Do Electronic Health Records REDUCE Patient Care? - Comments Page 2

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Posted by:

Jack
29 Jun 2018

Well, this is something that has bothered me for a long time! I have brought it to the attention of my primary doc--"Yes, doctor, I know you have to worship the beast first!"--but there nothing changes. To his credit, he does spend more than the average 5+ minutes you cite in your article and is an excellent physician. But both of us are bothered by the demands of "corporate" for his attention to his computer. Worse, he often has trouble finding the information he wants in the system. The exception (sometimes) seems to be lab results which are uploaded by his staff. I was an IT guy for more than 45 years. I say: Woe unto you IT geeks who do not understand patient needs comes first, not system IT performance!

Posted by:

Mike
30 Jun 2018

I like the fact that my VA Doctor and my Local Doctor can both see what is going on. I am down to only going every 5 months to the Va and once a year to local Dc. My VHA Doctor is great but since I live over 45 miles from the Clinic She wants me to keep a local Doctor for emergency's. At work we have health clinics and they also e-mail both Doctors blood work and physical condition.I have a password for my records so if I want I can see what is posted. If my life is on the line I want whom ever is trying to save me to know what has been going on.

Posted by:

j
30 Jun 2018

Where do I start?? I have an orthopedist who used to be great. Then his group was purchased by a larger group and the service is gone. He walked into the room the other day and thought I was a different patient. That was uncomfortable for both of us. Also, the electronic records had me down as a multiple drink/day drinker. I haven't had a drop in several years and never had several a day or even a month!! How many places is that information at now? My PCP organization charges me $250 "facility fee". When I asked what that was for, I was told it was for inputting my records in the electronic data base. I offered to do it for much less. I wasn't taken up on the offer. Do I think EHR is good? No. For many reasons of which just a very few are stated above.

Posted by:

MARK FOTHERINGHAM
30 Jun 2018

This article is clearly written with experience relating to the(north)American market - understandably considering the author's location (and experience)
In the U.K. where most patients are treated under the National Health Service (NHS) my experience of the introduction of EHR (from the patients perception) is mostly positive.
A medical consultation must surely result in some form of note taking be it long hand or voice recorded notes for later transcription and both are subject to errors causing problems for others requiring access to the information. Whilst EHRs may take a little longer to complete surely the advantages out weight the minor inconvenience.
With EHRs the practitioner's notes are available to the hospital specialist. MRI,x-ray or any other diagnostic information is quickly able to added to the patient's record and is accessible to any physicians at any establishment. Also as a patient I have the right to access my records and can see and review the record of consultations and be able to ask questions of those providing medical service.
Equally important is the systems ability to alert physicians to contra prescribing of drugs that may pose a health risk to patients.
Yes, there are risks, including the risk of unauthorized access to the information but that applies to virtually all other avenues of life these days.

Posted by:

MmeMoxie
30 Jun 2018

@Mark Fotheringham - Your experience isn't just in the UK, it is here in the USA, as well. I know exactly what you are talking about, because I have experienced most of the same things, you have.


EHR is a positive enhancement for doctors, as well as patients. I see many comments that complain about EHR but not one person has commented on the positive benefits from EHR.


I went to a Clinic for over 10 years and saw this clinic go from transcription to EHR. Your privacy is well protected, even if you don't want to believe that. At the Clinic, my records, as well as my husband's records were seen by every doctor that we went to within the Clinic. The BEST positive is that ALL medications were noted and each doctor seen knew what they were and what to add and NOT add. Meaning, contraindicated and do NOT mix such and such with so and so!!!


Now, that is a real positive in my book, especially when you take over 16 different prescriptions daily! This makes for better care by your doctors in the end. Is this spying??? Hell no, it is called good medicine and proper care of the patient.


There was another benefit with the Clinic we went to. . .When either of us was put in the hospital, all of the doctors on staff, could see our records and know what meds we were taking and prescribed. They also could get information about any conditions we had. This to me is vital when you are put in the hospitals.


Most hospitals today have Hospitalists who take care of you , as a patient. Now, please understand that the Hospitalists can see your records, but can NOT change any of them from your doctor's offices. However, Hospitalists can add to your records, so that your doctors, especially your PCP can read the progress notes daily.


After being a patient in a hospital where my EHR records could be seen by a Hospitalist, I know that my care was wonderful and awesome. Sorry, but all that has happened to me and my Hubby while hospital bound, has only enhanced our stay with proper care!


Both of us are seeing new doctors, since we have moved. NO, they are not a Clinic, but the doctors we are seeing are connected by the group of Hospitals that we can go to. The system is called the WellStar system. It does have a EHR program from ©Epic EHR System. For me, it is wonderful.

I can see my complete list of medications, my diagnosis of medical issues that I have and I try to go to doctors that are part of the ©Epic EHR System, so that the new doctors know what is necessary about me or my Hubby. Both of us have definite medical issues that must be addressed at the first visit. Then after that first visit, it is a simple matter of quickly updating what has happened to you, your tests and results.


My and my Hubby's data is NOT going for "data sharing" that we have read so much about. The sharing is only within the perimeters of those who need to know, period and nothing more.


I have worked in Acute Hospitals and a Doctor's Office, plus I have been a hospital patient multiple times. I will stand by EHR and all of the benefits it provides, when you, as a patient, know how to use the system. First of all, you need to have a computer, so you can benefit from all of it's positivity and workability.


Bottom line, I see no difference in the time spent by my PCP or Specialists with me or how much they listen to me. I have had the issue of a doctor NOT listening to me and trust me, I quickly fire them! I don't mind the short time that has been granted by the Office Manager to visit with my PCP. We get a lot done and if more time is needed the doctor takes it. That is they way it should be
.

