4 ms·

(disclaimer: I used to work on EHRs, hence the name...) This article is melodramatic and terrible, and I feel sorry for anyone who gets their opinion on EHRs f

(disclaimer: I used to work on EHRs, hence the name...) This article is melodramatic and terrible, and I feel sorry for anyone who gets their opinion on EHRs from it. It reads like some kind of expose, like it's uncovering some disturbing truths and showing the reader that our system is totally broken, or something. Not true at all, it's just that some people have bad experiences that get sensationalized and put into an attention-grabbing news piece. And then people read it and only hear about the bad stuff. As someone who's worked in EHRs, I can tell you we're a lot better off with EHRs than ever before (particularly compared to hospitals that used to put everything on paper, in a freaking file cabinet...) and we're just improving with time. Granted, bad EHR software does exist out there, but as a whole we make patient care significantly better. I put some real examples below. I think we have tons of anecdotal evidence pointing to the positive impact of EHRs, but I'll admit we don't have many statistics either (good or bad). I think you basically have to work in the EHR/healthcare space to see the positive impacts for yourself, but I hope this post helps people see the good things we do, too. + Catching medication administration and other procedural errors that would lead to patient harm and death + Allowing patient info to be accessible at other hospitals, when it's needed to adequately care for a patient (real example that has happened countless times: patient comes into the ER unconscious, but has a nametag; nurse uses it to look up the pt in the system, but he's never been to that hospital before. No problem; nurse requests his record from the hospital he has been to, and gets his whole history, allergies, etc so they can better determine a cause and what treatment is OK for the patient) + Allowing anonymized patient data to be used for population health and other research; a doctor used this to catch the Flint, MI water crisis + Nurses/docs can just look up patient info in one system instead of searching through an ever-growing file cabinet, or having to go get their paper record from another department, etc. It's just all in one place. Hospital admins can more easily run anonymized reports/statistics on their patients, departments, etc. to see how everything's going. + EHRs are able to suggest tests or screens for the patient depending on their symptoms and their whole medical history (which, again, is all in one place). In some cases, this is just a nice reminder for the provider, but in other cases can indicate something deeper is going on with the patient that really needs to be tested. + Sending prescriptions to pharmacies is often automatic instead of needing a call, which essentially removes another point of failure. Sending information about specimens, like blood tests or scans, can also be automatic depending on the EHR. + Patients may have a patient portal with the EHR that gives them a view of their past history/visits and provides an easy way to request prescription refills, schedule appointments (no call required!), and receive test results.

caycep 8y ago
Counterpoints > >+ Catching medication administration and other procedural >errors that would lead to patient harm and death Depends on the end user. EMR medication checking is only as good as the tech who put the bar codes on the bags. I've seen a number of med errors b/c nursing blithely scanned "correct" barcodes on wrong meds. Other meds are routinely ordered wrongly or the errors are so useless the ordering MD/RN just clicks through them to dismiss. The best hedge against med errors are hiring dedicated pharmacists per floor double-checking the orders. > + Allowing patient info to be accessible at other hospitals, when it's needed to adequately care for a patient (...) This never happens. EMRS are not routinely interoperable with each other. Especially EPIC who prides itself on lock in and exclusivity. We always get records printed out and faxed. >+ Allowing anonymized patient data to be used for population health and other research; a doctor used this to catch the Flint, MI water crisis Maybe if you're the head honcho w/ top level access and a bunch of EPIC minions to do this for you. For the average med student/resident/grad student....eh. Did you ever try and get broad clinical data out of EPIC or Cerner or anything else? It takes a huge amount of technical head scratching the way everything is implemented. Most pilot projects w/ academic centers still have a fellow or resident click through each record and gather data manually for their research. Otherwise a huge committee is required to wave their arms to...download data from a MUMPS database. + Nurses/docs can just look up patient info in one system instead of searching through an ever-growing file cabinet, or having to go get their paper record from another department, etc. It's just all in one place. Hospital admins can more easily run anonymized reports/statistics on their patients, departments, etc. to see how everything's going. It's one system but the data is hidden away in a thousand clicks. There have been attempts to make "dashboard/portal" interfaces in EPIC but I suspect the API's and toolkits are not really there...no self respecting MD trusts those. + EHRs are able to suggest tests or screens for the patient depending on their symptoms and their whole medical history (which, again, is all in one place). In some cases, this is just a nice reminder for the provider, but in other cases can indicate something deeper is going on with the patient that really needs to be tested. Again - depends on the implementation. Maybe in the ideal world, but most of the errors and suggestions that pop up are considered nuisances and not correct. + Sending prescriptions to pharmacies is often automatic instead of needing a call, which essentially removes another point of failure. Sending information about specimens, like blood tests or scans, can also be automatic depending on the EHR. For e-scribe, this is gradually getting better - we still have to sometimes resort to fax or phone scripts for a lot of this. For lab tests - it's still an issue, we never reliably get "e-results" that automagically pop into our EHR. It's still fax. A lot of it may rest of implementations of lab providers (Quest, LabCorp, etc) but whatever the reason, this still sucks. + Patients may have a patient portal with the EHR that gives them a view of their past history/visits and provides an easy way to request prescription refills, schedule appointments (no call required!), and receive test results. We paid our megacorp EHR for this feature but it's "down" most of the time. Other companies may have better uptime. AT least for test results and records. YMMV also for scheduling...calls are still pretty much required in that we have to screen insurances for patients who are actually allowed to see us, rather than have them show up at appointment time and get denied by their HMO.

