Wednesday, October 23, 2013

Electronic Medical Mess

Observers across the political spectrum are raising questions about the ObamaCare electronic medical records mandate. (Note: This is the physician side of electronic records, separate from the website problems reported by patients trying to sign up for insurance on the "exchanges".)

Dr. Dan Morhaim, who is both a physician and a Democrat representing Baltimore County in the Maryland House of Delegate, wrote the following in the Washington Post, in "An electronic medical records mess":
These systems tend to be fantastically complex. One doesn’t have to be intimately familiar with, say, Hertz or Enterprise to rent a car online. But many electronic health record systems have pull-down screens listing each of the 68,000 possible diagnosis codes in the World Health Organization’s International Classification of Diseases and 87,000 possible procedure codes.

Or consider what happens when I write a prescription: Every potential drug interaction or side effect listed generates a warning prompt. Inevitably, recognizing that the warnings are generally inapplicable and take time to sort out, clinicians start to bypass the alerts. Sooner or later, ignoring one will lead to serious complications...

Perhaps the most pernicious side effect is the erosion of the provider-patient relationship. When I first began working with electronic health records, I caught myself staring at the computer screen instead of engaging patients, who rightly felt ignored. Like many colleagues, I’ve reverted to the practice of talking with the patient and taking notes with pen and paper. After the evaluation is over and the patient has left, I type in the data. This takes much more time, but it is the only way to complete a proper history and exam....

Ideally, electronic health records would provide doctors with instant access to information and help patients track their medical histories. Such records should be a giant step forward in continuity and comprehensiveness of care. So far, the “cures” are worse than the disease.
Conservative columnist Michelle Malkin wrote the following in "Don't Forget Obamacare's Electronic Medical Records Wreck":
In June, the Annals of Emergency Medicine published a study warning that the "rush to capitalize on the huge federal investment of $30 billion for the adoption of electronic medical records led to some unfortunate and unintended consequences" tied to "communication failure, poor data display, wrong order/wrong patient errors and alert fatigue." Also this summer, Massachusetts reported that 60 percent of doctors could not meet the EMR mandate and face potential loss of their licenses in 2015. And a few weeks ago, the American College of Physicians pleaded with the feds to delay the mandate's data collection, certification and reporting requirements.

Dr. Hayward K. Zwerling, an internal medicine physician in Massachusetts who is also president of ComChart Medical Software, blasted the Obamacare EMR mandate in a recent open letter: "As the developer of an EMR, I sincerely believe that a well-designed EMR is a useful tool for many practices. However, the federal and state government's misguided obsession to stipulate which features must be in the EMRs, and how the physician should use the EMRs in the exam room places the politicians in the middle of the exam room between the patient and the physician, and seriously disrupts the physician-patient relationship." Zwerling's call to arms appealed to fellow doctors to pressure the feds to repeal the mandate. "It is past time that physicians reclaim control of their offices, if not the practice of medicine."

As I've mentioned previously, my own primary care physician in Colorado Springs quit her regular practice and converted to "concierge care" because of the EMR imposition. Dr. Henry Smith, a Pennsylvania pulmonary doctor, also walked away. "Faced with the implementation costs and skyrocketing overhead in general," he told me, "I finally threw in the towel and closed my practice"...

Dr. Michael Laidlaw of Rocklin, Calif., told EHR Practice Consultants that he abandoned the Obamacare EMR "incentive" program "when I realized that I spent the first two to five minutes of each visit endlessly clicking a bunch of garbage to make all the green lights show up on the (meaningful use) meter. I said to myself: 'I'm not wasting precious seconds of my life and my patients' time to ensure some database gets filled with data. I didn't go into medicine for this. It is not benefiting my patients or me. I hate it.' I actually refused to take the $10K-plus this year. I have even accepted that I would rather be penalized in the future. What is worth the most to me is AUTONOMY."  
Electronic medical records can be a tremendous benefit, if adopted organically by physicians and hospitals based on their needs and requirements.  But ramming them down the throats of doctors is merely hampering good patient care.

(Note: I also discussed electronic medical records in part 3 of my 4-part PJ Media series on the changing face of health care in , "The Eyes of Big Medicine: Electronic Medical Records".)

Update: Even kids know this is a problem.  Here's a drawing made by a 7-year old girl published in the 6/20/2012 issue of the Journal of the American Medical Association.

The article explains:
No one was more surprised than the physician himself. The drawing was unmistakable. It showed the artist—a 7-year-old girl—on the examining table. Her older sister was seated nearby in a chair, as was her mother, cradling her baby sister. The doctor sat staring at the computer, his back to the patient—and everyone else. All were smiling. The picture was carefully drawn with beautiful colors and details, and you couldn't miss the message.
(Click on image to see full size.)