Do Electronic Health Records REDUCE Patient Care? - Comments Page 2
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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! |
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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. |
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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. |
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This article is clearly written with experience relating to the(north)American market - understandably considering the author's location (and experience) |
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@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.
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.
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.
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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. |
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Mme Moxie's post gives good examples of the good things electronic records can bring about. Unfortunately, it shows ignorance of the other side. (2) Misdiagnoses and vindictive comments will thus be easily spread and will follow you forever. 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 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. |
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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. |
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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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