Yes, I’m stupid and I don’t pay attention and I wanted to be a rocket scientist but I became a doctor for my mother’s sake.
I’ve been following EMR’s since Octo Barnett, M.D. first implemented MUMPS in the MGH Emergency Room during the early 1970’s. I also beta tested some of Dr. Lawrence Weed’s early work in medical A.I.
Along with my residencies in Family Practice and Internal Medicine, I spent a year studying the role of information systems in Medicine as a Robert Wood Johnson Clinical Scholar. During my tenure as scholar, I worked in Dr. Robin Lake’s lab in medical computing at Western Reserve where I did some basic work with the original NASA database.
During my term there, Jack Medalie, M.D. had a team that was attempting to create a Medical Information System on DEC equiptment in Mumps. I very briefly participated in a HYPO (Heirarchical, Input, Processing and Output design) analysis.
With a team of buisness students under the direction of Miles Kennedy, PhD, we accomplished an information requirements analysis and system design for a free standing Crisis Respite Center. The design integrated both clinical and financial management functions.
At the University of Nebraska, I worked with Gerald , M.D. , then President of HITS Health Information Technology Systems, performing quasi-experimental analysis of 2,000 patient encounters leading to publications in Family Practice Journals. Dr. Fleishli and I produced a basic medical information system on a Commodore PET.
In 1990, I, as president of MD1, participated in the design and production of Medical Office System Software. At that point my medical practice duties and limitations in hardware and software made it clear that EMR’s with substantial power were impossible.
I’ve been following one project for a middle size Health system creating their own e-health system with a lot of smart people, good and innovative hardware and software, and money(3.5 Billion at the end of 2009). The system looks good and it manages to put on computer files what would have gone on paper.
This EMS (and other projects thus far documented on the net) still haven’t significantly saved much time, facilitated many communications, obviated many errors or demonstrated any ability to cut cost while maintaining quality.
The stumbling blocks are too familiar. Vendor’s are promising the world, the moon and the stars to any qualified prospect. The medical industry is glassy eyed and salivating over illusory quick profit, and there is a new “.com”-esque stampede for quick profit based sure to be broken promises.
Unless EMR’s become an agency of their own like the “U.S. Medical Information Authority,” There is some serious ground work that has to be done. Frankly it is to the industry’s interest to police itself because the future requires that a large number of very important decisions have to be made, and the industry may have to live with them for 50-100 years.
Initially hospitals have been attracted to EMR’s in order to retain patients, while several of the key advantages of wide-spread acceptance of EMR is universal accessibility to qualified doctor, nurses, etc. As early as some of the Markle Foundations seminal reports this was mentioned.
With such capabilities now clearly available have charts less accessible through some proprietary process in an emergent could be dangerous or fatal. Unlike manual systems EMR could easily fail to perform acceptably over and over.
Folks, like it or not EMR systems need to be seamless as well as secure. Seamlessness doesn’t need an engine, but at the level of medical information, the adoption of sets of standard (hopefully, public domain)codes for diagnosis, procedures, clinical orders etc. are fundamental.
Greg Starr, M.D.
There are other issues, HL7 now has a for profit affiliate that purports to be creating an “engine” that will serve as a translator between systems. It appears that they are intending to select coding systems for diagnoses, procedures, clinical orders, diets, etc to produce uniformity across systems. Their, so far, has be to select copyrighted codes, thus placing a fee on the use of their “engine” but also on the use of their codes.
The complications are so expansive and so little is being done. Unless these issues are responsibly addressed in a very substantial and far-reaching fashion, no company with any amount of money is going to make any sense out of the EMR business for themselves or the public.