I suggest that everyone needs to get personal with their PCP, especially, since that is who you will see the most. Trust your PCP to recommend the best Specialists for you, when needed. If, you know of an excellent Specialist, especially one that uses the same EHR system, suggest them yourself. This is called having good medical care. You do have a right to make suggestions on your own, when it applies.

It is also easier to get your prescriptions to the pharmacy that you use with EHR. Most of the EHR programs have some sort of electronic prescription system that can easily be sent to your pharmacy, so that when you go to get your prescription, it should be ready or almost ready.


Bottom line, EHR is more of a benefit, than a problem, in my book and I have been dealing with EHRs for over 10 years now and embrace the whole idea and system.

Posted by:

Don
01 Jul 2018

My doctors are superb. In the past 15 years, only one doctor has entered data during my interview/examination, and she had the computer out to examine my current x-rays. Several doctors have a nurse-practitioner/assistant to take down observations and comments, or to upload photos of my skin into the record. The doctors focus on me.

But user interfaces are often horrendous. My mother's PT can't enter a repeating appointment (Monday and Thursday at 2 PM for a month); they have to enter every one individually, even though my smart phone can do it in a trice. Choosing from lists of conditions may produce easily searchable categories, but they are slow to use, and typically miss subtleties so that they end up being at least somewhat inappropriate.

Yet interoperability is the big hassle. I haven't looked into it yet, but there's where the biggest benefits lie. One list of medications, not 3 or 4 or 5, some of which have not been updated recently, and some with typos or misspelling of drugs. We keep signing releases to allow our data to be shred, but it seems like it never is, because even different departments in the same organization can't access others' data. I can only speculate that vendors of the software don't want data shared outside their systems, because it will lose sales - or else they are too busy adding new features to advertise to put in features which are needed.

What's required is for the federal government to establish an XML standard for sharing information between health systems, like the WWW consortium - and require every manufacturer to comply with it, providing means to import, export, and validate data on demand.

Posted by:

top squirrel
02 Jul 2018

Mme Moxie's post gives good examples of the good things electronic records can bring about. Unfortunately, it shows ignorance of the other side.
(1) HIPAA allows disclosure of your records "for treatment" to anyone with credentials (or even just working in a medical office), WITHOUT leaving an audit trail if it's alleged to be "for treatment." They don't check to see if the requester really is treating you. Your consent is never requested nor are you ever notified nor is there any indication in the chart that such a disclosure has been made. In other words, if your privacy has been violated six ways from Sunday you'd never be able to find out. And you can't tell if it's happened already.

(2) Misdiagnoses and vindictive comments will thus be easily spread and will follow you forever.
And they will refuse to correct them even when you show that the misdiagnoses were not evidence-based. They diagnosed me with hypertension and diabetes despite the fact there is no BP reading out of the normal range (and plenty within it) and there has never been an A1c anything but normal(never higher than 6.4, last one 5.3). But present providers pick up on and carry forward misdiagnoses, calling a normal one "in remission" and ordering tests forevermore to "make sure of that," meanwhile, who do you think pays the cost, and the uprated premiums for medical insurance once there has been a diagnosis (and it doesn't matter if it is wrong or not -- they just ask "have you ever...").
Of course if you refuse the tests and challenge the false diagnoses, by this point the relationship between you and the provider is ruined. I tried to put a "do not share nohow" on my records and they just laughed at me. Were we into paper records diagnoses and incompetent practitioners could safely be put behind you and you wouldn't have to drag around obsolete or incorrect stuff the rest of your life. Thank you, electronic records.

I therefore don't want my records shared unless I share them. That electronic records takes the decision out of your hands is one mark against it.

Knowing the above, my only recourse is to avoid medical care entirely, and had I started doing so long ago I would be no less healthy today. And a lot more moneyed. Of course, this means that if something really bad happens, I'll wind up getting care after a lot of damage is done. And it will cost a lot more. Time for the insurance provider to thank electronic records.

Everything good about EHR could be preserved if the patient just had a copy of his records and could show them to anyone treating him. By cutting the patient out of the decision process much bad stuff is perpetrated.

They made a big deal about your records being accessible to the patient via the "patient portal," but what you can access there is just a portion of your chart. Most of the real important stuff is excluded, including things like the doctor's thoughts, plans, what he really thinks of you and where this seems to be going. You have to go to medical records and sign all sorts of stuff and wait a few weeks to get the full records
while any doctor can get them in 2 seconds at a computer terminal. I tell them if he can get such access there is no reason I can't have similar access instead of just a portion. No answer.

I'd have no problem with EHR if they were restricted just to people who had a real need to know, and if the patient had the same access your doctor has to them, and has the power to opt out.

I suspect Mme Moxie has never run into a problem caused by electronic records. If and when she does, she may learn what it feels like to get stuck in a vat of jello and stop being such a believer.

Posted by:

Ken Mitchell
05 Jul 2018

I've known medical professionals (several nurses and at least one doctor) who have "retired" abruptly after electronic health record systems have been deployed.

One of the biggest problems is, as Bob notes, that the EHR systems are designed by programmers rather than doctors. And nurses are entirely cut out of the design loop. Too many irrelevant fields are mandatory; SOMETHING needs to be filled in there. And too many of the fields are highly structured; the doctor must pick an option from a drop-down list rather than being able to enter data directly.

For lazy doctors (as with lazy police officers) the temptation to copy/paste notes from the last visit rather than typing new, slightly different notes is irresistible. This is especially true with surgeons who routinely perform the same procedures over and over.

Posted by:

Kenneth Heikkila
08 Jul 2018

My doctor also uses a scribe via the internet. Seems pretty efficient and simple. There is another person looking at me via something like Skype during my visit, but I'm not particularly shy.

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