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.
An excellent blog post was forwarded to me for comment – an Internal Medicine physician reflects on his patients’ common underlying condition: isolationism.
Today I saw patients with the following problems:
- A person who had attempted suicide over the weekend
- A person who was possibly acutely suicidal and was abusing narcotics I was prescribing
- A person who is in an abusive relationship and has a severe eating disorder
- A terribly depressed woman in a dysfunctional marriage
- A pre-teen child whose father had suddenly died
My observation from today is that most of these people are isolated. They have difficult situations to face and the people who normally surround them are somewhat uncomfortable, not knowing what to say…
Western culture is obsessed with avoiding suffering. We entertain ourselves to avoid having to face the harsh realities of life. People die and suffer daily, and we are obsessed with the latest TV show, the latest political soapbox, or the latest self-help tool. We feel that the goal of society is to create happy and secure individuals. This is not true. The goal of society is to function as a unit in a healthy way – with the weak parts supported by the strong ones…
What I emphasized to the people I spoke with today was the need to find people who had gone through the same things. Those in the eye of the storm need to hear from people who have gotten to the other side that it is OK to feel the way they feel. Those who have gone through hard times have something huge to offer those who are going through them now – experience. You lose the pat answers when you have suffered yourself.
It is my hope that those who are struggling will find others online here at Revolution Health who can support them, and that those who have made it through to the other side will reach out to help others through our online community. Suffering is not meaningless if you harness it for good – your wounds can heal others.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
Microbiologist Charles Gerba has made a career out of scaring people with news of how dirty seemingly innocent surfaces can be. Dr. Gerba has taken media on germ tours of kitchens, bathrooms, and offices, and now in his new research study he finds that office desks have 400x more bacterial colonies than toilet seats. Moreover, he found that women’s desks generally have 4x more bacteria than men’s. He attributes this to women having more makeup and food products in their desks, as well as having greater contact with small children.
Well, before we all become totally grossed out and paranoid, lets think for a minute about this. If there are so many bacteria all around us (even on our desks) and we’re generally not sick, then I guess we shouldn’t all rush out to buy bleach and sanitizers. Other studies suggest that sanitizers disrupt the natural ecosystem around us, creating resistant organisms that are harder to kill.
Personally, I think that precautions should be taken to reduce transmission of viruses and bacterial infections (especially in the hospital environment) but that it is unreasonable, and perhaps even harmful, to wage an indescriminate war on all bacteria everywhere.
If your loved ones are sick, minimize your exposure to their droplets, wash your hands frequently, and sanitize surfaces that they are in direct contact with. Otherwise, if you’re feeling well, I wouldn’t worry too much about bleaching your desk surface.
As one microbiology lab says,
“Support bacteria. It’s the only culture some people have.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
A new initiative funded by the health department resulted in the distribution of 150,000 free condoms to unsuspecting subway riders in NYC. The condoms were colorfully labeled with a subway themed wrapper, and handed out by city workers and volunteers in all 5 boroughs.
Condoms are critical for the prevention of sexually transmitted diseases, but I wonder if the candy wrapper marketing and non-selective distribution methods are contributing to an over-sexualization of society?
Now, I know a lot of you will think I’m being prudish, but I worry about children being over-exposed to sexual content all the time. What does it say to them that subway staff are handing them condoms? Is it just me, or does anyone else think this is a bit much?
Go ahead, let me know!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
Within the past few years the Centers for Medicare and Medicaid Services (CMS) chose to enforce a rule (casually known as the “75% rule”) that resulted in denial of services to many heart, lung, and cancer patients requiring rehabilitation therapies.
CMS was looking for a way to cut costs in rehabilitation facilities, and decided to create a rule whereby these facilities would lose their approval status if they admitted too many patients with certain conditions. The CMS arbitrarily decided that 75% of all patients admitted to inpatient rehabilitation facilities had to have one of 13 diagnoses, or else the rehab facility would not qualify for Medicare reimbursement. Many important diagnoses were not included in those 13, including cancer, heart and lung disease, and many types of orthopedic injuries.
What does this mean? It means that getting admitted to a rehabilitation facility is no longer based on need, but on diagnosis code. Because of the financial pressure exerted by CMS (Medicare is the primary payer for most facilities) these rehab centers cannot afford to be delisted. So they turn away patients in need, for patients who have the “right” diagnosis.
What has this rule done?
- Limited clinical decision making by doctors – a physician is no longer able to recommend patients for acute inpatient rehabilitation purely based on their need for it.
- Decreased choice for consumers – people recovering from heart attacks, cancer or COPD (to name a few) will generally not be offered the opportunity to be rehabilitated in an acute, inpatient setting.
- Reduced quality of care – rehabilitation facilities specializing in oncology or cardiopulmonary rehab will need to divest themselves of aggregated expertise. Since these centers would no longer qualify for Medicare funding, they can’t afford to remain centers of excellence in these fields of medicine. Instead, they will need to turn their attention to the 13 diagnoses that qualify for inpatient rehabilitation.
- Puts lives in danger – patients who are not admitted to acute rehab will be forced to recover in nursing homes (also known as “sub acute facilities”) that do not have the level of expertise to take care of them safely.
The 75% rule is one example of the kinds of decisions that a government sponsored universal healthcare system will make. When one payer (government or non-government) develops a monopoly, their decisions can single-handedly limit consumer choice, prevent physicians from exercising clinical judgment, and decrease quality and safety of care. What will Americans say when the decision to fund organ transplants for people over 65, for example, is denied across the board?
When medicine is no longer applied in a personalized (case by case) manner, and population-wide rules are in effect, we will face ethical dilemmas far surpassing those we already have. A system that serves the needs of many still fails the needs of some – and when we lose the flexibility to “bend the rules” for the exceptions we will lose the best of what American medicine has to offer.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.