caycep 8y ago

Counterpoints > >+ Catching medication administration and other procedural >errors that would lead to patient harm and death Depends on the end user. EMR medication checking is only as good as the tech who put the bar codes on the bags. I've seen a number of med errors b/c nursing blithely scanned "correct" barcodes on wrong meds. Other meds are routinely ordered wrongly or the errors are so useless the ordering MD/RN just clicks through them to dismiss. The best hedge against med errors are hiring dedicated pharmacists per floor double-checking the orders. > + Allowing patient info to be accessible at other hospitals, when it's needed to adequately care for a patient (...) This never happens. EMRS are not routinely interoperable with each other. Especially EPIC who prides itself on lock in and exclusivity. We always get records printed out and faxed. >+ Allowing anonymized patient data to be used for population health and other research; a doctor used this to catch the Flint, MI water crisis Maybe if you're the head honcho w/ top level access and a bunch of EPIC minions to do this for you. For the average med student/resident/grad student....eh. Did you ever try and get broad clinical data out of EPIC or Cerner or anything else? It takes a huge amount of technical head scratching the way everything is implemented. Most pilot projects w/ academic centers still have a fellow or resident click through each record and gather data manually for their research. Otherwise a huge committee is required to wave their arms to...download data from a MUMPS database. + Nurses/docs can just look up patient info in one system instead of searching through an ever-growing file cabinet, or having to go get their paper record from another department, etc. It's just all in one place. Hospital admins can more easily run anonymized reports/statistics on their patients, departments, etc. to see how everything's going. It's one system but the data is hidden away in a thousand clicks. There have been attempts to make "dashboard/portal" interfaces in EPIC but I suspect the API's and toolkits are not really there...no self respecting MD trusts those. + EHRs are able to suggest tests or screens for the patient depending on their symptoms and their whole medical history (which, again, is all in one place). In some cases, this is just a nice reminder for the provider, but in other cases can indicate something deeper is going on with the patient that really needs to be tested. Again - depends on the implementation. Maybe in the ideal world, but most of the errors and suggestions that pop up are considered nuisances and not correct. + Sending prescriptions to pharmacies is often automatic instead of needing a call, which essentially removes another point of failure. Sending information about specimens, like blood tests or scans, can also be automatic depending on the EHR. For e-scribe, this is gradually getting better - we still have to sometimes resort to fax or phone scripts for a lot of this. For lab tests - it's still an issue, we never reliably get "e-results" that automagically pop into our EHR. It's still fax. A lot of it may rest of implementations of lab providers (Quest, LabCorp, etc) but whatever the reason, this still sucks. + Patients may have a patient portal with the EHR that gives them a view of their past history/visits and provides an easy way to request prescription refills, schedule appointments (no call required!), and receive test results. We paid our megacorp EHR for this feature but it's "down" most of the time. Other companies may have better uptime. AT least for test results and records. YMMV also for scheduling...calls are still pretty much required in that we have to screen insurances for patients who are actually allowed to see us, rather than have them show up at appointment time and get denied by their HMO.