Do Electronic Health Records REDUCE Patient Care? - Comments Page 1

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All Comments on: "Do Electronic Health Records REDUCE Patient Care?"

Comment Page: 1 |  2 

Posted by:

pdsterling
29 Jun 2018

fwiw, my PCP has a girl take notes and only minimally interacts with his tablet. same with the ophthalmologist.

Posted by:

Lester Noyes
29 Jun 2018

Doctors could dictate into something and someone else [or an app?] could transcribe. You could download your record from a website. (Of course, that would make it harder for doctors to note, "This person is a flaming hypochondriac...")

Posted by:

H M White
29 Jun 2018

No time to examine and treat the patient? No doubt true. But time is the least of it. I get a feeling that there is just a total decline in patient treatment. There is just a general attitude of "who cares?" Their training is different now. The whole goal is efficiency in running a medical system.

I recently had a doctor who refused to put his patients' records in a computer system because he does not consider that the internet is safe. I agree, plus being able to see earlier reports from former doctors who may or may not have done a good job influences the current doctor. And, yes, most seem more interested in reading the former reports than in listening to the patient.

Anyway, that doctor who refused to do computer records had plenty of time to look at his patients, ask questions and explains possibilities. He was not limited to 15 minutes.

h m white

Posted by:

John at Maple Knoll
29 Jun 2018

Yes, it's time consuming. Teachers have to do it also; record keeping severely limits the time teachers can devote to actual teaching. However...consider scientists. When they do experiments, they take notes, both on the way they are proceeding and the observed results. That also takes a lot of time, and it's been going on for centuries. If we want to have accurate information available for future use about an experiment, a child's behavior, or a medical exam, we need to WRITE IT DOWN somehow.

Posted by:

Bart
29 Jun 2018

I have practiced medicine for 34 years. No EHR for me. I'm not burned out. Written charts can't be hacked and when my pen "goes down" I just take out another one. Medicare penalizes me for not giving all the data they want, but it's worth it to preserve my productivity and my sanity.

Posted by:

Art Sulenski
29 Jun 2018

Doctors must either write down what they observed or type it into a tablet/laptop, it actually would take less time to type it out. What they don’t like is the records can be accessed at anytime, anywhere. When I moved to Costa Rica my whole medical history was put on a CD to bring with me as a retired person. Doctors don’t want patients to have that kind of access to records. The huge paper file isn’t readily available to give to the patient so they pass it off whereas making a CD can be done in minutes. They don’t necessarily want other doctors seeing what was done to or given to a patient as they may have not given the correct or the best to that patient.

Posted by:

Will
29 Jun 2018

My dermatologist has an assistant entering data and 100% of my Dr's time is spent with me.

Posted by:

Will
29 Jun 2018

My primary care Dr spends time at the keyboard. I receive a printout of the visit data when leaving. At one visit I found two errors in the data caused by the listening skills of the Dr. For the skeptical, I was clear and explicit in my sharing with the Dr. I challenged this and had conversation with a manager who said he would work on a method for adding patient comments. That hasn't happened yet. I changed to another Dr in the office. It makes me question what has been entered on record in the past. As far as I know, the errors are still on record.

Posted by:

David Hakala
29 Jun 2018

Will, you have a payday coming! HIPPA requires health care providers to give patients the means to put their criticisms into their records. Should be worth about $500 for ya.

Posted by:

BobD
29 Jun 2018

Re: "...EHR systems tend to be designed by computer programmers who do not have to work with patients."

This is a generic problem. Cars are designed by people who don't repair them. Laws are made by people who ignore them. Wars are started by people who don't fight them.

Posted by:

BobD
29 Jun 2018

On my recent visit to my urologist, I met Pete, the doc's "scribe". Pete sat behind a curtain and typed on a laptop while I and the doc yabbered about medical stuff. I asked Pete a couple of times, "Pete, did you get that?" Much better than waiting silently while the doc typed into some programmer's application.

Posted by:

BobD
29 Jun 2018

We will solve this problem in the obvious way: with good old AI. The doc's laptop will listen, record, transcribe everything that's said, deploy info into a database, and upload to the national database. Voila! Now any urologist in the world can discover the size of my prostate without having to do a rectal exam. I can hardly wait.

Posted by:

Daniel Knorowski
29 Jun 2018

Embracing EHR may correlate to the PCP's age group. My PCP focuses on my health concerns no matter if he is "behind schedule" AND he updates the EHR very quickly and accurately.

