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79 Comments
- Bowie, on 07/16/2009, -0/+18I am a Unix admin for a large hospital in the southwest US. (Sorry, I'm not clear what my employer's policy is w/ regard to work info disclosure, so, pardon my being vague...) Anyway, I maintain the systems responsible for the core infrastructure of the hospital. Everything from our patient records databases to billing to finance. Myself, and my coworkers are ground zero for EHR deployment.
There are two things I can tell you are certain when it comes to EHR.
1) The smarter hospitals out there are ready, and wont have much difficulty in retrospect. The dumber ones, and there are many, are going to have a hell of a time. Industry-wide, everyone's known for years that this is the direction we're all headed.. But some hospitals have been dragging their feet to an almost ridiculous degree when it comes to modernizing even the most basic elements of patient care. These are the hospitals that are going to have the most difficult/bumpy/scary time with it, and this is where the majority of the bad press will come from -- Hospitals that didn't position themselves to evolve properly, and transition smoothly. The bad press you'll hear is NOT the fault of EHR. It's the fault of hospital administrations who brought the difficulty onto themselves. Here's a good example -- The hospital i work for bought out one of our competitors in town. After the ink was dry, a bunch of us were sent over to have a look at their IT infrastructure. (This was just a few years ago, mind you.) We were absolutely shocked when we discovered how they handled their IT needs --- miles upon miles of serial cables connecting terminal servers to mid 80's greenscreens. Their server room consisted of a large utility closet where critical systems were kept alongside floor mops and buckets. That's the level of technological sophistication you'll be dealing with in some places.
2) The benefits of EHR far, far, FAR outweigh any argument you can make against them. Every single one. Believe me. The technology is there, it's plenty scalable, and given a hospital understands the role IT needs to play (and funds them accordingly), moving to EHR pays for itself, simply in terms of reduction in insurance liability.. Liability is a HUGE concern in healthcare. I'll give you a good example -- Legal came down one day a few years ago with the orders to ensure that all of our core servers' clocks were synchronized against eachother, from billing to patient records. We told them we were already doing it via NTP. Not good enough, they told us, and requested that we purchase our own GPS-driven time servers at a cost of $15,000 a piece. So, that's what we did. The hospital has two redundant NTP servers racked in the server room with GPS transcievers mounted on the roof that watch half a dozen or more satellites in orbit 24/7/365. It's not as insane as you think --- $30,000 worth of expense on hardware is a drop in the bucket from a legal standpoint. Suppose a patient sues the hospital for malpractice. Their attorneys are going to take apart every last bit of data from their client's stay, minute by minute. I'm told one of the common tactics they use to point out a hospital's "negligence" is to show in court things like a patient arriving in the ER at 10:51, but began recieving treatment at 10:49. If two different systems are being used to log patient activity, they'll do so by their own clock. To an outside observer, however (read: jury), it makes the hospital look like it doesn't have it's head on straight. If $30,000 is all it takes to take that card out of a malpractice attorney's hands, a hospital will pay for it gladly.
Long story short, dont be afraid of EHR. Be afraid of hospitals that are being dragged out of the stone age. 10 years from now, we'll be absolutely dumbfounded that we allowed the system to grow this far and NOT have an EHR.
I'm lucky to be working for a hospital that's been doing it right. We'll be going completely electronic later this fall. Our biggest obstacle right now is communicating to the public that EHR does NOT mean "Computers will start making patient care decisions instead of doctors.". - dustinbolton, on 07/16/2009, -7/+22These comments suck.
- LoneStarLizard, on 07/16/2009, -7/+19We should not be debating whether or not hospital records should be computerized, we should be debating whether the government should FORCE hospitals to computerize their records. A lot of things sound like good ideas until you stop and think about government forcing the issue. Government is all about force.
- foontala, on 07/16/2009, -0/+8"Government is not reason; it is not eloquent; it is force. Like fire, it is a dangerous servant and a fearful master. Never for a moment should it be left to irresponsible action." -- George Washington
- dleas, on 07/16/2009, -5/+13I will add my opinion, at the risk of being another "sucky" comment. I have worked in the computer systems for a bit. They are clunky, inefficient, and completely arcane. Any movement towards a government-selected program will be even worse. If a hospital can't get past who knows some other guy's dad who worked for the company that designed the program, how much more blocked do you think the government will make it? The computerized records will only serve to further fuel lawyers who want to nit pick each doctor until they have bumped up against any and every mal-practice maximum they can find, while the government uses a made-up mandate to use its access to our most private details of our lives to further its own propagation. This isn't a partisan view. Any political party in control will use the power.
