The same Commonwealth Fund survey revealed that 78 percent of US physicians who used seven to 14 computerized functions --such as decision support or drug and allergy alerts -- felt well prepared to take care of patients with multiple chronic diseases, compared to 68 percent of physicians with low IT capacity.
“I have been practicing medicine nearly thirty years,” said one New York City physician. “Using EMR is time-consuming, and it gets in the way of my relationships with my patients.” A Midwest general practitioner echoed the sentiment: “I am in a situation where the clinic where I work has mandated using EMR, and it takes me six to eight hours a week to learn how to use it and to input information. Instead, I could be using this time to see more patients.”
A recent Centers for Disease Control study found 7.6 percent of physicians older than 65 used some form of EMR, compared with 47 percent of physicians younger than 35 -- but the slow movement to EMR has more story lines to it than age.
Let’s take a closer look at the factors involved in physicians’ EMR adoption (or lack thereof):
Cost. The average cost of an EMR system is $20,000. Many smaller medical practices have found EMR hard to afford and to implement, even though the federal government now affords doctors $44,000 over five years for EMR hardware and software.
Changes in the doctor-patient relationship. There are physicians who believe that electronic tools like EMR dehumanize the doctor-patient relationship. “Have you ever been ignored by someone who was texting or otherwise engaged in a digital conversation? Did you feel that the person was being rude and unresponsive to you? If your answer to both of these questions is ‘Yes,’ then you will understand the real reason why some doctors don’t want to adopt electronic medical records systems (EMRs),” recently blogged an anonymous doctor. “We know instinctively that the human side of medicine -- the attentive listening, the visual cues, the continued eye contact, and the careful history and physical exam -- is critical to our profession. The problem we have with EMRs is that they often interrupt the sensitive and intuitive parts of what we do. EMRs and other digital ‘tools’ designed to make our work more efficient, may do so at the expense of the human connectedness our patients deserve and need.”
Integration. The majority of medical records are paper-based, and there currently is not a standardized EMR, nor a universal interface that assures that all EMR systems can talk with one another. This lack of interoperability does little to eliminate the risks that doctors and other medical practitioners already face when it comes to ensuring that every medical and pharmaceutical detail about a given patient is known.
Despite these challenges, EMR adoption is continuing to move steadily forward in both technology and medical quarters. The Internet plays a major role in facilitating interoperability in medical records management, and technology companies and healthcare are pooling their efforts.
Also encouraging is February 2010 data indicating that the number of US physicians using EMR has risen to 36 percent. “I’m getting used to EMR,” reported the Midwest GP. “And I’m starting to see the benefits in easier access to patient information.”
Exactly, Mary. There are only benefits from using EMR for both, patient and doctor. In just a moment the doctor can see your clinical history on her screen having a quick and accurate panorama on your health issues, lab tests, meds prescribed, allergies and even info coming from your dentist, which sometimes relates to other medical issues. At least that is the way it is working in Finland where all the health system has adopted EMR.
Last time I went to the dentist and we were discussing about how a dental infection can cause other serious problems as bacteria easily reach the blood and therefore is transported to the whole system infecting organs and all, he checked on my EMR and saw the latest lab test which I had had recently didn't show any abnormality or signs of infection. Isn't that wonderful, Mary? I can hardly understand how come there are some doctors who still offer resistance to the implementation of EMR. Again I have to say that they just seem to be lazy and don't want to give up his golf time for learning more about EMR.
All the long series of Q&A times are gone with the implementation of EMR saving time and giving room to accurate and fast reaction from the doctor's side in case of an emergency. Isn't that what a good doctor wants?
The feds could force people to only go to EMR-complaint hospitals but that's too harsh and when we talk about health, there's not much the feds can do.
EMR has to be considered as a tool, not a replacement, for the kind of checks and balances that medical staffers have in place. Automation will always introduce its own problems and can't be counted on to replace existing protocols.
That said, I would venture that the mistakes you mention, Paul, are better considered not as part of the new EMR but as overall medical mistakes, which proliferate in today's environment of overwhelmed medical systems of all kinds. I'm not making excuses, simply saying that human error mistakes probably outnumber machine-driven ones. And both are part of a larger issue.
And it's also important to note that any new system, like EMR, is not exactly a panacea.
Shortfalls will be introduced that "old ways" already had provisions for--and that software developers could not begin to imagine--unless they were diligent in having medical people alongside of them every step of the way.
