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    Friday, January 28, 2005

    Into the 21st Century: President Bush was in the area yesterday touting computerized medical records. At his press-op was a woman with this tale of wonder:

    It was one of those cryptic messages that physician's offices are famous for: Your blood tests have uncovered a problem; please make an appointment to see the doctor.

    But it would be two weeks before Patty McGinley's doctor -- Dr. Bob Juhasz of the Cleveland Clinic's Willoughby Hills Family Health Center -- would be able to see her.

    A phone call to the office revealed that her cholesterol was the problem. But how high was it? Was McGinley, as she put it, ``a little unhealthy or a lot?''

    Seated next to President Bush at a forum at the Cleveland Clinic on Thursday, McGinley talked about her problem and its resolution.

    ``I'm a worrier,'' the 48-year-old Concord Township woman said. ``I felt pretty helpless and concerned.''

    Then she got an e-mail message from the Cleveland Clinic that included a link to her electronic medical records. In the message were not just her test results, but also charts that showed where her results fell in relation to normal ranges of cholesterol and triglycerides.

    ``I went from feeling helpless to being in complete control,'' she said. ``It really empowered me.''

    Of course, her worry could have been avoided if her doctor had just sent her a note in the mail with her results and the explanation instead of sending the cryptic "call the office" message. You don't need computerized systems to avoid problems like that.

    The Administration has ambitious goals and hopes:

    Dr. David Brailer, Bush's national health information technology coordinator, said the goal in the next 10 years is to have every doctor use a computer to record and read patients' medical records, to order tests, to write prescriptions and to view images, such as X-rays or CT scans.

    The real challenge, Brailer said, is creating connections between different -- sometimes rival -- hospitals, so that if people find themselves in an emergency room in a different city, their medical records will be readily available to doctors who have never seen the patient before.

    That will improve safety, said Dr. Martin Harris, Cleveland Clinic's chief information officer.

    ``A patient will never have to worry about receiving the wrong dose or an inappropriate medication simply because someone couldn't read the handwriting on a piece of paper,'' Harris said.

    No, but a patient will have to worry about typographical errors in their prescription.

    It will be some time before there's a Micro-Soft of EMR, used universally by everyone, large and small. And that's what they're really talking about, isn't it? A system that's used universally so that information can be freely shared electronically? Who's going to develop that? Who's going to pay for it?

    As to empowering the patient, the only advantage my electronic medical record affords my patients is that I can fax their prescriptions over to the drug store so they don't have to spend so much time waiting for it to be filled. The EMR is more an advantage for myself and my staff than it is for my patients. It does improve patient care somewhat, by improving the organization of the chart, but the main advantage is to myself and to my staff. A physician reader who has some experience with electronic records thinks they aren't all that advantageous to physicians, either:

    I was involved with a task force which evaluated computerized records for a large medical group. The bottom line is that computerized records, as currently formulated, will slow down the productivity of MDs. The data entry is slower than handwriting or dictating. The pull downs on some encourage fraud in record keeping. (as a side note I review charts for the state medical board. The state's investigators never believe a chart when it is done with computer records. It has been their experiance that more often than not that computer records are false and do not reflect what occured at the visit.) Interestingly the advocates of computerized record keeping do not suggest that it makes you more efficient. The selling point is that it can improve reimbursement by documentation (see above sidebar) , that it is more readable, or that it is easier to find information. Unless it actually improves efficiency it may remain a geewiz device that is nice to have if you have a lot of excess money in the practice and a minimal patient load. Good Luck with making it work when you are busy. (You might want to try check off sheets for common complaints. that is what the large medical practice ended up doing)

    Although right now it's slowing me down as I enter old patient information (past history, allergies, medications, etc.) in each patient's chart, eventually it will make me more effecient. I won't have to go look for a chart when I have an abnormal lab, I can just pull it up on the computer. The staff won't have to pull charts for the next day and insert paper for the note. I type much faster than I write, and the electronic record I have is designed to use codes for frequently used phrases. For example, if I type amox500, what shows up on the screen is "Amoxicillin 500mg po tid x 10 days. Disp:#30 No refill."

    It's true that some templates are more expansive than most people ever are in the office, but it would be a mistake to assume that everyone who uses a template is lying. An auditor should never go into an audit assuming their victim, er client, is guilty. Even when I write my charts by hand, I write the same things over and over and over again when it comes to physical exams. A template just makes the process faster. If I use a template that's just like my repeatedly handwritten exams, then it's really no different, except that it's much faster. And check-off sheets are subject to the same problems as templates - it's easy to mistakenly check off something you didn't actually do. And if you're going fast, you might not even catch it.


    posted by Sydney on 1/28/2005 08:05:00 AM 0 comments


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