Author Topic: Death by electronic healthcare record  (Read 500 times)

MillCreek

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Death by electronic healthcare record
« on: March 18, 2019, 05:04:36 PM »
http://fortune.com/longform/medical-records/

https://www.npr.org/sections/health-shots/2019/03/18/704475396/why-the-promise-of-electronic-health-records-has-gone-unfulfilled?utm_medium=RSS&utm_campaign=news

Being old enough in healthcare to have worked in both the paper-based and computer-based records, the paper records were not perfect either.  But the computer gives you the opportunity to make mistakes 10,000 times faster or for hundreds or thousands of patients at once.
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MillCreek
Snohomish County, WA  USA


Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

Hawkmoon

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Re: Death by electronic healthcare record
« Reply #1 on: March 18, 2019, 09:59:28 PM »
I'm seeing that first hand. I get much of my health care at the nearby VA hospital. They blew it when I had a cardiac problem in 2014, so I went to a private cardiologist using Medicare, and had heart surgery at the nearby university teaching hospital. I continue with the outside cardiologist because (1) he's a nice guy, and (2) he saved my life.

I recently spent several days in the ICU at the VA hospital with a collapsed lung. I had a regular 6-month follow-up with the cardiologist a few days after I was released from the hospital. He was, of course, curious about the records of the hospitalization, and he couldn't get them. He is part of a cardiology group that's owned by the university hospital. His comment was, "The university runs the VA hospital ... and we can't see their records." And that's exactly right. The VA has its own system. I can walk into a VA hospital or clinic anywhere in the country and they can call up my record. But ... the teaching hospital where all the attending physicians and residents at the VA hospital come from? Nope. The university is on EPIC, and EPIC doesn't communicate with the VA records system.
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AZRedhawk44

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Re: Death by electronic healthcare record
« Reply #2 on: March 19, 2019, 03:46:28 AM »
I was a database admin for an EHR reseller/host for several years.

The expectations put forth in this article crack me up.  In order for information to interchange, it needs a source, a destination, and a schema to interpret the information.  However, this is privileged information intended to be treated as secure.  So, that puts validation constraints on your source and destination.  Then, each source and each destination has to agree to use the same transmission schema.  In an industry where there are dozens of EHR software suites, each of which will sue the others for using the same database relationship diagram in their proprietary product.

When we set up secure tunnels, data was sent using HL7, which is an XML formatted data string with only a limited subset of the total information input by the provider in their EHR app.

The particular EHR app we supported initially allowed practices to highly customize their templates (the UI in front of them).  But, as the database backend evolved, this became horrifically unsupportable in the long run and standardized templates were enforced to facilitate interchange like HL7. 

All in all, I left the industry because I could see it spiraling into a technocratic greek tragedy.  Doctors are better off dictating into a recorder and handing that off to a documentation specialist.  As a patient, I find that it demeans a doctor to have him spend more time making eye contact with a computer screen than with me.  I see him as a cause/effect ICD/CPT technician rather than an investigator into what might ail me.

The money spent on compliance enforcement, documentation, training, software licensing and hardware to run the application was not coming from thin air.  It was coming from the up-spiraling fee schedules each insurance company agreed to pay for each procedure.  This would ultimately come from increased premiums for the patient/employee/whatever.

Note that health insurance is far less pervasive in dental medicine and veterinary medicine.  Look how much time your dentist (rather than the hygienist) spends on paperwork.  Look at how much dental surgeries cost compared to general surgery.  Look at how much pet surgery costs compared to human.  Look at how much screen-typing your vet does, versus probing of your animal or other investigation and building of trust.
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