At some point we have to ask ourselves "At what cost are we going to sell our personality/life/individuality for?" Do I think that hospitals can run more efficiently? Yes, absolutely. Do I think that the government is the one who knows how best to dictate said efficiency? No, absolutely not.
These computerized systems will align coding to fit an even more absurd profile. Physicians have to write key words in their reports that help get the hospital the proper reimbursement from insurance companies. If they were to say "Patient was anemic" instead of "Patient suffers from acute-blood loss anemia" the patient doesn't get any better, but the insurance company jumps up and down and claps their hands because he didn't say the magic word. The problem lies within the system of insurance. Doctors have to cut the time down with each patient because insurance won't pay. Try overstaying your next surgery post-op and see how uncomfortable the staff gets because they start bleeding money. Even if you need the care, they are put in a tough bind because they are losing thousands of dollars per day, because insurance companies are getting rich off of premiums and robbing their customers with claims of "pre-existing conditions" that have never been diagnosed as such.
You want your government to take a stand for the people and for our healthcare? Tell them to take it up with insurance companies and get them to be more responsible. Forget the computer systems, coding practices, and lawyers. Let the doctors be doctors, and let the people get the treatment they deserve, not the treatment their insurance company pays for. - 5ean, on 07/16/2009, -1/+9The US has the lowest predicted life expectancy out of the G7 countries. Canada, France, Germany, Italy, Japan, and the UK all have universal health care coverage. The only country that neglects to do so is the US, we also have the lowest life expectancy out of these countries.
http://www.nia.nih.gov/NewsAndEvents/PressReleases ... - arunforce, on 07/16/2009, -5/+12Recession isn't a Depression. Far, far from a Depression.
Also, conspiracy much? - fury420, on 07/16/2009, -10/+17yeah, obviously there will be short term issues, costs, etc... but the real savings is over the long term
- tsmallm, on 07/16/2009, -2/+8@yourmartdotnet
yeah and don't you guys know that if the government fails once it means they fail forever! and who ever heard of any private industry failing. bah! I mean look at the current health care system seems to be working just fine doesn't it, I mean 62% of all bankruptcies were due to medical bills and of that 62%, 78% had health insurance so what's the problem? - markf3388, on 07/16/2009, -0/+6LOL. what are all you guys whining about. I have kaiser which employs a computerized records system. Its great, the doc walks in, goes on comp, has all your info is right there. Also for prescriptions, inputs it in the computer and it gets sent to the pharmacy read for pick up. It Works great and is way better then the regular thousands of sheets way.
- tsmallm, on 07/16/2009, -4/+9yeah government run always means "conservative use and development of advanced technologies" I mean what has government innovation every accomplished? I mean besides the atomic bomb, the space program, oh and the friggin internet!
- kelstock, on 07/16/2009, -0/+5That to me sounds like bad interface design, resulting from a poor software development approach. An idea doesn't suck because it was poorly implemented - I would think that part of your own job would have been to adapt the initial design to the needs of your hospital customers.
Also you're emphasising the 'moving the records' aspect, rather than the benefits you get _after_ the initial transition time investment. Most systems that would be considered for this sort of problem today would have something of a client-server architecture where the database of records itself is almost completely independent from the front end user interface your users had issues with.
Redesign and iteratively improve the interface based on the user feedback of what sucks and how things can be improved. User-Centered Design 101.
/Armchair assessment from a HCI/medical robotics engineer and enthusiast :) - kooredaan, on 07/16/2009, -4/+9They also run the military, roads, bridges, police, fire department.....
No entity is perfect. I trust the government as much as I trust most large corporate entities (small ones are different). Think an audit by Arthur Anderson would do wonders for an Enron-type company. But I have even less control of large corporate america than I do the government. - JohnnyRyde60, on 07/16/2009, -8/+13Ah yes, because obviously since a couple of examples of a system have had some bugs in the past, clearly it means that it is doomed to failure and we should never rid ourselves of stacks of paper records...
Badly written article.
Okay, maybe there are some fundamental flaws with electronic health records. Maybe for the next few centuries, humankind will be stuck with having medical records stored on paper... But, if you're writing an article on that subject, at least explain *WHY* the goal is not achievable instead of just pointing out failures...
It's like presenting the Wright Brothers with a list of failures and then concluding that what they will do is obviously going to fail...
