Are electronic medical health records an epic fail or a maturing technology?

For patients, few aspects of their interactions with their care-givers can be more frustrating than the repetition of medical histories, medications, tests taken, and procedures undergone. This process also can be time-consuming and costly, especially when physicians, in an abundance of caution, re-order tests or procedures because they can’t be sure if they were done before. As part of the Affordable Care Act, billions of dollars were allocated to improve coordination of care, and hopes ran high that high-tech marvels would help boost the efficiency and cut costs in America’s bloated health care system.

Alas, as Mother Jones reports with a distinctive personal touch, the miracle of electronic medical health records hasn’t materialized exactly as optimists imagined. Doctors and hospitals have raced to spend a lot of money, effort, and time to install and run new, complex, record-keeping software systems, making a small group of companies wealthy and powerful. Within individual institutions, the systems may be performing their hoped-for role.

But, as writer Patrick Caldwell notes in the muckraking progressive magazine, all the computer-based systems aren’t always a boon for patients like him. He was diagnosed with acute lymphoblastic leukemia and says that three years of intensive care has left him with a walloping medical file as well as a recurring need to see an array of care-givers at different facilities.

The problem? It’s a lack of “interoperability” — that is, the fancy electronic records-keeping system as hospital A doesn’t talk to the machines at lab B or scanning facility D. So patients are still back to fending for themselves, joining with physicians in a ridiculous rigmarole ritual that expensive systems were supposed to curtail or end. Caldwell and others have particular unhappy things to say about Epic Systems, one the giants in the electronic health records field and whose head is a notable friend of the Obama Administration.

Epic, by the way, insists it doesn’t see interoperability issues — as Caldwell notes the company charges hospitals and other facilities to facilitate records’ exchanges. While physicians themselves have expressed continuing frustration with the new systems, including how it forces them to type notes into patients’ records rather than, say, providing hands-on care, it seems as if the software is here to stay and care-givers are in for a long haul to get them to work as optimally as possible.

Doctors are also voicing complaints about the new e-systems. One huge problem is the system designers haven’t consulted closely with end-users. Result is a lot of clumsiness in forcing doctors to spend  time with dropdown menus and such when they would prefer  putting hands on their patients.  A recent piece in the New England Journal of Medicine had this headline capturing the uncertain benefits, so far, of the changes: “Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine.”

Lawyers like me who read a lot of medical records for our work representing patients have also seen both good and bad features of electronic records.  Errors in one early entry end up getting copied downstream and are hard to root out, especially when no one is listening to the patient’s story carefully.  The point-and-click menus also let providers instantly check lots of boxes claiming this or that was done for the patient when in fact it didn’t happen.

So we have a long ways to go before we’ll see real benefits from e-systems.


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