The medical profession needs to get over its fear of information technologyOuch.
Continued objections to Electronic Health Records (EHR) by sections of the physician community are bogus. They arise from past entitlements and a lack of accountability.
That will not go unchallenged, no doubt vitriolically so in many quarters.
But, on one point,
Quality of treatment can improve significantly: When a complete medical record is available about a patient, including details of visits to multiple healthcare professionals, the quality of diagnosis and hence treatment decisions should improve greatly. This improves patient safety and reduces medical errors, since everyone has access to the same set of data.I don't see how anyone can rationally disagree with that, in general. Of course, once we get past what I irascibly call "Interoperababble."
Now, "fear of information technology" is surely a deliberately inflammatory bit of clickbait headline work. More likely is "antipathy" borne of feeling put-upon by clinically ignorant Health IT policy geeks and regulators more broadly.
When I'm looking for astute information and analysis on the issues, I always turn to Dr. Jerome Carter's "EHR Science" blog. to wit:
Technology usage patterns differ from person to person. Any number of factors could account for the differences such as varying needs for specific features, lack of familiarity, or being unaware of available functions. Two recent studies that looked at physicians’ EHR use may offer a much more nuanced and interesting take on this topic.
Like anyone who has practiced in a setting that used paper charts, I noticed specific information management patterns among my colleagues. Some kept meticulous notes that read like novels, while others created notes that were so sparse they were nearly unusable. The same held true for things like preventive maintenance. Some charts had documentation that was clear and precise while in other charts the only way to tell if a mammogram had been done was by slogging through radiology reports. Why such a wide variation? Do disparities in recordkeeping have anything to say about the quality of care rendered?...
...I was not surprised that those who valued information kept better records and used EHR systems to a greater degree. I wonder how useful this information is for understanding clinical care issues such as diagnostic errors and results management. Does uncertainty absorption coupled with low EHR use point to a lower level of vigilance and lower quality care?...IN MY INBOX TODAY
Some people will find this merely further evidence of the prevailing anti-clinical workflow priority. A long-standing complaint regarding EHRs is that they are primarily billing platforms. e.g., Dr. Carter:
EHR system-clinical work impedanceFrom Health Affairs:
The automation of clinical care with current EHR systems has resulted in numerous complaints from clinical professionals who are fed up and discouraged by systems that make their jobs harder to do. The number of workflow disruptions that occur as a result of EHR use should surprise no one. Disruptions were to be expected because EHR systems are archival systems that do not contain models of clinical work. Making matters worse is the fact that EHR systems have their own internal workflows. Consequently, a good portion of EHR training is spent helping EHR users learn to adapt their workflows to those of the software. Thus, training times are one hint of impending EHR system-clinical work impedance and attendant clinician misery.
The Final Stage Of Meaningful Use Rules: Will EHRs Finally Pay Off?
by Ashish Jha
Six years ago, President Obama signed into law the HITECH Act, which spelled out a path to a nationwide health information technology infrastructure. The goal was simple: every doctor, nurse, and hospital in America should use electronic health records — and do it in a way that leads to better care delivered more efficiently. The Act provided $30 billion in incentives for providers and hospitals who met the criteria for “Meaningful Use”, which the Obama administration was given the authority to define. The rules were set up to be rolled out in three stages, and while the first two stages have been out for a while, the criteria for the third and final stage of Meaningful Use (MU) were finally released on March 20...
Opening up closed EHR systems...
The big deal in the stage 3 meaningful use rules is data flow. Here, I think federal policymakers are helping to fix the big problems with EHRs, though they could go further. The current EHR vendors have prioritized integration with legacy systems and complex, secure systems over ease of use and support for better care. That’s a problem. Most of these systems are closed, making it difficult to use 3rd party vendors to improve provider experience or share data with others...
However, by forcing EHRs to allow for sharing of data with patients, and by pushing EHRs to incorporate patient-generated data, the new proposed rule will begin to create leaks in these closed systems. And that’s a helpful start. As the data in the EHR begins to be able to break free, third party vendors will build better tools that engage patients in their care. Requiring EHRs to incorporate data generated by patients will push the industry towards greater standardization.
….but not quickly enough.
While these are helpful steps, they may not be enough. If we are serious about addressing EHR’s poor usability and inability to support the kind of care we are increasingly demanding, then we need to open up the EHR systems in a more robust way. As part of certification, the Office of the National Coordinator could require that all EHRs publish their full application-program interfaces (APIs). The proposed rule begins to do that, but only as it relates to sharing information with patients. This is not enough. ONC should require that any vendor that enjoys federal subsidies for its products make its full suite of APIs widely available for third party products.
This may sound like a technical issue, but it’s a critically important one. If these APIs become widely available, third party vendors will build the tools that currently limit EHR utility and value. Hate the way your EHR does clinical documentation? Use the one just developed by a new vendor down the street. That kind of competition will make everyone better.
If you were locked into using the Apple map forever, they would have little incentive to improve it. That’s how the world works – and to improve EHRs, we need the kind of competitive pressure created by open ecosystems. Stage 3 meaningful use rules move us one step towards that goal, and that’s a good thing. But given how long the journey is between EHR adoption and better care, we could surely move faster...
[The] Office of the National Coordinator could require that all EHRs publish their full application-program interfaces (APIs). The proposed rule begins to do that, but only as it relates to sharing information with patients. This is not enough. ONC should require that any vendor that enjoys federal subsidies for its products make its full suite of APIs widely available for third party products.That's about as close as we'll get to my "Data Dictionary Standard" argument. Maybe it will suffice.
More to come...