easy to keep bringing the same ideas forward via the template or cutting/pasting.

#5 the EMR has likely greatly changed the doctor-patient relationship. More doctors now look at the computer and type and not pay attention to the patient. I suspect very few docs wrote their handwritten note while interviewing the patient. But now many type away while the patient talks. I consistently hear this from patients.

There are other problems but I think these are important. I look forward to other’s comments