If EHRs were perfect, there wouldn’t be so many companies developing communication workarounds. And why does a HIT consultant play Blame The Doctor?
Practice Unite, an early-stage company fresh out of Newark (cross the Hudson, head south) that knits together patient and clinician communications in highly customized app platforms for healthcare organizations [TTA 11 Mar], has put together a thought-provoking and fully attributed list of 30 ways mHealth is impacting healthcare: the value for patients and clinicians, the need for mHealth apps as part of collaborative care platforms and communication, plus the investment trail towards digital health. Hat tip to @PracticeUnite via Twitter.
One notable point is the difficulty current systems have in integrating data and the increased administrative load (+10 percent more) physicians experience with EHRs versus paper patient records. Confirming this are two items in Thursday’s POLITICO Morning eHealth: one, the privately-driven workaround for universal health data interoperability that the CommonWell Health Alliance is seeking as a non-profit trade alliance. and two, what happened when the GE Centricity EHR used by MedStar Health group’s DC and Baltimore-area outpatient clinics crashed after a weekend upgrade and stayed down through Tuesday night. Weekend data was lost. One doctor’s reaction:
“They kept saying it would be back up in an hour, but when I left work Tuesday night it was still down.” This doctor told us that the outage was “disruptive and liberating at the same time. I wrote prescriptions on a pad for two days instead of clicking 13 times to send an e-script. And I got to talk to my patients much more than I usually do. But of course we didn’t have access to any notes or medication history, and that was problematic.”
Now this observation is neither petty nor isolated. Last Fall we noted a JAMA study of internal medicine physicians finding that for both experienced physicians and trainees, there was a loss of time across the board in taking notes, reviewing patient data and at least one data management function was s-l-o-w-e-r. [TTA 12 Sept 14] Houston, we have a problem.
Yet there are still the ‘nothing to see here, move along’ types sailing down A River in Egypt. Others blame the victims, as in the doctors, for their cloddish unwillingness to Get With The HIT Program.
An extreme example of that attitude is contained in an article in CIO (and picked up at Becker’s Hospital Review). Concerns about EHRs and patient care “… are bogus objections that continue to be raised by a community [physicians] that clings to its past entitlements and easy money attached to little or no accountability.” The ‘pro’ arguments marshaled from Rand and the author, to this Editor, are tired cheerleading with tatty pom-poms dating from the rosy days of 2008 and how Meaningful Use would achieve the Triple Aim. In nothing flat.
Instead of addressing the problems, the author closes with:
At the end of the day, the biggest benefits of technology will accrue from our ability to integrate patient medical information from EHR systems, and analyze them in conjunction with data that is going to be available through wearable devices and other consumer health technologies. If some parts of our physician community do not get this, we need to leave them behind and move on. [Editor emphasis]
A closing absurd on the face of it, on every point. Let’s start with the doctors.
Doctors and health systems have been using EHRs for quite a while. There are problems, not just complaints. The Joint Commission issued a Sentinel Event Alert on 30 March (below) on adverse events related to EHRs. That isn’t beanbag. Ask Texas Health Presbyterian Hospital in Dallas about how an Ebola patient was misdiagnosed last summer due to bad EHR workflows, setting off a panic and spreading infection. Ask specialists, especially psychiatrists and mental health professionals, who struggle with the structured data setup of current EHRs that don’t fit patient records that for quality of care require extensive progress notes. And as we have noted, many companies like Practice Unite, Zynx Health and CommonWell, as noted above, are seeking functional workarounds to what EHRs aren’t doing now in communication and health data exchange.
And about integrating the tsunami of health and fitness device data into EHRs? Say wot? When EHRs can’t deal with current data, workflows and communications far higher up the hierarchy of acute care necessity? Is that data even necessary or desirable except as compiled or summary, and shouldn’t this be at the patient’s option?
Consider that the author of the original CIO article is an independent consultant in technology, outsourcing and management consulting for… healthcare enterprises. Is this self-serving? The reader must judge, and many have from comments. If so, this kind of article from an ‘expert’ does nothing to bridge the gap or solve the problem productively, or help physicians ‘heal thyselves’, but serves only to exacerbate resentment of EHR designers by EHR users.
Previously in TTA: EHRs: now safety, info exchange concerns (US, AU, CA) references the Joint Commission’s Sentinel Event Alert on EHR-related adverse events. Not just those balky American docs, but Australian and Canadian too.
Editor’s Note 15 April: A comment on Becker’s led me to investigate the claim–from the hospital–of flawed EHR workflows around travel history leading to the Ebola misdiagnosis. Texas Health subsequently withdrew it, stating that the physician did not read the nurse notes on the patient’s travel which were available in the Epic system. However, the Sentinel Alert has more examples and one wonders why the notes weren’t read. ModernHealthcare