In a happy coincidence, my favorite blog fodder feeder sent me a link to an article about Kaiser Permanente’s electronic medical record woes a day prior to Dr. Feld’s latest post on the subject of EMRs. Dr. Feld’s thoughts on the matter will certainly help to round out this discussion.
I’ve always been fascinated by technologies that are ahead of the curve. I blame this on my parents (take note – parents can be blamed for good things). Growing up in rural Canada our family was ahead of the tech curve – we had a satellite dish before there was scrambling, we had the very first Apple computers at home, and we built our own yogurt factory complete with an advanced digitally automated temperature gauge system, before the rest of the industry had moved beyond millimeters of mercury.
In college I was the first kid with a laptop in class, and in med school I was one of the first with a PDA. I took a portable printer with me to Europe in the late 80’s to go along with my Wordstar word processing program. I thought I was pretty cool, I guess! Stirrup pants, granny boots, permed hair and pink lip gloss. Those were the days.
Cliff Bassett recently asked me why I was working at a new company (Revolution Health) that was so cutting edge rather than remaining in clinical practice. I had never thought about why I did it before – but now I see that it was part of my pioneering pattern. There’s nothing more fun than being ahead of the curve… but it can be aggravating as well.
Technologies are awkward for their first adopters – they aren’t streamlined, they can actually take more time rather than saving it, and they can make communications with others (who don’t use it yet) more difficult. But a few of us do it anyway – we jump in head first, believing by faith that the enterprise itself is worthwhile and that once we get to version 3.0 we’ll be sitting pretty.
But what do we do when we’re at version 1.0? Normally, we just tear our hair out and send lots of “bug alert” messages to developers. But when the technology affects someone’s health, the bugs are a lot more sinister. The recent article about Kaiser Permanente’s digital growing pains is disturbing indeed:
Kaiser Permanente’s $4-billion effort to computerize the medical records of its 8.6 million members has encountered repeated technical problems, leading to potentially dangerous incidents such as patients listed in the wrong beds, according to Kaiser documents and current and former employees… Other problems have included malfunctioning bedside scanners meant to ensure that patients receive the correct medication, according to Kaiser staff.
Still, 90% of physicians use paper records, making it difficult to share information – and this is no doubt contributing to the IOM’s estimated 98,000 error related deaths/year. Dr. Feld explains the complexity of a fully functional electronic medical record:
However, a paperless chart is in reality worth little unless the information entered is usable in a relational data base format rather than word processing format. Only then, can patient care be enhanced…An effective Electronic Health Record must consist of five components
Electronic Medical Records
Personal health records (PHR)
Continuity of Care Record (CCR)
Electronic health record (EHR)
Financial Management Record (read more…)
So, the bottom line is that the EMR is in version 1.0 at Kaiser Permanente, and only a twinkle in our government’s eye. It is complicated to create, nearly impossible to coordinate, dangerous if implemented half-way, and yet utterly necessary for ultimate cost savings and patient safety.
What can we do between version 1.0 and 3.0? Prayer and vigilance come to mind… it will be up to the foot soldiers (the docs, nurses, and hospital staff) to keep patients safe while juggling paper and digital until digital can fly on its own.
How do you think we can minimize our digital growing pains?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.