EHRs – why good ideas do not always work

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Category : Medical Rants

Any entrepreneur will tell you that not all their brilliant ideas work. Any researcher will tell you the same thing. As we develop great ideas, we cannot work through all the implications of those ideas.

One attribute of great managers involves knowing when to go to plan B. James Yorke stated, “”The most successful people are those who are good at plan B.”

Unfortunately, the EHR road has no apparent exits. We have no plan B. Once we enter the EHR road, we are going 100 MPH with no exits, no brakes, and mounting obstacles in the road.

OK, please excuse me my attempt at hyperbole and humor. There is nothing funny about the EHR saga. My friend Bob Doherty has written a brilliant blog post on the subject today – Imagine if your mechanic couldn’t fix your car before consulting an “electronic car record”

We all know that the road to hell is paved with good intentions. When Congress enacts a law, they rarely consider the unintended consequences. When new drug appears, and patients develop medication side effects, lawsuits follow. Often the medication is reviewed again, and removed from the market. My medical career has seen many GREAT drugs fall by the wayside onto the shoulders of our highway.

EHRs are a great idea. But we should have allowed the market to convince physicians of their usefulness. Instead, we have companies developing products to impress administrators. We have EHRs focused on billing rather than patient care. We have EHRs that do not help physicians care for patients. WE have EHRs that get between the physician and the patient.

Thanks to Bob for putting the problem into the proper context. I am tired of horses out of the barn or ships already sailing. Wrong is wrong. The Coca-Cola company took “new Coke” off the market and returned to the old formula. We must demand that this runaway train slow down. It really could, if we just speak loudly enough.

Comments (8)

The link is broken. please fix.

fixed

If you speak too loudly you are a ” disruptive physician”. The train really has left the station. It’s all bean-counting and Press Ganey Scores now. No one really knows what you ( as a physician) do to make a difference.

EHRs should act like Google. There’s just one input box, and I can type in a sentence in plain language, and it parses it out reasonably well, then I click to confirm. Or better yet, I can write out my assessment and plan, and the computer parses the text and generates a prescription that I can check, edit, and send.

Instead I need to click the “Orders” tab, then scroll past a bunch of junk to “Medications,” type into a box, go through a massive list of guesses (who knew there are so many kinds of ibuprofen to choose from?) to hunt for the one I want, click the little box for dose and type in the dose, click the little box for frequency and enter that in (oh wait a dialog box – did you mean daily in the morning, daily in the evening, daily at noon, or daily PRN?), click on a box for route! (should he take his ibuprofen per rectum?!), click on a box for number of refills and scroll down and then select the right number, then click “confirm.” Then a little pop-up says that because he had an “allergy” to vicodin (made him delirious), there’s a cross-reactivity between the acetaminophen and the ibuprofen and DO I WANT TO RISK IT??

In fact, they were a good idea in theory, but we just didn’t know enough about them to realize they wouldn’t be a good thing in practice, altho there were hints
http://www.theguardian.com/commentisfree/cifamerica/2011/apr/23/nhs-health

It is too late now. The problem can not be fixed, only ameliorated.
There are two reasons- first there are too many people invested on the status quo, including the Government. Second, as new trainees in the healthcare industry (ugh what a term) enter, they know nothing different, so they don’t understand the problems and don’t see a need for anything different. Ask someone on the wards for a pen or pencil today. Watch the looks you’ll get.

Actually, my mechanic DOES have an electronic car record that has proven very useful. It reminds him, and me, of when we replaced the timing belt, of when the rattling in the wheelwheel began, and so forth. It also is helpful when our main guy is out and his second-in-command has to do the job.

Yes, EMRs are early and will seem primative in five or ten years, but they’re far better than the alternative: paper based records.

EHRs ought to act like Google. There’s only 1 input box, and that i will sort during a sentence in plain language, and it parses it out moderately well, then I click to substantiate

Paul:
Exactly why are they far better than paper-based records, other than handwriting and occasional memory issues?

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