“Death By A Thousand Clicks: Leading Boston Doctors Decry Electronic Medical Records” (WBUR) gives the practitioners’ perspective on our country’s trillion-dollar(?) investment in computerized medical records (how do we get to $1 trillion when a typical hospital seldom spends more than $100 million on the initial implementation of a system?; I’m factoring in years of typing by personnel as well as the ongoing support and service costs for these IT systems; we’ll get to $1 trillion soon enough!).
My perspective on this has always been that most of the value of a DBMS comes from situations where comparisons across records have a lot of value. So an electronic medical record (EMR) would be most valuable if a doctor treating Patient A wanted to see what happened with Patients B through Z or what happened with all patients having the same condition who were treated in that hospital. These turn out not to be common queries.
Are we budgeting to pull out of this financial dive when full artificial intelligence is developed? An AI assistant will listen to a doctor or nurse speaking and then fill out the screens of a $100 million electronic health record system that has its technological roots in the 1960s?
Related:
- Electronic medical records don’t save money (2013 study)
- Most efficient medical record system for dogs and cats: paper
- Brain surgeon tortured by software developers and hospital bureaucrats (they’re not doing any better over in England)
- How well will hospitals adapt to their new $100 million IT systems? (2009)
- Health care IT industry profits from crony capitalism (2013)
They want a robot to feed all the diagnostics into Watson to form diagnosis and plan treatment. They need the digitized corpus of records to train Watson.
I suspect the main problem is that the systems are designed around the requirements of insurance company billing departments rather than the information needs of clinicians.
“billing departments” should read “claims processing departments”
@bobbybobbob: don’t let the hype you hear and see around Watson excite you. Watson is a disaster and all that it can do is already doable and has been doable for years by Google or even Amazon and Bing.
I use to work on Watson Health, not any more.
Oh, I assumed it’s a racket. It’s just that the impetus for more and more record keeping and digitization in a bunch of industries is the pipe dream of an elite mangerial caste to optimally control everything with fancy pants algorithms. It’s not about making things better for doctors or something like that.
We have all become slaves to our computers. Tons of professionals spend a lot more time doing computer busy work than necessary. This has been happening for decades across dozens of industries. Medicine is just the latest victim. I suspect the good next generation doctors will find ways to improve their work flow to eliminate a lot of this time wasting but it will take time.
Back when I was a young engineer we had a secretary who was great at typing reports and copying stuff and setting up meetings. It took me a hour to write a report long hand and give it to her for typing and fixing my bad grammar and setting up follow up meetings. Now I have to spend about 2 hours doing this same work as I need to fix my own grammar mistakes and send several texts and emails to get the meeting scheduled. The quality is probably better and the results are quicker but it costs me more time. I am sure new generation engineers operate differently and their results may be better.
I am also sure that the use of Excel and modern computer tools have dramatically improved engineering results. Likewise I am sure modern computer tools have made medicine analysis and patient monitoring a lot better.
So there are trade offs.
I’m impressed by my doctor and medical groups use of medical records. The nurse and doctor seem quite proficient in its use. No more charts or paper records to pull. Instant access to current and historical test results. Prescriptions sent instantly to my pharmacy. I can view test results online, which without medical records may have consumed 20 minutes of a nurses time. I can also send messages to my doctor, which like the test results, can be read when convenient. I expect the systems and their usage will improve drastically when the doctors who grew up with technology come into the workforce.
@George A: Are you familiar with the MD Anderson – IBM Watson story?
“Big Data Bust: MD Anderson-Watson Project Dies. Top Cancer Center Spent $62M”
http://www.medscape.com/viewarticle/876070
“The original contract terms called for IBM to deliver the MDS leukemia product within 6 months at a fixed fee of $2.4 million. However, that contract was extended 12 times, with total contract fees of $39.2 million.”
Interesting part – I’ve seen many science “power” couples where husband gets a top position and the wife must be given one as well, this is just another example:
“The “ultimate goal” of the project is “to elevate the standard of cancer care world-wide,” according to the audit report, which paraphrased the project’s initial leader and creator, Lynda Chin, MD, former chair of the MD Anderson Department of Genomic Medicine, who is married to the cancer center’s president, Ronald DePinho, MD.
Dr Chin is no longer leading the Oncology Expert Advisor project because she left the institution in April 2015 to lead the University of Texas System’s Institute for Health Transformation.
However, Dr Chin was no stranger to controversy while at MD Anderson. She was the principal investigator of an $18 million grant that was awarded in 2012 to the cancer center and Rice University in Houston for a research–business incubator project from the state-funded Cancer Prevention & Research Institute of Texas (CPRIT), which was at that time the largest grant ever awarded by the agency, as reported by Medscape Medical News.”
This very recent article in JAMA highlights another major problem with Electronic Health Records… 80% of the notes are copy/pasted!
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2629493
@GermanL, yes I’m families with MD Anderson and the Watson project, other than that, I cannot say much more.
The sad part for me is this: this same effort was tried by another company called eHealthDirect.com back in 1999 [1], later renamed to deNovis Inc. [2] IBM was involved with this effort [3] and it looks like IBM thinks it can do a better job today using Watson.
[1] http://www.computerworld.com/article/2575806/it-outsourcing/health-insurer-to-use-ibm-s-automated-claims-processing.html
[2] http://archive.boston.com/business/technology/articles/2004/10/23/lexington_software_firm_shuts_down/
[3] http://www.bizjournals.com/boston/stories/2000/09/25/daily1.html
Medical Record Management should be left to software market, under 3 laws:
1. There should not be mixed of use of the health systems (software or hardware) for personal use.
2. Systems must be secure according latest security standards, i.e. use email encryption etc
3. Privacy law, it already exists, it could be softened in some parts and made stricter in others to secure patient privacy but allow for patients family awareness.
After that, either doctor decides email X-Ray slides in filesystem folders, or buys off the shelf system or hires IT programmers, it should be up to the doctor.
Some countries use similar arrangements and they seem to be working.