One way single-pay advocates kid themselves about the cost of government-mandated “universal” health care is to ascribe magical powers to EMR. Typically delusional on this point is Maggie Mahar, who advises her readers that electronic medical records “guarantee many fewer errors, and much greater efficiency.”
I have been an enthusiastic advocate of EMR implementation in every hospital with which I have been associated. But I also know that it won’t ”guarantee” anything. Software is no better than its users, and Nurse K offers some illuminating comments about the users upon which the success of EMR depends:
There are some doctors that won’t order certain things because they can’t figure out how to enter it on the computer or order something Q6 hrs PRN instead of “one time” because they can’t figure out how to switch the default order to “one time”. If they forget to order something, it’s the computer’s fault.
And this, presumably, is just a garden variety order entry system. Such systems are nowhere near as nuanced and difficult to navigate as a serious EMR set up. Yet the behavior that Nurse K describes is pervasive, and it won’t get better until medical software in general becomes easier and less time consuming to use.
The “progressive” answer to this is predictable: have our masters inside the Beltway issue a federal mandate requiring all medical practices and hospitals to have electronic medical records implemented by some date certain. That would, of course, be a very expensive failure.
New technologies are adopted en masse because they are easier, faster, and cheaper than the technologies they replace. Unfortunately, EMR is at present harder, slower, and more expensive than the technologies it is expected to replace. Until that changes, the health care system will never benefit from its magical powers.
Comments 1
These EMRs don’t just appear on the scene. It cost our hospital alone millions to implement, including the costs to add more staff to the hospital for a month or two so people could learn the program and not be overwhelmed with the usual load of patient care. The same would go with clinics and everywhere else.
I personally don’t mind it that much, but I catch so many mistakes, far more than I had to worry about before. It’s easy to open the wrong chart and order a whole bunch of stuff on the wrong person and, low and behold, a patient is getting dig or metoprolol when it was intended for the guy next door. Luckily, the doctors are getting better about this, but it still happens frequently.
Also, the things like the Q6hr PRN defaults mentioned above: When that happens, the pharmacy doesn’t receive a flag that the medication is “stat” for the ER and the order goes unfilled until someone changes the order and this causes delays. This happens at least 2 or 3 times per shift just on my patients alone.
Another subtle problem includes the standard order sets for diagnoses. If your patient is listed as “infection”, an entire default order set for sepsis will pop up and the doctors will click on far more tests in that order set than I think they probably otherwise would have. A little old lady with normal vitals (except a temp of 99.2), cough and body aches got a million-dollar sepsis work-up from ionized calciums to lactates a couple days ago, for instance when all she needed was a flu swab and rest.
I personally don’t mind our system and most of the younger doctors like it, but it’s far from idiot-proof and doesn’t decrease mistakes.
Posted 15 Mar 2008 at 10:50 am ¶Post a Comment