This article is just rambling, nonsensical silliness... - sulthernao, on 07/16/2009, -3/+8I've worked in a Doctor's office. I can attest first hand to how much a pain and a waste of a paper that the paper system was. I spent half my time pulling files and then sorting them after the patients left. And when one got lost it was such a pain trying to go looking for them. And Doctors were frustrated with the paper system as well, because patient information had to be received and individually filed for each patient, instead of instantly being sorted into a patients record like an electronic system would do. While I was there we had begun to make a transition to a electronic system. It was a lot better. Yes it was pain to scan files into the computer, but once it was in, things were great. The electronic system meant that the doctor could easily keep track of everything that happens and has easy access to patient information. This is especially true with lab work, prescriptions, etc, which were right there. We were electronically connected to the hospital, so we easily were able to get patient info (x-rays, etc) FROM the hospital. Unfortunately when other doctors needed files on patients we had to manually fax the entire file to the doctors. Do you know how time consuming and aggravating it is fax one by each page?
The fact is that if we had a completely electronic system with no paper, we'd save a TON of money and time and be far more efficient. And be eco-friendly while doing it. We'd also probably save some lives. There are serious issues with having information electronically stored, but I think that we can tackle the privacy/security issue and computerize the data. In my opinion computerizing data would be the easiest way to bring down health care costs. - GhostInAShell, on 07/16/2009, -2/+6The postal service is broke.
They recently petitioned the gov't for funds.
This means it is increasingly unsuccessful.
Also, gov't run healthcare in Massachusetts is contributing to bankruptcy of the state, and Hawaii abandoned their healthcare system failure. - MetalHead73, on 07/16/2009, -5/+9That's why it's an OPTION.
Don't like/want Govt. Run Health-Care?
Don't get it, stay with your private insurance. - tsmallm, on 07/16/2009, -2/+6yeah Socialism, like public highways, public school, national parks, public police and fire departments, the military, all tax funded jobs, damn socialism.
/s - tsmallm, on 07/16/2009, -1/+5@NMRgentleman
"a small idealogical majority" does that even make sense? I think that's an oxymoron. or in your case just a moron. - MetalHead73, on 07/16/2009, -1/+5Did I sound like I was attacking?
Oh wow, I was trying to be more informative then a dick. - wsnich, on 07/16/2009, -4/+8The one thing about moving all of the health card records to hospital mainframes is that it drastically increases the time it takes to process a patient while they are in the hospital. While the technology could eventually decrease the time to process the patient, it is too new for now. I've worked on optimization at hospitals with a focus on electronic record systems and found that the time to process a patient nearly doubled after the system was installed. The hospital had hoped to completely eliminate paper after it was installed but after 8 years, found itself using even more paper than before due to antiquated computers, poor communication between docs/surgeons/nurses/anesthesiologists, and the interface for the electronic record system requiring too many steps to process a patient.
- moothemagiccow, on 07/16/2009, -3/+7Last week I wanted to go to the doctor. Looked up my network on Blue Cross, which just kicked in a few weeks back. 6 of them have the same number, because they all work in the same clinic. 1 doctor, with badass review on google, turns out only does urgent care. 1 phone number's disconnected, meaning there are 3 doctors I can't contact. One doctor's out of the country, but the receptionist will be happy to schedule an appointment with her colleague, except he's not taking new patients. I call the multi-doctor number - it's the big clinic. I'm on hold for ten minutes. It tells me I can schedule online. I do that, and I get an email saying I need to call. So I call, wait for 15 minutes, tell my symptoms and Im told the receptionist cant schedule an appointment, I have to speak with the nurse. I'm on hold for 30 minutes solid. Finally, I get my appointment.
Frankly I don't think you're making a fair comparison. It's between the US Government or the people who run health insurance now. Health care now is about 15 Hurricane Katrinas. - DettoAltrimenti, on 07/16/2009, -0/+4years ago, I worked for a private practice that went digital, and there are a few points I think are important:
-there are plenty of CRM programs that have been tailored to hospitals, and many private practices work with programmers to tailor a system specifically for them.
-this is an important part of health care reform- using digital files makes it easier to switch doctors, store much older files, and have several doctors work with the same information. (On a related note, I spent countless hours in 100-degree storage facilities looking for a piece of paper that proves Mr. Smith was given a prescription to medication X so he can get his $10 share of a class-action lawsuit)
-I think the best way to pass a law requiring hospitals to make the switch to digital files is through the HIPAA act- paper will always be less portable and less secure than digital.
one last point, for all the OSS proponents out there:
-the most expensive aspect of implementing these systems is finding software that will work with the equipment you have: our EKG machine cost six figures, and we ended up having to buy a new one- the only one that could be used with the ERM we dedided to go with. Imagine asking a medical hardware producer to share its source code with you to write drivers for an EKG machine! - danj484, on 07/16/2009, -1/+5Goddamn you're an idiot.
