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Thursday, July 12, 2018

The Medical Record: Paper or Pixels?

"It doesn’t matter if you’re a patient, a doctor, a clinical coder or a CEO. It doesn’t matter if a patient’s medical record is paper or pixel, or whether it’s being lifted out of a box in a hospital basement or accessed from thousands of miles away via an app on a hospitalist’s smartphone. No matter how quickly you can get it, the information is of no use if it’s wrong."
Just came across an article on The Huffington Post by science writer Abby Norman:
‘Minor’ Errors In Medical Records Can Have Major Consequences
“Quality” is a buzzword in many industries ― but in health care, it’s lumped in with “safety,” since poor quality can lead to much more than just customer dissatisfaction.

Medical errors are the third leading cause of death in the U.S., according to Johns Hopkins University School of Medicine researchers: Each year, approximately 250,000 patients in the U.S. die due to such errors. But more often than not, medical errors hurt patients in unobvious ways, just as an illness doesn’t always present itself clearly and instead takes root perniciously, over time and under the radar. They’re a sign of a much more severe ailment that plagues our entire health care system.

One place these errors lurk is in documentation and medical records.

As long as people have been practicing medicine, they’ve been keeping records ― if only for the purpose of billing and not necessarily to facilitate continued and coordinated care. Today, medical documentation, whether paper or electronic, serves a number of purposes, facilitating billing and patient care and serving as evidence to help doctors avoid lawsuits (or help patients litigate). 

Though we’ve seen a major push in the last decade to digitize health information and make it more widely accessible to both providers and patients, dreams of the “shared electronic medical record” have been slow to come to fruition.

Why? Because providers and health care systems are being asked to switch to new technology, which requires an investment of finances and time. And if health care providers in this country are short on anything, it’s time…
Good article. Read all of it (linked in the title).


The debate rages on, as it has since I first came to do EHR work in 2005 under the QIO "DOQ-IT" initiative ("DOQ-IT" -- "Doctors' Office Quality - Information Technology.")

Based on my long experience (as an analyst, a HIT operative, and a patient), I can assert confidently that "paper is much slower" overall. The relative error rates, however, remain rather unclear -- and empirically complicated by the "shooting-at-a-moving-target" problem.

Beyond those issues, there's Margalit's beef: "Are structured data the enemy of health care quality?" Do digital "structured data" adversely impact the SOAP process?

Workflow efficiency and clinical cognition concerns aside, Abby Norman's piece is about health care data accuracy. Hmmm... what comes immediately to mind? Theranos, perhaps? Beyond that scandal, see my prior post "The upshot of dirty data."

"I was recently reviewing my own chart with a nurse before a routine appointment, only to be informed that at some point since I’d last reviewed my records, my chart had been altered to say I had eight sisters, all of whom were in good health. I don’t have any sisters."
Lordy Mercy. Again, read her entire HuffPo article.

Some earlier thoughts of mine going to "data forensics."


Haven't read this. Don't know that I will, but it looks very interesting. The Amazon blurb:

In the fall of 2010, Abby Norman's strong dancer's body dropped forty pounds and gray hairs began to sprout from her temples. She was repeatedly hospitalized in excruciating pain, but the doctors insisted it was a urinary tract infection and sent her home with antibiotics. Unable to get out of bed, much less attend class, Norman dropped out of college and embarked on what would become a years-long journey to discover what was wrong with her. It wasn't until she took matters into her own hands--securing a job in a hospital and educating herself over lunchtime reading in the medical library--that she found an accurate diagnosis of endometriosis.

In Ask Me About My Uterus, Norman describes what it was like to have her pain dismissed, to be told it was all in her head, only to be taken seriously when she was accompanied by a boyfriend who confirmed that her sexual performance was, indeed, compromised. Putting her own trials into a broader historical, sociocultural, and political context, Norman shows that women's bodies have long been the battleground of a never-ending war for power, control, medical knowledge, and truth. It's time to refute the belief that being a woman is a preexisting condition.
My late daughter Danielle was blown off and stonewalled by her new Primary (at Kaiser) for many months. Maybe she'd still be alive. Maybe not. I stew about it episodically.
More to come...

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