Jan22
Electronic Medical Records
on January 22, 2013 at 8:17 amSo far, so bad. And Ezra Klein, to the surprise of no one intelligent, comes off as a fool.
So far, so bad. And Ezra Klein, to the surprise of no one intelligent, comes off as a fool.
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My primary care doctor seems to like electronic records. (As a computer geek by day, I asked him about that when they made the conversion.)
He also likes the fact that they were able to clean out the old records room and put in an ultrasound and other diagnostic tools. I liked it too – they sent me down the hall for an ultrasound rather than to the hospital like they had to a couple of years ago.
Electronic records also mean that I can log into my doc’s secure website and see lab results, schedule appointments and generally spend less time playing phone-tag with my doc.
Again speaking as a computer geek, the effectiveness of electronic records in particular and computer software in general depends a lot on the details of design and implementation. If, like one of the docs quoted in the link, one is spending too much time doing data entry, then either redesign the software or do what my dermatologist does and tell your assistant what to key in. (He went with a wireless solution using tablet PCs in his office.)
What the article discusses just seems to be poor application user interfaces. There is no reason why it should take more time to use an electronic medical record. Done properly it should even take less time since you can easily pull the previous prescription history of the patient to make a new one. Electronic documents also make it a lot easier for the people actually supplying the medication to read the prescription rather than trying to decipher what is often little more than gibberish. Heck you could even send the electronically signed form over the Internet to a store and have it delivered on your home, or made available for you to pick up without questioning yourself if the store has the product in stock or not.
What Godzilla said.
Half or more of the complaints I’ve read (at McArdle’s, for instance) were about incompetently designed user interface.
Properly implemented EMR systems should be at least a draw with paper ones, with the advantage of never having to digitize the physical document.
(Of course, when there’s a top-down mandate, where’s the incentive to spend a huge amount of time and effort making the UI and UX good?
There isn’t much of one.
Of course, doubtless, this will be sold as “market failure”…)
And that’s the point that needs pushing. It was never any damn business of Congress to tell doctors’ offices they had to adopt e-records before they saw a system that would meet their needs — at which time they would adopt that system on their own initiative.
People have simply lost any notion of what “it’s a free country” actually means.
Any freedom which existed in the Medical industry died with the Medicare Act. The payer of the piper calls the tune, and all other payers (big blue or patients) are bit players compared to Medicare.
Ironically, the one thing that keeps America from sliding into the single payer/provider hellhole is Medicare. So there’s that.
So the problem is “only” with incompetently designed user interfaces?
There is a certain genre of what in a loose sense is called a “movie” where there is a certain formulaic scene, where certain actions take place at the initiative of one of the characters, and where that character demands that the counter-party admit to “liking” or “enjoying” what had taken place.
We are forcing Health Care Reform on an unwilling populace, but you are “going to like it” once you have experienced it. We are forcing the Electronic Medical Record on reluctant health care providers, but were we to get over our prejudices, the Electronic Medical Record is a perfectly wholesome and natural way for a doctor to interact with their patient or with other doctors caring for the same patient. But we are forcing this on people, and there are people out there “not enjoying it”, to say the least.
It is also such a “geek software developer” form of hubris, perhaps aligned with the hubris of certain players “in those movies”, that competently designed user interfaces are an easy thing, or at least “I would supply a competently designed interface” that my user community would certainly like or maybe even enjoy.
There are deep social, cultural, procedural, methodological, and historical influences in the practice of medicine, and for some geeks-who-think-user-interfaces-are-easy to come along and think they know what they are doing or think they know what their health-care-provider customers want, such “insights” into the practice of medicine are at the level of the insights into another form of human interaction to be gains from those movies.
Let me put it another way. Every health care provider I have encountered socially (clinically doesn’t count because a doctor doesn’t want to make known to a patient that their “tools” are no good), and even some clinically, hate, just hate with a white hot hatred, their Electronic Medical Record software.
There are dozens of different electronic medical record systems available. Nobody is forcing anybody to pick one that doesn’t meet their needs.
I call “Gell-Mann effect” on that response.
Many if not most health care providers, and it isn’t just doctors who wrestle with these systems, I have gotten an earful from a neo-natal intensive care nurse, those providers are employees of rather large group practices, clinics, and hospitals. It is not individual doctors making the purchase decision on those systems.
And the real earful I get is when it is made known, in what-do-you-do-for-a-living social encounters, that I develop software and that my professional reputation centers around a product to collect physiological data in a research setting, not anything like the medical records software except loosely in the sense that the user interface is an important part of the design.
Those systems are not, dunno, like some accounts receivable system that some people program “in house” or purchase from some small software company. I am aware that there is more than “one player” in the electronic medical record systems market, but dozens sounds like a stretch. There are network-effects that would drive the market towards a “Medical Microsoft” rather than patronizing every startup offering a product.
And tell me I could just start a software company developing one of these systems without having to cross a large number of regulatory hurdles.
I have heard first-hand the recruitment pitch given to my students from one of the software companies, emphasizing the role to be played in providing customer service along with portraying the company product in a very favorable light, and also heard first-hand “from the other side”, health care providers I know socially who have a different point of view regarding how content they are as customers.
One thing I know for certain regarding that one supplier, the medical records software is not like choosing Microsoft Word, and if that doesn’t suit you going with Open Office or even LaTeX. The software supplier provides a great deal of configuration and customization of that product for the customer, and this much I know from the software supplier seeking to hire engineering grads for that work. Once one makes a decision on implementing a medical record, there are contractual obligations, and you don’t get to ask them to leave your house if they are making a mess of the bathroom sink.
First time I didn’t copy an entry before clicking post in some time and wouldn’t you know it, I got a WordPress error that wiped out my response.
It’s likely that a poor user interface design and implementation is behind many of the problems. However, there can be other factors such as, does the program require the service provider to enter more information than was customary on paper forms? We don’t know, but since government mandates and data standards are in play, that’s certainly possible (like a census form that asks for a lot more information than they really need). Another factor can be the use of lists and combo boxes for data entry. They can reduce errors but take a long time to fill in if they’re using values from a database.
My doctors have been using computerized records for over 10 years and I’m guessing most people’s doctors have too. It isn’t some revolutionary technology that will save a bunch of money. IT systems and maintenance are expensive. Just because a computer is involved, doesn’t mean the process will be cheaper, especially when there is the requirement to collect data for the government.
A side effect of the reporting requirements is an increases in costs due to coding. You used to go in and get a check up or physical but now every single thing you talk to your doctor about has a code. So what was once a fee for a physical is now a physical, dietary consultation, pulmonary exam, ect ect. Each has its own cost which is forwarded to the insurance company and your self.
> Nobody is forcing anybody to pick one that doesn’t meet their needs.
Wanna bet? Where I work we are routinely forced to use systems that don’t meet our needs. By the corporate bureaucrats (i.e. our fellow workers) who choose them. It doesn’t work any differently when the government mandates that a solution be chosen as when our CEO mandates it.
But that’s the free market at work! Your “corporate bureaucrats” aren’t the government, they are the owners (or representatives of the owners) making decisions as they see fit.
Yes the “suits” managing these group medical practices, clinics, and hospitals are dumb. And the government policy makers throwing billions in subsidies to drive these rent-seeking practices are even “dumber-er.”
You call the government subsidy to accelerate the adoption of this tech “the free market?”
Actually, most medical practices are managed by the doctors, not the suits.
“Obamacare is free market!” Jeez, this Gerrib character is dumb as a stump…
Thales – read what I wrote before you call somebody a dummy. If the CEO picks the software, that’s not the government, and hence is the free market.
It is not a free market when the law commands you to buy a product.