05/19/08 06:18 pm ET
A recent article the Congress Daily reported on a forum sponsored by Health IT Now, a group lobbying for the creation of a national electronic health information communication network and experiences of IT directors at different health care facilities regarding how electronic health (EHR) records are improving the quality of patient care.
For instance, in the article, Chuck Goux, vice president of information technology for Golden Living, a Fort Smith, Arkansas-based nursing home chain with facilities in 24 states, is quoted as saying his company had switched from a paper to computer-based system in the last several years. He said the system allowed medical personnel in the facilities to "push a button, find out what needs to be known (about a patient) and act on it." He added that "to have this information at your fingertips is a tremendous asset."
What is interesting is that a recent article in the New England Journal of Medicine titled "Off the Record — Avoiding the Pitfalls of Going Electronic" (Volume 358:1656-1658) by Harvard Medical School faculty members Jerome Groopman and Pamela Hartzband warn that based on their observations, some EHR system designs are impeding the quality of patient care instead of improving it.
Groopman and Hartzband describe how some physicians, because an EHR system can captured everything, are being overloaded with data, forcing them to play "where's Waldo?" to try to find that one critical "nugget" of needed information.
Other EHR designs are primarily template and/or checklist driven, leading physicians to practice a "generic approach to diagnosis and treatment."
Too often, Groopman and Hartzband write, the EHR system also interferes with the doctor/patient relationship: "One of our patients has taken to calling another of her physicians 'Dr. Computer' because, she said, 'He never looks at me at all — only at the screen.' Much key clinical information is lost when physicians fail to observe the patient in front of them."
(I recently wrote an article for IEEE Spectrum magazine on how IBM researchers are trying to overcome this particular problem.)
Well-designed EHR systems can improve the quality of patient care and reduce health care costs; however, designed poorly, they can do the opposite.
Unfortunately, the quality of EHR systems and their impact on patient care is one area that there does not seem to be a lot of work, from what I am aware of. The focus today by EHR supporters seems mainly to get EHRs into practice, which I can understand, but also risks a backlash from physicians who use systems that aren't designed well.
Maybe a bit of HHS money needs to go to address this issue, in addition to the attention and resources that it has paid to certifying EHR systems to meet certain standards of functionality.
COMMENTS
My wife visits several Dr's because of several medical problems. In the two most visited offices, someone uses an EHR system (with an apparent checklist) to question before the Dr comes into the room and then the Dr uses the same system..in both instances it seems they spend too much time asking oft repeated questions (which are quite often not related to the visit) rather than getting to the heart of the visit by actually asking the patient. It's very frustrating.
NextGov Reader 05/20/08 03:28 pm ET