Thankfully, this PCP's group IS INDEPENDENT and is NOT submerged into a huge corporate structure.

Posted by:

Steven A Horn
29 Jun 2018

Why not standardize the way data provided by new patients is input so that doctors can integrate this information with their observations? Making the process interactive would reduce the time doctors would have to spend on data gathering and management. There are issues involving integrity of the data (like who maintains the master record) which would have to be addressed but these are not in themselves insuperable.

Posted by:

tiranda
29 Jun 2018

" The doc's laptop will listen, record, transcribe everything that's said, deploy info into a database, and upload to the national database. Voila!"

Not for a while yet, though. Go to Youtube, pick a video, turn on closed captions and turn up the sound. Now compare the spoken word with the printed word. So often captioned words are just wrong, even make no sense in context, yet you can tell the AI picked a very close sound to the spoken words. Happens on videos with trained speakers too...this goal needs some more time...

Posted by:

Bob
29 Jun 2018

As a practicing physician for 30 years, I've been through paper only to complex EHR systems. Yes, I take a laptop in the room, yet make dedicated time to talk, eye contact, allowing questions etc. Using scribes may be a solution for some yet in primary care that's another salary and benefits to pay and we are not reimbursed enough to make that doable, unless you see 50 plus patients per day. I see 15 maximum per day. Not using EHR is appealing yet the penalties from insurance are getting bigger and bigger each year if you don't use one. Main thing to me is the user interface could be much more user friendly. As mentioned above, software is not made by those who actually have to use it.

Posted by:

Jkcook
29 Jun 2018

It’s much easier for doctors scribble or voice notes and have someone else transcribe what they’ve put down. Doctors were not trained to be fast typists and so when they have to spend time keyboarding instead of seeing patients, that takes time away from the patients. Until insurance companies are willing to pay for the transcription of the doctors notes, the patients lose. It’s all about money

Posted by:

Charley
29 Jun 2018

I use a large health provider (Sutter Health)that has multiple facilities. When I go to a specialist at a different facility, they have access to all my records. Also, I have online access to 15 years of my records (lab work, visit summaries, xrays, etc.). For me it is a great.

When I was seeing a specialist at Stanford, he would dictate into his cell phone and it would get automatically transcribed into the the EHR.

So it really depends on the particular EHR system. It also depends on how well the EHR is supported by the IT staff at the facility (small doctor offices have a harder time than large facilities). Also it makes a difference how well trained the doctors are on using it efficiently.

Posted by:

top squirrel
29 Jun 2018

The more efficient electronic records are, the less privacy we all have. You may be delighted any urologist anywhere can learn things about your prostate that only an exam can discover, but the down side is that any clerical employee of any medical office can too, and that is the death of your privacy. Private investigators slip somebody a c-note or two and get a complete copy of your medical records. Errors, vindictive statements and all.
HIPAA gives patients a right to get a complete copy of your records (not just the portion they put for you on line) and the right to propose amendments to correct the glaring errors that virtually all records include. Doctors never admit a mistake so they routinely deny amendments but HIPAA gives the patient the right to add a statement of disagreement to his chart. [Just Google US Code 45CFR164.526(a). ]When I do, the statement is the text of the rejected amendments. And if they try to bury it, tell them you will complain to the US civil rights commission, which oversees such things, and demand that your statement of disagreement enjoy equal prominence to the doctor's flawed Notes.
I insisted Notes for my chart be on paper. I get a copy of the Notes for each visit and I wait until they're ready. I want the doctor to know I'll be reading his stuff. And I file amendments (so be careful, and no inappropriate comments).
Doctors I know usually retire early, complaining medicine has been taken over by the business types who interfere with the proper practice of medicine. You can't really blame the doctors for this. I'd say the universality of insurance and the interference of government (Medicare and Medicaid, and much, much worse if single payer ever gets started) are responsible.

Posted by:

Phil
29 Jun 2018

Way before electronic health records came about and right to the present many doctors would use a recorder that would be transcribed into your record if, in fact, they didn't do it themselves.

I like the EHR's because the records are more complete for transfer to another physician. A doctor that won't use the system is doing his/her patients a disservice IMO.

Some doctors have an aid entering the notes right in the examination room.

Because of EHR we now have access to our records via patient portal although I will admit that in many cases the record isn't posted due to that being yet another task for the staff.

EHR's are here to stay and I like it.

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