Mission: Healing August 4, 2011

PGY 39, Day #35
The Business of Medicine: Follow the money
Health Information Technology: Top Ten Problems

A few days ago, I promised a Blog on the Top Ten HIT problems. Of course, this is just my opinion ... based upon more than 40 years experience in patient care, teaching, administration and research. That is ... experience in a cross spectrum of patient care from primary care to tertiary care and quaternary care ... from primary prevention to treatment ... from home to hospital ... treatment of some of the sickest patients in the nation. Granted, my experience is limited to the East coast. I have not worked west of New Orleans, but, I don't think patients are much different west of the Mississippi. When I started in Medicine around 40 years ago, there was NO technology available to help develop HIT systems. Now, we have all the necessary technology, but Mission: Healing is lost in the race for $$$ by the HIT providers. Ah, yes, greed again. I suggest that the Non Profit Doctor-Patient Cooperative could take this on as one of its tasks.

In any case, this is the way I see the TOP 10 Health Information Technology PROBLEMS today.
Report Card: Overall Score 2/10

1. Interphase: Too Cumbersome and too much time is used interacting with computers.
These machines should make it easier for us to spend more time with and take better care of patients. But, in fact, they interfere with patient care. They take precious time away from patient care activities. In other words, they add non patient care tasks to our daily activities ... far in excess of paper charting. According to my observations and estimates, 25% to 50% of provider time is tied up interacting with the EMR. That's not good.
These Systems should have to pass a risk/benefit test ... like all our drugs and procedures, before they are allowed to enter the Healthcare arena. HIT Providers charge outrageous prices, because they can ... and because they promise to improve reimbursement ... under the guise of better care.
Let's look at cost benefit and design systems to IMPROVE PATIENT CARE FIRST! Improve Quality First! And, while you are at it, prove that you are improving quality. A "from scratch" system would be in order ... without proprietary restrictions.

2. Data Entry: Too Cumbersome
Related to #1 above, but separate, the data entry points should duplicate our clinical flow sheets that have been developed over the last 50 years! Jumping around from place to place for the ease of developers is neither necessary nor acceptable.

3. Data Shareing: Too Cumbersome because proprietary systems don't talk to each other.
We can't add data from outside sources (EG images) very easily, if at all, and, no matter where the data comes from, it is difficult to find, or access some of it.
A Health Information Exchange Network (Health Internet) needs to be established ... preferably by the government. Similar to banking, private HEALTH INFORMATION BANKS kept in Doctors' offices and Hospitals, need to "store" the data, like banks store your money. And, in addition, each patient would have their data and data could be shared among patients and providers with permission ... over the secure Health Internet.

4. Security: Inadequate & related to #3 above
The health record belongs to the patient, so it should be given to the patient in electronic format and shared only via secure Health Internet & and between patient and providers.

5. Ease of USE: Non existent
Outlined above. Some combination of touch screen and voice activated data entry would work best, given today's technology.

6. Time dedicated to machine: Excessive
Outlined above

7. Redundancy: Inadequate In other words, when the power goes out, or the system goes out, the data is not accessible. A flow sheet summary should be printed on a regular basis one for the patient and one for the provider. This was a major problem during Katrina. We had critically ill patients with no patient information.

8. Reliability: Inadequate
Thses systems go down all the time ... for one thing or another. Automatic printing of flow sheets on a scheduled basis (depending upon severity of illness) is necessary and lacking, as outlined above in #7.

9. Comprehensiveness: Inadequate

These systems should be designed for patient care, administration, teaching and research. I will expand on these topics over time.

10. Flexibility: Minimal
The IT people have these systems locked up. (I believe that the EHRGuy was referring to this. Perhaps he will comment on my blog, once I publish it.) They should be simple enough to enable users (admistrative users) to make changes that will make them more specific to particular front line use anywhere in the world.