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Switching to electronic health records necessary but not fun

BY DR. PATRICK NEUSTATTER

I was really mad the other night. I had to work an extra shift at the Moss Free Clinic because the doctor who was meant to work canceled.

You might think I’m using this space, and this story of hardship, to recruit more doctors, nurse practitioners and physician’s assistants to volunteer at Moss—and that wouldn’t be a bad idea, as we are always in serious need.

But what I’m really writing about is why this guy felt so overwhelmed that he couldn’t come tend the dispossessed.

The answer is: His office is changing over to electronic health records (EHRs).

He is one of many already over-busy primary care doctors who is caught in a squeeze, with ideological overtones, between the government and the EHR industry.

The government has mandated that all patient charts be computerized by 2014. But the EHR industry is way behind other industries in terms of technological ease and savvy—and jealously guards its turf.

NO MORE SANSKRIT NOTES

There’s good reason to get doctors to switch to electronic records. The system of handwritten, illegible notes (which appear to be written in Sanskrit, as the joke goes) isn’t exactly error-proof.

Paper charts can be disorganized and cumbersome—one Moss pharmacist jokes about charts “the size of Rhode Island.” It’s not exactly 21st-century technology.

Getting all doctors to use EHRs, and the greater goal of implementing a nationwide (or worldwide) electronic health information system, has massive potential. It can:

  • Record and share
  • patient information.
  • Reduce medical errors by alerting providers to
  • potential snafus such as drug allergies and interactions.
  • Enhance provider-to-provider and provider-to-patient communication (reducing the need for office visits).
  • Send e–scripts to the pharmacy.
  • Make billing easier.
  • Allow for disease and population surveillance.

And a whole lot more.

The Obama administration allocated funds through the American Recovery and Reinvestment Act to help hospitals and doctors make the switch, with a mandated implementation date of 2014—and financial penalties after 2015 for noncompliance.

But to date, less than 20 percent of the 700,000 practicing doctors are using EHRs, according to the

Information Week Healthcare website.

There is something of a scramble going on. You may have experienced chaotic scenes and harried staff if your own doctor is converting or has converted to electronic records—especially when the Internet goes down.

Friend, colleague and fellow family physician Dr. Matt Hengy is in the midst of the same anguished implementation, having gone live two weeks ago. It was 9.30 p.m. one evening recently before he was done with the nightly chore of data entry and was finally able to call me back and give me an earful of his personal reflections on the matter.

“I had a great system with my paper charts, with all the labs easy to find and a problem list, highlighted in yellow, of the things that needed to be followed up on,” he told me. “Now I have to go through multiple screens to get the information I want.”

DOCTORS’ RESISTANCE

It is a recognized fact that the medical profession has not exactly been in the forefront of computerization. The resistance is due to “reflexive conservatism and technophobia of medical folks,” as the Economist put it in a recent article.

Adding to the problem, “physicians find themselves locked into pre-Internet-era electronic health records” claims a recent, scathing article in the New England Journal of Medicine written by Dr. Kenneth D. Mandl, an associate professor at Harvard Medical School, and Dr. Isaac S. Kohane, director of the Children’s Hospital Informatics Program in Boston.

EHR vendors perpetuate a myth that there is something different and arcane about health care systems to “protect their prices and market share,” Mandle and Kohane accuse. They note that there are more than 700 vendors now produce about 1,750 distinct certified products.

People in the information technology field say the rest of the digital world has forged ahead of the EHR field—developing slick methods of data storage, search tools, communications, graphics and analysis.

Meanwhile, “doctors become increasingly bound to documentation and communication products that are functionally decades behind those they use in their ‘civilian’ life,” say the NEJM authors.

The bad joke within the profession is that “digital medicine,” to a doctor, means doing someone’s prostate exam.

OVERCOMING HURDLES

This whole business of getting the industry of medicine digitized seems to me to be a microcosm of the conflicting ideologies between those who promote government control and those who favor a free market.

“Get the government off our backs,” suggests Hengy. But to me, the EHR vendors demonstrate nicely the foibles of free enterprise. (You will get to express your opinion on this type of ideological conflict in November.)

Meantime, having gone through a conversion to EHR when I worked at Pratt Medical Center, I can tell others, “I feel your pain.”

But I also can tell them I have experienced how something that appears to be an insurmountable hurdle can become an indispensable tool that can greatly enhance your efficiency.

Dr. Patrick Neustatter a longtime family practitioner,  is the medical director of the Lloyd F. Moss Free Clinic. He can be reached at healthyliving@freelance star.com.

 

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