Friday, October 30, 2015

A Couple Of Perspectives On Electronic Health Records That Face Reality For A Change.

This appeared in the New England Journal of Medicine last week:

Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine

Lisa Rosenbaum, M.D.
N Engl J Med 2015; 373:1585-1588
October 22, 2015 DOI: 10.1056/NEJMp1509961
A decade ago, a primary care physician I admired seemed to come undone. His efficiency had derived not from rushing between patients but from knowing them so well that his charting was effortless and fast. But suddenly he became distracted, losing his grip on the details of his patients' lives. He slumped around, shirt half-untucked, perpetually pulling a yellowed handkerchief from his pocket to wipe his perspiring forehead. Everyone worried he was sick. His problem, however, turned out to be the electronic health record (EHR).
Ten years and nearly $30 billion of government stimulus later, the mandate to implement EHRs has spawned many similar stories, some of which Robert Wachter catalogues in The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age, which explores the tension between the push to digitize medicine and the sanctity of the doctor–patient relationship.1 Wachter centers his EHR analysis around the story of an 18-year-old given a 39-fold overdose of Bactrim (sulfamethoxazole–trimethoprim) — a near-fatal error partially caused by an EHR. Investigating the root causes, Wachter discovers design flaws, such as defaulting to certain units for medication dosing and alerts rendered meaningless by their sheer number. But he concludes that the mistake stemmed less from the EHR itself than from its effects on our collective psychology. “I realized,” he writes, “that my beloved profession was being turned upside down by technology.”
For inhabitants of this upside-down world, Wachter's “House of Horrors” tour is vindicating. There's the critical care doctor who, unable to identify new information in daily notes, has begun printing them out and holding two superimposed pages up to the light to see what's changed. There's the cardiologist who says, “It could be worse . . . I could be younger.” To these tales of EHR fallout, most of us could add our own. Physicians retiring early. Small practices bankrupted by up-front expenses or locked into ineffective systems by the prohibitive cost of switching. Hours consumed by onerous data entry unrelated to patient care. Workflow disruptions. And above all, massive intrusions on our patient relationships.
These complaints might be dismissed as growing pains, born of resistance to change. But transitional chaos must be distinguished from enduring harm. According to sociologist Ross Koppel, who has studied the EHR's limitations and why they've been largely ignored, one key barrier is that physicians who voice reservations are labeled “technophobic, resistant, and uncooperative.”2 But in fact a recent RAND study showed that most physicians recognize the potential of EHRs and appreciate such features as the ability to view data remotely. Nevertheless, the researchers found remarkable EHR-induced distress. They conclude, “No other industry, to our knowledge, has been under a universal mandate to adopt a new technology before its effects are fully understood, and before the technology has reached a level of usability that is acceptable to its core users.”3
Lots more here:
Then we has a discussion of Health IT risk.

Your safety can't be guaranteed in the use of IT for healthcare

Monday 19 October 2015 5:30PM (view full episode)
When you think of medical risk you might assume that the most harm would arise from surgery or multiple x-rays.
But what if the use of IT systems was causing you more harm than any visit to the GP?
Farah Magrabi says that this area of healthcare needs to be more thoroughly researched.
She has advised governments on IT-related patient harm in the US, UK and Australia.
Web site is found here:
So many clinicians are unhappy and others have good reason to be concerned about the safety of the tools.
Hardly the nonsense ‘all e-health is good’ that some like DoH, NEHTA and the CHF push.
I think we need much more nuanced discussions.
David.

1 comment:

Bernard Robertson-Dunn said...

"She has advised governments on IT-related patient harm in the US, UK and Australia."

I wonder who she advised in Australia.