February 15th, 2010 by DrWes in Better Health Network, Health Policy, Opinion
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It’s an age-old problem, made more complicated by our new era of electronic medical records: optimizing collections in a time of unprecedented price pressures on our health care complex. With the economic downturn and declining government payments for services, everyone in health care is feeling the pinch.
It is no secret that work not billed will ultimately be work not paid. Hospitals and practice managers, adept at business principles, know this. Deep down inside, doctors know this, too. Historically, doctors dictated when they billed their patients, even if it meant waiting over a week to do so. If a doctor was to take a vacation, some of those billings could wait until his return.
Not so any longer. Read more »
*This blog post was originally published at Dr. Wes*
February 1st, 2010 by RyanDuBosar in Better Health Network, News
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Generation Y medical students are supposed to be the tech-savvy ones. As it turns out, they may be more familiar with Facebook than with the electronic health records they’ll likely use in their medical practice. (Modern Physician, free-registration required)
Educators at the University of Illinois at Chicago College of Medicine assessed nearly 190 fourth-year medical students on their use of EHRs during a mock encounter simulating a cancer patient hospitalized with complications from chemotherapy.
Students were scored on their ability to find information crucial to the patient’s case within the EHR and their ability to analyze the EHR without alienating the patient. While most couldn’t access the information, they did interact with the patients face-to-face and even explained when they looked away to the computer.
Following more research, the school may incorporate class work on using EHRs.
*This blog post was originally published at ACP Internist*
December 28th, 2009 by Edwin Leap, M.D. in Better Health Network, Health Policy, True Stories
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We have a new EMR system. I like it because I type well. I’m facile at using a keyboard and touch-screen. Not everyone in my group is so blessed, and we’ve had some difficulties using the voice-transcription software. Nevertheless, my gut tells me that in a month or two more, we’ll be getting along with our new system swimmingly. It’s the sort of thing I have wanted for a while, since I truly hate to dictate; and especially hated dictating the information the nurses had already entered into the computer!
However, I have an issue. Not so much with our EMR, but with all EMRs. I have an issue with the deeply-held delusion that computerization will automatically improve charting and patient care.
Some time ago, the inimitable, world famous blogger Dr. Wes (who can be found at http://drwes.blogspot.com/ ) told me that his facility’s conversion to EMR caused him to spend far more time at the computer than with the patient. And true to his great wisdom and insight, that’s where I find myself. It isn’t the location of the computers. We have portable ‘tough-books’ that can go to the bedside. Read more »
*This blog post was originally published at edwinleap.com*
December 9th, 2009 by KevinMD in Better Health Network, Health Policy, Opinion
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Have electronic medical records made a difference in patient care?
According to a study looking at digital medical record adoption of 3,000 hospitals, electronic records have made little difference in cost or quality of care.
That’s discouraging, considering that the government is investing billions of dollars into the technology.
Very few physicians use electronic record systems effectively. For instance, many are simply scanning paper records into a computer, which provides minimal benefit. It’s difficult to track quality improvement data doing that. The problem is further compounded by the archaic interfaces that the current generation of EMRs have, which is akin to a user interface circa Windows 95.
It’s no wonder that most doctors find electronic medical systems actually slows them down. The next generation of systems needs to focus on facilitating the doctor-patient encounter, rather than being an impediment. Taking a few lessons from Google, and improving the user interface would be a good start.
Only then can EMRs realize the potential relied upon by the government and health reformers.
*This blog post was originally published at KevinMD.com*
July 19th, 2009 by Nicholas Genes, M.D., Ph.D. in Better Health Network
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There’s a satisfying post on WhiteCoat where he rants against patient-reported allergies. A sample:
When I ask patients about their medical allergies, more often than not patients suffer from at least one. During a recent shift, I had 17 people who told me that they had medication allergies. When someone has an allergy, I always ask what the allergic reaction is. The responses I received included the following:
* Seven people had allergies to various medications (most often penicillin) because their parents told them they had a reaction as a child. They didn’t know what the reaction was, but they have never taken the medication since.
* Four people had nausea and vomiting with medications that typically cause nausea and vomiting as one of their side effects…
He’s right — a lot of people have unwarranted concerns about mild or entirely predictable reactions, and sometimes this can be frustrating on a busy shift. But I also like the commenter who wrote:
I’m not sure how you think the patient is supposed to know which things actually require medical attention, especially when doctors and nurses refuse to give any guidelines over the phone. ‘Come on in, and if you’re aren’t seriously ill, then we can make fun of you on the blog tomorrow.’
Patient perceptions of allergies is a subset of a larger issue facing all of emergency medicine — patient perception of disease. We don’t expect patients to triage themselves, or figure out which symptoms are worrisome and which are benign. That’s our job. I try to look at proper allergy reporting as another opportunity for patient education (my favorite is explaining why someone can’t be allergic to the iodine atom).
More importantly, from the informatics perspective, allergy reporting is a big frustration as well (and one we can actually do something about, ourselves). Patient-reported allergies find their way into every EMR, and trigger the most inane alerts and stops, forever. If a patient reported vomiting once after codeine, every subsequent doctor who sees this patient will have to jump through electronic alert hoops just to order IV morphine. It doesn’t matter if the patient is taking oxycontin and wears three fentanyl patches. The same goes for antibiotics — I think most lay folks would be surprised that we have to wrestle, years later, with the inherited family warning of about penicillin reactions, even when ordering a 4th-generation cephalosporin with essentially no cross-reactivity…
There’s no intelligence built into the system, yet, I think because everyone’s afraid that if a patient has a bad outcome because that 14th medication alert was eliminated, they’d be liable. This line of thinking ignores the notion that bad outcomes are probably happening because there are so many useless alerts, they all tend to be ignored.
Someone told me recently (perhaps it was Dr. Reider?) that non-clinical folks involved in setting up electronic health information exchanges thought that communicated allergies to new providers would be the top priority, and were surprised when physicians considered allergies to be less important than, say, recent EKG’s, imaging, current med lists, and the like.
I wonder if this attitude toward allergy records is because we don’t think most allergies are that serious, because we can most often treat whatever arises… or because we’re overcome with alert fatigue.
Whatever the reason, there’s no doubt in my mind that if we had an intelligent, efficient system to process patient-generated allergy reports, we’d be less frustrated with this information, and more sympathetic to the patient’s concerns.
*This blog post was originally published at Blogborygmi*
It’s an age-old problem, made more complicated by our new era of electronic medical records: optimizing collections in a time of unprecedented price pressures on our health care complex. With the economic downturn and declining government payments for services, everyone in health care is feeling the pinch.
