This is lspikol's Profile page. Use it to view lspikol's comments, other users' replies
to these comments, and comments lspikol has endorsed.
As a family medicine physician who until recently was working for a large hospital system and has experience after going through three electronic health records I can endorse the issues that Ms.Sinsky so aptly puts forth. This problem is common to all enterprise electronic health records at this point in time.
The basic problem is that electronic health records have had two masters-the clinical part of the record which is important for patient care and the billing part of the record. Which one do you think has won out?
The other overriding issue is how physicians and systems are paid. Most systems are still paid on an RVUs/piecemeal basis. The dirty little secret is that electronic health records could be excellent at “not seeing patients” and taking care of populations. By this… more »
I am a family physician with fairly extensive experience with patient generated health data. Until recently I was working for a large hospital system. I exchanged email with patients over the past 12 years. I also used software called instant medical history whereby patients could take an interactive history and this could be part of the healthcare record. For most of my time in the hospital system, I was very frustrated as I was given little encouragement and virtually no help especially from the information services point of view. So here are a few observations/suggestions:
1. The inability of electronic health records and data in general to communicate with different systems in United States has been a disaster in my opinion. There has been very little incentive for electronic health record… more »
Funny you should ask-
About two years before I stop working at the hospital system, I saw patient who was transferring to me because of insurance issues from the other large group in town. The interesting thing about this is that the hospital and the other large group in town used the same electronic health record and it was still impossible to transfer data from one system to the other even though both records were the same. (Apparently the records were different enough and customizable enough that it was impossible to transfer digital data). What the heck is going on. Disgraceful.
Sure, here is my suggestion. Since most of the large players in the industry supply enterprise systems which are very costly, my suggestion would be to withhold Medicare money from hospitals who have products… more »
I do not personally have any experience with organizations that use computers effectively to take care of populations outside the office environment, however from what I have read organizations such as Kaiser, health Cooperative of Puget Sound etc. are much further along in this process as they seem to have a logical, system-based organization that are well aligned.
Welcome to Planning Room, Ispikol, and thanks for your comment.
You note that electronic health records could be set up as a communication device to take care of populations outside the office. In your experience, have you seen any services that do this effectively?
Thanks for your comment, Ispikol. You note that a large problem is that different systems do not communicate with one another. Can you give examples as to how this issue has impacted your workflow as a physician?
Do you have any suggestions as to how electronic health record companies could be incentivized to make this easier?
Thank you for your suggestions, Ispikol. Does anyone have other suggestions for how developers could be incentivized to make products that are compatible with each other?
In our practice we have developed a team based model of care, where the nurses take an active role in prevention, chronic illness care, care coordination and documentation. We are hampered in our efforts by limitations in our EHR(McKesson) and constraints of policy, both of which are often designed for the old paradigm in which the sole important interaction is between the doctor and the patient, or perhaps more perversely in recent times, the doctor and the computer.
From technology we need 1. a team log-in 2. better longitudinal records 3. improved usability.
From policy makers we need evidenced-based policies around security, signatures and order entry.
For example, my team and I spend several hours each day on wasteful workflows. A task that should be doable on one screen… more »
While each of these may seem individually trivial, they add up to hours of wasted effort each day, increase professional burnout and are a threat to clinical quality. « less