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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Consider the following: By mid-2011, Nielsen estimates, there will be a US smartphone user base of 150 million, with 300 million mobile subscribers and 120 million mobile Web users. And in 2010, over 25 percent of US households are using mobile phones exclusively, eschewing landlines.
It was at a technology conference in New York this past July that Erik Brynjolfsson, director of the MIT Center for Digital Business of the Sloan School of Management, told his audience that coming out of this recession will be unlike any other, in that companies are determined to not reopen jobs that they cut during hard times.
Enterprises that have successfully migrated mission-critical applications to the Internet may balk at the news that a growing number of firms are opting to reverse that cost-saving process.
Now that some of the initial excitement about mobile apps is beginning to wear off, and they are moving toward the realm of mature technology, developers are taking a closer look at the business contexts in which the technology is being used, with an eye to how form might better fit function. In short, they’re finding places where smartphones fit better than tablets, and vice versa.
SIP (Session Initiation Protocol) is an increasingly important Internet integration technology, but there are still areas where critical interoperability work remains to be done -- including on IP PBXs, on SIP-enabled service provider connections, and on fax-over-IP (FoIP) solutions.
Getting to Work on Smart Work: How IT Is Transforming the Implementation of the 'Internet of Things' Organizations in all industry sectors are becoming more instrumented, interconnected, and intelligent -- and that's changing the way they approach virtually every facet of their operations. It's up to IT to help organizations adopt a "Three I's" approach that leverages the emerging Internet of Things and enables them to work smarter. READ THIS eBOOK
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Nielsen’s recent numbers on the increasing use of texting bode well for enterprise networks. Shunning the phone in favor of text messaging could mean reducing bandwidth.
Cisco's UCS and IBM's zEnterprise have upped the ante for virtualization and 21st century computing. In the future, look for integration of disparate operating systems at the firmware level, self-healing architectures, and workload optimization across entire data centers.
Nielsen’s recent numbers on the increasing use of texting bode well for enterprise networks. Shunning the phone in favor of text messaging could mean reducing bandwidth.
RIM is giving in to demands by India to snoop on encrypted BlackBerry data. It's time to develop cheap or free encryption software for BlackBerrys and other cellular phones.
Two studios have filed suit against an ad broker for placing ads to help monetize P2P sites suspected of copyright infringement. That's taking a dangerous step toward what might be a worthy goal.
By 2014, mobile devices will overtake laptops as the appliance of choice for consumers. But device makers still have some wishes to fulfill, including mobile app simplification and the ability to better perform word processing/spreadsheet functions.
Google's foray into pay-for-view movies may be an indicator that the days of free ad-sponsored content are numbered, or at least that ad sponsorship won't fund nearly enough content.
Online education, improving to better replicate the interactions that occur between teachers and students face-to-face, grew in double digits during the recession. Still, there’s more work to be done.
Google's decision to link VoIP calling of PSTN numbers with Gmail, and to let Google Voice "call" Gmail VoIP clients, will devalue the PSTN and force telcos to fund unprofitable services or create their own VoIP transitions.
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