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Overworked Doctors and EMR's

By GregStarr ·
Alscript and Eclypsys are merging; that's a good thing. I've often had to remind some designers that interoperability is spelled with a 'per,' and that means with other doctors and other hospitals seamlessly. Let's take the example of a 72 y/o widowed woman who commutes between Florida and Massachusetts according to season. Both of these states, by the way, rank among the poorest states regarding validated outcome measures such as premature mortality and incidences of morbidity. I discussed that phenomenon, the poor care that is, in another entry so I won't go any further with it for now.

Well, this 72 y/o has a EMR in Massachusetts that was an implementation of a company that has now been acquired by Alscript. This woman is high functioning and healthy. She manages her own finances has an active life style. She does have hypertension and problems with her vision. Her primary doctor in Massachusetts sent her to an ophthalmologist and endocrinologist who did not know what medicine she was on and thus wasted a visit each. When she presented at her primary doctors office, again he was unable to find what medication she was on in Florida and was placed on another anti hypertensive to which she had a hypotensive reaction, fell and fractured her hip.

She was briefly hospitalized obtained the attention of an orthopedist and a neurologist . She had here hip pinned and the neurologist was unable to determine the cause of her fall because she had been taken off her antihypertensive while she was in the hospital. She was discharged from the hospital without an antihypertensive. Only when she returned to her primary care doctor was her antihypertensive restarted, she again became posturely hypotensive and her antihypertensive was at the etiology of her falling.

Well what do we have to learn from this? Yes, admittedly there are doctors that are narrow in their scope, that don't communicated very well and are not particularly willing to take responsibility of the well-being of their patients.

A even more glaring problem is that information system has two silos that are in the back yards of individual doctors and hospitals that were intended to be a interoperable. Everyone should have known what everyone else is doing. The key to savings was quality of care at every encounter that who have saved a boatload in money.

There is far more low hanging fruit in the form of savings secondary to quality, coordinated care than there is by having the 'dopey' doctors participating in the management of their practice. Eclypsys may have been able to show real increases in income through more aggressive coding, faster turnover in accounts, "case management," even cost cutting and prompter credit/collections. The whole attempt is futile. DRG and expense cutting mentality has to be smashed.

Were the criteria of transparency applied, we'd find that billings were up, expenses were down and that the number of happy, healthy patients had decreased overall. There will be refuges from the system as doctors and patient fail in performing to arbitrary standards.

Until the "quality through coordination" is exploited to its utmost, computerized medicine is just so much magical thinking on the parts of designers and administrator. Failing to recognize the new challenges the US medicine(in quality measures the US ranks 48th 1 step ahead of Cuba and is 30% more expensive than the next nation of Switzerland) has placed on doctors, patients and the economy, in my opinion, will not result in overall savings and improvement in the quality of life that the US patient pays for so dearly. It is of interest to note that England (among the top 5 countries in quality)has a simple universal chart system that functions well.

To label a "cut and pasted" nursing flow sheets in common diseases as "decision support" is tantamount to sending tricycles to dig the Panama canal.

There is a reason why the "purse" is so large. The reason is the need is critical. So far, state of the art medical computing fails to be competitive with some 1980's vintage paper forms, a fax machine and medical assistant available 8hrs-5days-50weeks.

The quality is in the design. The low hanging fruit is there but there is a real need to transcend some paradigms that have already proven themselves ineffective and wasteful.

Ultimately the shell game of disappearing medical money has to be replaced with transparency. The islands of competence in care have to learn to breath as one through interoperability, and the heavy burden-blessing of US enabling medical technology has to be transferred to the physician that makes sense. This is more than a "cut and paste job."

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That's interesting

by Dr Dij In reply to Overworked Doctors and EM ...

about allscript and eclipsys.

Doctors avoid computerization sometimes because then others might see what they are doing. Plus they don't always make the piles of money that everyone thinks they do.

So this works out great only if there is not a situation like you described or the person doesn't visit another doctor locally. A rec came thru out lab last night where a person had gotten a BMP, then visited another, presumably a referral, more specialized DR and he ordered a CMP. (the CMP of course includes all tests the BMP has). So there was waste of effort there, that indicates the same thing you were mentioning.

HL7.org is dedicated to interoperating EMRs. I don't think a centralized database is the answer like in the UK. I think exchange of data is much better.

Besides the blood tests which was just an added expense, the more critical one is multiple meds as you mentioned but patients are supposed to know what they are taking to avoid this, including bringing into appts all meds they take. I've been in front office when the patient brought in this huge plastic baggie filled with her prescription drugs.

What pt's may not always know tho, and sometimes even more critical is what radiation from imaging they've been exposed to. medical x-rays are now the major source of radiation exposure. and a CT whole body scan is equal to 440 regular xrays. While new low power versions are coming out, the majority are at this level now.

I used to maintain a radiation exposure database. We had to keep this forever basically, until the person died. But this was for medical personnel, dentists and nuclear plant workers, not patients.

this came out today about excess ct scans in ERs
http://news.yahoo.com/s/ap/20100621/ap_on_he_me/us_med_overtreated_er;_ylt=AlKdKZ5Q8IIQ2inikmLBW7JH2ocA;_ylu=X3oDMTNhdjBkOTB2BGFzc2V0A2FwLzIwMTAwNjIxL3VzX21lZF9vdmVydHJlYXRlZF9lcgRjY29kZQNtb3N0cG9wdWxhcgRjcG9zAzUEcG9zAzUEc2VjA3luX3RvcF9zdG9yaWVzBHNsawNlcmRvY3RvcnNsYXc-

Something similar needs to be done for patients for exposure from any source.

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