Friday, May 01, 2015

This Is A Rather Salutary Tale Of How A EHRs/Practice Systems Can Be Misused For The Worse.

This appeared a little while ago:

Ending EHR absurdities

Posted on Mar 02, 2015
By Michelle Ronan Noteboom, Contributing writer
For all their promise, electronic health records sometimes suffer from design flaws that can lead to processes that are just plain nonsensical.
I’m a self-proclaimed health IT enthusiast. I applaud providers who ditch paper and embrace tablets. I always pick the portal over the telephone to schedule my appointments. I get a little giddy when I’m able to walk out of my doctor’s office, head to the pharmacy, and find my meds ready for pick-up, thanks to the miracle of e-prescribing.
But as much as I love health IT, I realize that our not-so-perfect systems have the potential to create some absurd workflows. Case in point: I recently I made a trip to the emergency room as patient. Despite my physical discomfort (all is well now), I did my typical perusal of all things health IT-related there, and paid particular attention to how the staff was using the EHR.
I noted that no one was documenting at the point-of-care; everyone not providing direct patient care was staring at a computer monitor. Staff jotted new notes either onto a paper copy of my (two) previous ER visits or on a paper intake form.
It was the intake form that particularly intrigued me because the staff seemed very set on following it precisely. Part of the conversation with my nurse went something like this:
Nurse: "Do you drink alcohol?"
Me: "Yes."
Nurse: "Do you drink once a day, socially, or more than three drinks a day?"
Me: "Once a day and socially."
Nurse: "No, no, no. You can only have one answer. It has to be either once a day or socially."
Really? The intake form – which was obviously based on the EHR’s format – apparently required users to provide a single, discrete answer for each question. Because of the EHR’s design, the staff was apparently unable to accurately record my practice of drinking a glass of wine a night and partaking in more than one serving while in a social setting.
Once I fully recovered from my ER visit, I got to thinking about other ways that EHR design and workflow are creating processes that don’t always make sense. I recalled a series of visits I had with my daughter when she was experiencing some foot pain. I took her to an orthopedic surgeon, who diagnosed her with plantar fasciitis. During the initial visit the medical assistant took her blood pressure, which seemed reasonable given that the doctor had never seen her before and wanted to ensure her general health was normal.
However, I did find it a little over the top when her blood pressure was taken for each of the two follow-up visits. After all, her case was pretty straightforward: she visited the doctor because her foot hurt; after a little physical therapy and KT tape she was back to normal. I understand that the blood pressure check was incorporated into the workflow to allow the practice to justify a higher level of billing, but does it make it any more logical?
More here:
Looks rather like a need to make more money and a lack for flexibility in workflow can lead to considerable nonsense in the US.
Of course it would never happen here!
David.

3 comments:

Mayan said...

Paper is flexible, secure, and allows for unimpeded interaction between client and doctor. In short, everything electronic records are not.

About secure: imagine the honeypot any sizable online database will be. Now think national. Paper can be destroyed too, while assuring destruction of electronic records is harder. Also, access is more easily controlled for paper over electronic. I have worked in a very secure, defence-related environment. I learned that important, sensitive things go on paper.

Anonymous said...

So these important sensitive papers, were they hand written, typed, or created on a computer? How were they distributed? Were they photocpied?

Regardless of the format, information wants to be free.

The real loss is NEHTA has lost its discipline and runs as a hackshop for stubborn blind fools and salesmen dressed as strategists and architects.

Bernard Robertson-Dunn said...

At the risk of repeating myself - OK, I am repeating it, but maybe one day it will sink in - it's all about processes and information, not technology.

Better information, better ways of using it, improved ways of doing health care, that's where the value will come from.

Bad use of technology, as illustrated in this article, gives health information systems a bad name.