4 ms·

Let's not conflate the theoretical (and very achievable) advantages, with the shit being peddled to date. The current state of available systems is really abysm

Let's not conflate the theoretical (and very achievable) advantages, with the shit being peddled to date. The current state of available systems is really abysmal, and I'm sure it's true that using any of most of the systems on the market won't save you money. "Fundamentally there is not as much value to be obtained by having the ability to do a structured query into multiple patients’ data. Nor is there much value in being able to do a structured query into a single patient’s data." I supremely disagree with this point, especially the first bit. Specifically, the author is comparing the labor of him looking for information he's thought to look for in one or more patient's records via computer or paper, and finding them similar. That's the sign of a completely failed system. Most EMR systems are built to act like the file cabinets they replace, which is a shame. Meanwhile, my mint.com account sends me emails when I'm charged an ATM fee and facebook knows way too much about my current interest in purchasing a juicer. I believe the unrealized benefits of automated predictive, proactive, and historical analysis of patient health data is enormous. The author is excused for disagreeing with me though, because presumably billions of dollars at this point have been poured into building software that rivals late nineties Visual Basic POS systems in quality and effectiveness. There's so much untapped potential here it's unreal. It's just such a shame that the Health IT industry has eroded the patience of caregivers over the last decade, especially ones who were eager to explore the possibilities early on. [Full disclosure: I build electronic medical record systems for a living - http://www.quora.com/What-product-is-ElationEMR-building http://www.quora.com/What-product-is-ElationEMR-building]

shawn-butler 14y ago
I have also built EMR systems. They do not achieve much over paper to be honest. Where they do make a difference is at the point of care. Scanning patient, nurse, and medications prior to delivery for example removes errors. But in terms of cost savings it really isn't that significant. Patient satisfaction is not really the issue being addressed here. Cost of delivery and efficient use of limited resources is.
mcphilip 14y ago
I worked on a browser based full fledged EMR (i.e. Charting, Billing, Scheduling, etc). Besides being an enormously complicated software system in general, there were many factors related to consumers' usability of the product in a real time interaction with patients. For instance, we built IMHO beautiful note taking app where doctors could free text in notes taken from patient consultation. The beauty of the system is it had a large natural language parsing backend that would help highlight parts of the notes that could be codified in a system such as ICD9 or SNOMED. There was even a rich templatimg system allowing doctors to pull up a note template for something like chest pain and then the system would prompt the doctor to fill in the relevant codifiable sections. It demoed great to physicians interested in an EMR, but in practice, doctors did not like the extra effort required to record a real time interaction in a codifiable way. I'm not sure what's to blame: EMR usability or hospital staff's lack of time and training to document patient care in a standardized format. Like Google said, Health care is hard...
- dazzawazza 14y ago
  I know a few doctors in the UK and they don't understand two things: - they are a reasonably efficient expert system - large scale data mining can find patterns of behaviour and disease that are impossible to find any other way. Point one can partly be explained by the fact that as a society we rightly respect doctors and as humans over the years they take it to heart that they really are quite special. They also rightly diagnose hundreds of common illnesses a week which boosts their ego. Point two is a common problem for people outside of the tech world. Doctors are used to small studies growing to large studies about a specific illness. They do use meta studies and use large scale statistics to medicate (everyone over 60 gets cholesterol medication etc) but that is the exception. They don't understand that an abstract statistical analysis of patient records could deliver gold. So when asked to codify patients notes (something they have to do in the NHS using a ridiculous DOS based app, with over the top word templates for paper forms) they resent it. They don't feel the advantage of this. When the system controls their flow they feel like they are robots and that this gets in the way of their treatment of the patient. It pains me to have to explain to them that they are, for the vast majority of patient interactions, meat robots. For 99% of their interactions they are slower and less accurate than an expert system (although of course the doctors I know have a more pleasing interface than a robot). They can't see that if the burden of the 99% was lifted they could genuinely help their patients by having more time. Instead they insist awareness campaigns are the way to go: "If less people came in to the surgery with a cold we could DOUBLE the time they spent with patients"

shawn-butler 14y ago

I have also built EMR systems. They do not achieve much over paper to be honest. Where they do make a difference is at the point of care. Scanning patient, nurse, and medications prior to delivery for example removes errors. But in terms of cost savings it really isn't that significant. Patient satisfaction is not really the issue being addressed here. Cost of delivery and efficient use of limited resources is.

mcphilip 14y ago

I worked on a browser based full fledged EMR (i.e. Charting, Billing, Scheduling, etc). Besides being an enormously complicated software system in general, there were many factors related to consumers' usability of the product in a real time interaction with patients. For instance, we built IMHO beautiful note taking app where doctors could free text in notes taken from patient consultation. The beauty of the system is it had a large natural language parsing backend that would help highlight parts of the notes that could be codified in a system such as ICD9 or SNOMED. There was even a rich templatimg system allowing doctors to pull up a note template for something like chest pain and then the system would prompt the doctor to fill in the relevant codifiable sections. It demoed great to physicians interested in an EMR, but in practice, doctors did not like the extra effort required to record a real time interaction in a codifiable way. I'm not sure what's to blame: EMR usability or hospital staff's lack of time and training to document patient care in a standardized format. Like Google said, Health care is hard...

dazzawazza 14y ago
I know a few doctors in the UK and they don't understand two things: - they are a reasonably efficient expert system - large scale data mining can find patterns of behaviour and disease that are impossible to find any other way. Point one can partly be explained by the fact that as a society we rightly respect doctors and as humans over the years they take it to heart that they really are quite special. They also rightly diagnose hundreds of common illnesses a week which boosts their ego. Point two is a common problem for people outside of the tech world. Doctors are used to small studies growing to large studies about a specific illness. They do use meta studies and use large scale statistics to medicate (everyone over 60 gets cholesterol medication etc) but that is the exception. They don't understand that an abstract statistical analysis of patient records could deliver gold. So when asked to codify patients notes (something they have to do in the NHS using a ridiculous DOS based app, with over the top word templates for paper forms) they resent it. They don't feel the advantage of this. When the system controls their flow they feel like they are robots and that this gets in the way of their treatment of the patient. It pains me to have to explain to them that they are, for the vast majority of patient interactions, meat robots. For 99% of their interactions they are slower and less accurate than an expert system (although of course the doctors I know have a more pleasing interface than a robot). They can't see that if the burden of the 99% was lifted they could genuinely help their patients by having more time. Instead they insist awareness campaigns are the way to go: "If less people came in to the surgery with a cold we could DOUBLE the time they spent with patients"