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    Saturday, March 17, 2007

    The Cost of Progress: How expensive are electronic medical records? In some cases, very:

    The person in charge of setting up an electronic medical record system for the UC Davis Health System was paid a $42,100 bonus last year despite missed deadlines and other problems with the program. The bonus came on top of Dr. Thomas Tinstman's base pay of $78,399 and negotiated salary of $205,397, for total compensation of $325,896 last year.

    Internal documents show the project -- with the final bill estimated to be anywhere from $75 million to $100 million -- is two years behind schedule and up to a fifth of the budget went to an outside consulting firm whose expense reports are now the subject of an internal UC audit.

    I'm not certain, but I'm pretty sure that exceeds the cost of building a hospital or research center. Hope they're getting a good one. But chances are, they aren't. Computerized medical records are systems in evolution. No one has invented the clear leader in the field yet, although everyone thinks they own it.

    Which is why it's useful to keep in mind the myths of electronic health records. Here's one myth that is almost never considered:

    Myth 7 - Electronic records are more legible than paper records

    .....The truth, however, is that although the words are easier to read, the documents are often harder to read. The reason for this is usually a low/poor signal-to-noise ratio, meaning the amount of useful information (the signal) is less than the amount of irrelevant data (the noise).

    An example of a high/good signal-to-noise ratio that I have encountered came out of an older physician's patient database, which was composed of 3x5 index cards. Each index card contained a patient's first and last name with one-word descriptions of any diagnoses and recommended treatments. For example, "Susan Jones, pharyngitis, penicillin" would be written on a typical index card. These records were almost all signal.

    The other extreme I once came across outside my organization was an EHR-generated three-page report for the same diagnosis. Although most physicians would agree that it contained more than four words of good signal, they also would complain that the report contained much bad noise, making it harder to read.

    One of the hospitals in my area has started to use an EHR in their emergency room that generates the most difficult to read reports I've ever seen. Every sentence is followed by the name of the person who entered it into the system, even if it's the same person for every sentence. It's hard for the brain (or at least my brain) to process that interrupted narrative.

    posted by sydney on 3/17/2007 08:53:00 PM 1 comments


    You could build a small-ish hospital for $100M. They cost around $1M/bed to build. But then you have to operate it...

    By Blogger Tom Leith, at 12:14 PM  

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