- appleofdischord, on 07/16/2009, -2/+6I never trusted the Bush administration... that is what you were talking about, right?
- yaosio, on 07/16/2009, -0/+3How to fix it:
1. Stop using bad software
2. Learn how to use good software.
Step one is the hardest, because people love horrible software and hardware these days. - Dumbledorito, on 07/16/2009, -1/+4As someone who has to accompany his wife for several medical treatments and help her to fill out the paperwork, a simple computerized system for the HOSPITAL ALONE would be amazing. Forms that come with things pre-filled in that are IN YOUR RECORDS ANYWAY would be a huge time-saver for everyone involved.
I mean, I've been to several hospitals where they can't call up your records from building to building; they have to keep an individual physical file in each location. Simple off-the-shelf database and form software could solve a lot of problems. - tsmallm, on 07/16/2009, -1/+4@NMRgentleman
"Of course I think the Democrats health care proposal is largely unconstitutional anyways" either it is or it isn't. which is it? and what's constitutional isn't up to what YOU think it's up to what's written in the CONSTITUTION. and actually yes it does matter what 51% of America wants, that's how a democratic majority is defined, more than half. - cappiello, on 07/16/2009, -0/+3Kaiser Permanente already has a similar system in place that has begun to show great benefit. It was very expensive and very difficult to set up, but I think it was more than worth it. They've already used the data from it on whooping cough to show that vaccines work and that 'herd mentality' - that someone won't get something because everyone else is vaccinated - is dangerous.
It's going to be beyond difficult to set it up on a federal level, but it needs to be done. - appleofdischord, on 07/16/2009, -4/+7Your mom sucked last night.
- 5ean, on 07/16/2009, -4/+7But...but...it's all about Socialism.
/s - dleas, on 07/16/2009, -1/+4Sounds like you have done the math. Good data. Bureaucracies always cost less in the long term...
- SemiSarcastic, on 07/16/2009, -6/+9To all of the public option health care detractors: if our government can successfully run a military and postal service then why can't they run a health care program?
- billalbertson, on 07/16/2009, -0/+3Really? I think that would depend on how the implementation was executed, and how the project was rolled out, but not in how EHR might be generally inefficient.
I've been processed under paper and EHR systems, and I much prefer EHR for speed and accuracy. In three different health systems I have used before and after EHR, I have been treated more quickly, my medication ordered with fewer errors, and my medical history having either been more accurately represented, or misrepresentations being caught and corrected more often- all AFTER EHR was implemented.
Much of what EHR is going to do for any health system is be a force multiplier- if the administration of the hospital is smooth and efficient, then you will see that improve. If they are effed up, then all EHR is going to do is expose and exacerbate all of the administration's issues. But that is not an EHR problem, that is a problem with a hospital administration that needed to have been addressed before they started. - xexx, on 07/16/2009, -1/+4Yeah, I mean the police state can't afford photocopies now... what's to stop them when they're not required?
- billalbertson, on 07/16/2009, -0/+2It's a shame that this article was so light on facts. I really consider it more of a mal-informed editorial rather than a decent research piece. They should have interviewed the CIO for Sutter Health. Their EHR system kicks ass, and they are successfully integrating their system with other hospitals and doctor offices regionally. I've never had a problem with EHR. My doctor actually has more time for me, rather than less. Our prescriptions are correct. My notes can be discussed as the physician directly enters them into the system, so we both know we are saying the same thing to each other.
Kaiser has been on EHR for over a decade. The VA has been on EHR, and it has been much more successful since then (scary thought, but true).
I know that the article mentioned higher rates of death in some hospitals that converted to EHR, but was that due to EHR? No causality was ever defined nor discussed. For all we know, if there is a link, it might be because the records of malpractice could not be hidden as easily. Doctors can't go and backdate or add additional entries after the fact without leaving a clear trail. If someone misprescribes now, its not because of the handwriting or because the wrong slip of paper got the wrong name. A lot of this was easier to cover up with paper records, so if more issues are being brought to light, that can only be a good thing. - inactive, on 07/16/2009, -2/+4same deal, except it'll go on a server instead of on a sheet. less likely to get lost or mixed up that way.
- lightningrod220, on 07/16/2009, -0/+2Buried for Second Life screenshot in article.
- ltchimpo, on 07/16/2009, -1/+3So if we all hope really hard we can force the technological advancements that will allow this saving to occur?
Why does this need to be rushed through before the session ends? What is the big rush? Is it to curtail any debate that could prevent the largest govenrment spending from occuring?
