I always find it very ironic to see doctors bashing EMR on the Internet. They are bashing a tool designed to gather and organize information, improve communication, and give immediate access to important information, while using a tool that gathers and organizes information, improves communication, and gives immediate access to important information.
It is fine to bash the current state of EMR (I saw one site complain that EMRs have a Windows 95 feel, and I agree with that assessment). It is fine to bash the government’s attempt to force/lure doctors to use EMR. But bashing the basic idea of computerizing medical records is incredibly myopic. Are there really people out there who think paper charts are our best option?
To show how crazy this idea, let’s pretend that the Internet was constructed like a doctor’s medical record system.
1. To read this post, you would have to do the following:
* Get written approval and documentation on my writing system that you do have that approval.
* Wait for me to mail or fax them to you. I am terribly afraid that using email would jeopardize BIRPAA (Blog Information Readers Privacy Accountability Act) standards. To follow those standards to the letter, I would also have to get your fax machine authorized as truly being yours and not someone who wants to steal my blog information.
* Each post would be either dictated, taking an unknown amount of time to come back, or handwritten in generally illegible scrawl.
* Even after requesting the information (which you would do by phone or fax), you would have a fairly high chance of not getting that information.
* If I write anything about you, you would have to pay $5 per page to get a copy of it.
* If you request a single post, you would usually get a complete copy of every post I have ever written.
2. To comment on this post, you would:
* Quote the entire post back to me (as a specialist does with a patient history) before leaving your comment.
* Mail/fax the copy to me at my request. Most of the time, you’d just keep your comments in your own filing system that I have access to only at my request. You are terrified of violating BIRPAA as like me.
* Not have access to any of the other comments done by other readers unless you knew who they were and had written authorization to do so.
* Usually work with a very small part of this post to do your commenting about (as most specialists have almost no information from PCP’s when they consult).
3. My blog would have the following organizational system:
* It would be a bunch of paper shoved into a thick manila binder.
* Since I am a prolific blogger, I’d be on “volume 3” of my blog, with volumes 1 and 2 available only by request from my blog records department.
* There would be a large number of incomplete posts, and also many missing altogether.
* My list of topics and tags would be kept on the left side of the chart, and (since I have ADHD) they would include a number of errors and outdated topics.
* I would have a large stack of blog posts on my desk waiting for me to complete them.
4. My posts themselves would look different than they do now:
* I would have to use B/M coding for the posts to be acceptable. This means that the vast majority of the information in the post would be there simply to meet B/M standards, while a small portion would actually have useful information. (See my post on “fluff”)
* I would practice “defensive blogging,” in which I would write about a bunch of unnecessary topics with extensive footnoting to keep from being sued by blogpractice attorneys, who scour blogs for inaccuracies that could give people information that is not true or incomplete.
5. Those of you with computers would have very little advantage from those who don’t.
* The computers would not interconnect or share information.
* The systems used to read and write information would be very expensive and be antiquated.
* Blog posts generated via computer would have a lot more unnecessary information, but would meet B/M coding criteria.
* To share your posts written on your computer, you would have to print them out and mail/fax to another blogger. They would scan a copy of your post and put a PDF file into their computer system.
Thankfully, the Internet is what it is — not at all like medical records systems. We have instant information, instant access to data, and can share opinions and ideas rapidly. Would it be possible to construct a medical record system that did the same? Would it be possible to use the information system you are using right now to make patients records more accurate and accessible?
I admit that privacy is the big beast that prevents most of this, and that has some justification. I don’t want anyone to be able to subscribe to the RSS feed of my medical record. But medicine takes very little advantage of the Internet to improve care, and connect providers. Perhaps the first step needs to be forcing docs onto EMRs that meet a communication standard — I have heard from insiders that this is part of the big-picture plan. Regardless, we need to combine the two worlds. It is very easy to write about healthcare and share that thought, but it is near impossible to write about a patient and share that care.
Something is very wrong with that.
Rob Lamberts is a primary care physician who blogs at Musings of a Distractible Mind.
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