One challenging area for EMR that you falied to mention is the issue about safety as is reported by this investigative report:
"One day in March 2009, hospital workers misread small print on a computer screen, causing them to dispense 10 times the prescribed dose of a drug. Result: The patient has a heart attack.
Another time, a computer fails to alert doctors and nurses when a patient is moved from intensive care to their ward. Left unattended during the night, the patient suffers seizures for hours.
In December 2009, there's a report of a software glitch thatdelays a patient's medical treatment, causing a disabling injury. "Breakdowns of this magnitude endanger hundreds of patients simultaneously," warns a report on the incident".
I am hearing that medical institutions do see the light at the end of the tunnel in terms of cost reductions that EMR will ultimately provide. It's just that we are in the 'pain"process that preceeds the "gain" process.
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The average yearly tuition cost for brick-and-mortar colleges and universities in the US today is more than $20,000, an expense that has increased 1,120 percent since 1978. By comparison, students of all ages can often earn an online education for one fourth of this annual cost -- and more businesses are starting to acknowledge online degrees.
Healthcare providers have been moving to telemedicine treatments, where the patient and doctor can meet online, but insurance carriers are not required to pay for such treatments. This may change, though, as Maryland recently passed a law mandating that insurers pay up.
Healthcare IT faces an array of challenges and changes in the next three to five years, says the CIO of The Ottawa Hospital. Mobility will play a role in healthcare in a big way.
As smartphones and tablets forge into the mainstream, vendors can begin work on the next big wave: wearable devices. Apple and Google are two of the heavyweights reportedly investing time, effort, and money here. This broad category spans the range from devices that can be worn like watches to computers integrated with people's clothing.
More healthcare institutions are now using the electronic medical record, but having seamless, end-to-end communications is still a dream for the future. Getting EMR vendors to agree on a universal data structure would be one giant step forward.
New York's Metropolitan Transit Authority is conducting a pilot test of digital kiosks to guide subway users to where they want to go more efficiently and at lower cost.
The whole Amazon.reader debate is a double-stupid. It's stupid to think that there's any e-book buyer who doesn't know Amazon's URL, and it was stupider to let ICANN launch the whole free-form TLD initiative to start with.
New York's Metropolitan Transit Authority is conducting a pilot test of digital kiosks to guide subway users to where they want to go more efficiently and at lower cost.
The whole Amazon.reader debate is a double-stupid. It's stupid to think that there's any e-book buyer who doesn't know Amazon's URL, and it was stupider to let ICANN launch the whole free-form TLD initiative to start with.
While NFC's original goal was to enhance mobile commerce applications, it is finding its way into a number of other uses, which is creating both opportunity as well as challenges for IT departments.
Enterprises would like to move to cloud computing but are hesitant because they are concerned about providers’ ability to secure company data. Here are some tips that help to ensure that if breaches occur, the business is not left holding the bag.
Edmunds separates customers into segments based on the info it collects on its site and from partners, and uses that to push out custom content, said Brian Baron, director of business analytics for Edmunds.com, at Predictive Analytics Innovation Summit.
The automotive website uses propensity modeling to target ads and customer registration forms, said Brian Baron, director of business analytics for Edmunds.com, at Predictive Analytics Innovation Summit.
Expert Integrated Systems: Changing the Experience & Economics of IT In this e-book, we take an in-depth look at these expert integrated systems -- what they are, how they work, and how they have the potential to help CIOs achieve dramatic savings while restoring IT's role as business innovator. READ THIS eBOOK
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M2M: Rise of the Machines? Not Yet David Weldon In the 1970 science fiction thriller Colossus: The Forbin Project, two giant supercomputers from the United States and Soviet Union secretly join forces to take control of the collective nuclear might of the two countries. In the film, the two machines discover each other's existence, communicate back-and-forth, share their collective data, and cut their human creators out of the process. It is the ultimate example of machine-to-machine communications, or M2M. CLICK FOR MORE
M2M: Rise of the Machines? Not Yet David Weldon In the 1970 science fiction thriller Colossus: The Forbin Project, two giant supercomputers from the United States and Soviet Union secretly join forces to take control of the collective nuclear might of the two countries. In the film, the two machines discover each other's existence, communicate back-and-forth, share their collective data, and cut their human creators out of the process. It is the ultimate example of machine-to-machine communications, or M2M. CLICK FOR MORE
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