I like the idea of a public healthcare option, but not one that gets shoved through the door with cap & trade. We're spending too much money just so those in power can expand their voter base (by creating government jobs for them*).
*creating jobs is a good thing, but not government jobs in "infrastructure" - kelstock, on 07/16/2009, -0/+2Thank you for your insightful comment. I'm a recent graduate currently working in a related field - medical devices. Within the company I work I often see emails discussing the effect a Hospital's IT has on our efforts to effectively integrate our products. Often Hospital IT is either the strongest ally, or the strongest barrier to managing a new installation.
I'd personally really like to have a more thorough understanding of the sort of 'best practice' approaches a successful, forward thinking Hospital IT group (by the sound of it yourselves) has adopted. - nerd05, on 07/16/2009, -0/+2I actually work at the company that makes the software Kaiser uses, and I agree, it's a very slick system.
- 4AntiStupid, on 07/16/2009, -0/+2Buried...The idea of electronic medial records certainly didn't come from Obama.
- isgk, on 07/16/2009, -1/+3Having very similar ERP systems, it's pretty disturbing the promises. It's almost a direct mirror, computerize and spend all this money and you will eventually see lots of savings, that is until they find out what started out as a 2 million dollar project has grown literally into a fifteen million dollar boondogle that is 3 years late and doesn't even provide the information they had before. Just do a search for ERP & failures and you'll see example after example of this.
For another wonderful project on betting that computerization of things will just automatically make things cheap and wonderful... look at Britains National Health System database it will literally make you run away screaming. Britain is going to spend literally 24 BILLION dollars (on the low end with predictions into the 100Billion on the high) on computerizing their health system, it's over half a decade behind schedule.
Having seen lots and lots of grasping for the brass ring IT projects, this will follow the same route. The only way this kind of stuff works for things of this size in reality is not through a single massive across the board explossive change, but through gradual change that allows you to work through the kinks over years and or decades into something that actually works. - Bowie, on 07/17/2009, -0/+2*sigh*.
Yeah, screw the government!
I'll pave my own roads, and bring my own directions, thank you!
..and I'll make sure my own water is clean and drinkable!
..and I'll test all my food before I put it in my and my family's mouthes!
..and I'll test all my pharmaceuticals the doctor perscribes me! Where's my chemistry set?!
..and I'll deliver my mail myself, thank you very much!
..And all the aircraft that ship all the products I use to where I live? COMMUNISM! ! Air traffic control towers are OUTPOSTS OF MARXIST SOCIALISM filled with PINKO COMMIE MARXIST SOCIALISTS!
(Read: Please shut up. Turn off Fox News, and just. shut. the hell. up.) - gordigor, on 07/16/2009, -0/+2I want electronic medical files. Like to see what the doctor actually puts in my record.
- harry8227, on 07/16/2009, -0/+1Computerized record keeping is not a failure any more than paper record keeping. If you keep things up to date the information is good if not then there ya go. Problem isn't the system, it's the people running the system. I see it everyday.
- yourmartdotnet, on 07/17/2009, -0/+1I work in the surgery dept at a mid size "critical access " hospital. 90% of the surgeons I work with already struggle under the medicare/medicaid payment system. If payments are reduced and overhead stays the same it will no longer be profitable for most MD's to practice.I'm not saying they would go broke by any means, but with the cost of malpractice insurance it just doesn't make sense for them to continue. The government rules and regulations that we have right are set up like the tax code, hundreds of pages of rules some good, some pointless, and some that conflict with each other. For a small hospital like mine just keeping up with all the regulations is costing us 3-5% of our total operating budget if that cost increased we would be forced to cut back on the services we offer. If you're skeptical visit http://www.jointcommission.org/ and start looking at things, or better yet ask your local healthcare providers what they think.
- oxdeltaxo, on 07/16/2009, -1/+2So why can we not have a federal run health care program and decrease funding to the military?
Also why can we not eliminate all the funding that is put towards the drug war and put it towards the treatment of addicts rather than putting them in jail where they would cost us more to house and feed? - merky1, on 07/16/2009, -0/+1Electronic records doesn't even address that. Horrible management will still be rampant.
- merky1, on 07/16/2009, -0/+1What I have a problem with is that the government is dictating electronic records, but hasn't defined a standard. So basically what will happen is you will have several different, incompatible systems that really don't fix the current state of things, but costs money to implement.
I would much rather see the government take a leadership position and define a standard for data exchange, and let the market develop solutions around that. Meanwhile, we could look into overcharges and expense management in the system instead of putting more money into the black hole. -
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