This radio show aired in the US last week:
Why The Promise Of Electronic Health Records Has Gone Unfulfilled
March 18, 20193:15 PM ET
Heard on All Things Considered
The reality of electronic medical records has yet to live up to the promise.
A decade ago, the U.S. government claimed that ditching paper medical charts for electronic records would make health care better, safer and cheaper.
Ten years and $36 billion later, the digital revolution has gone awry, an investigation by Kaiser Health News and Fortune magazine has found.
Veteran reporters Fred Schulte of KHN and Erika Fry of Fortune spent months digging into what has happened as a result. (You can read the cover story here.)
Here are five takeaways from the investigation.
Patient harm: Electronic health records have created a host of risks to patient safety. Alarming reports of deaths, serious injuries and near misses — thousands of them — tied to software glitches, user errors or other system flaws have piled up for years in government and private repositories. Yet no central database exists to compile and study these incidents to improve safety.
Signs of fraud: Federal officials say the software can be misused to overcharge, a practice known as "upcoding." And some doctors and health systems are alleged to have overstated their use of the new technology, a potentially enormous fraud against Medicare and Medicaid likely to take years to unravel. Two software-makers have paid a total of more than $200 million to settle fraud allegations.
Gaps in interoperability: Proponents of electronic health records expected a seamless system so patients could share computerized medical histories in a flash with doctors and hospitals anywhere in the United States. That has yet to materialize, largely because officials allowed hundreds of competing firms to sell medical-records software unable to exchange information among one another.
Doctor burnout: Many doctors say they spend half their day or more clicking pull-down menus and typing rather than interacting with patients. An emergency room doctor can be saddled with making up to 4,000 mouse clicks per shift. This has fueled concerns about doctor burnout, which a January report by the Harvard T.H. Chan School of Public Health, the Massachusetts Medical Society and two other organizations called a "public health crisis."
Web of secrets: Entrenched policies continue to keep software failures out of public view. Vendors of electronic health records have imposed contractual "gag clauses" that discourage buyers from speaking out about safety issues and disastrous software installations — and some hospitals fight to withhold records from injured patients or their families.
Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.
Here is the link:
This audio is linked to the All Things Considered Heard On, is only 4 mins and is well worth a listen.
This is important stuff and change needs to happen and reasonably quickly. The #myHR is a block to progress not a help.
David.
> Electronic health records have created a host of risks to patient safety
ReplyDeletesee http://www.healthintersections.com.au/?p=1673 before getting too excited about this one. Of course they have, but that's not all the story
> because officials allowed hundreds of competing firms to sell medical-records software unable to exchange information among one another
well, they could have demanded that everyone wait for 20 years until (a) there's an actual definition of what 'exchange information' success means, and (b) there's a way to prove that vendors can do it and (c) they can convince all the institutions to actually do it. But course, it's all 'the officials' fault...
its all in vain David. There's nothing there that even smells of benefits for a secondary health record system so it will get ignored by ADHA and the government.
ReplyDeleteIt is the "Officials" fault Graham. We have had standards for nearly 20 yrs and there has been no attempt, on any level, by government to ensure people comply with those standards. We used to have AHML which went part of the way to addressing this but NEHTA sat on their hands. Currently ADHA think we will get inter-operability by self evaluation of the payload which is a joke. Payload compliance is the first base level of inter-operability and the ADHA just don't get that. They are a menace to good healthcare. There latest rushed attempts at throwing $$ at people are a joke, as there is only "self assessment" of message compliance and that has failed for 20 years.
ReplyDeleteIt is not solely the ‘officials’ fault nor are they not at fault. There have been many paths taken and some are still stuck in rabbit holes. If officials are to be slapped for anything it is perhaps going weak at the knees at the first sign of industry lobbying against conformance and compliance requirements ‘because its to hard’ they are also in my opinion guilty of throwing to much money around unevenly.
ReplyDeleteEven now here in Australia the great innovation Agency is flogging SMD from 10 years ago and creating a closed market monopoly, surprise the ACCC has not looked at the whole con.
Long live T.38 said...
ReplyDelete" great innovation Agency is flogging SMD from 10 years ago and creating a closed market monopoly"
I would agree and we have expressed that same opinion and refused to be involved
@Andrew this was about USA not Aus
ReplyDelete@T.38 - SMD is an open standard. It's not SMD that leads to a closed market; the problem lies elsewhere
SMD itself is not the issue, its the failure of NASH, poor provider identifiers, mostly absent or non location specific practice identifiers and a failure to focus on payload compliance.
ReplyDeleteAll of these things are infrastructure that we were promised and there has been a massive failure of delivery by successive national eHealth bodies. How can you lead when all your efforts are a failure and your level of understanding is that of a 2 year old. Stitching up business deals around non compliant, non inter-operable payloads and PKI of dubious trustworthiness simply allows government sanctioned closed shop monopolies. They are so desperate for something to come out of the $2 Billion spend that they will grasp at any straw.
SMD is mostly store and forward, although we did mange to get a real time point to point interface in, but its optional. The SMD technology choices simply reflect the now outdated FAD technology of the day and are inappropriate for high volume messaging, but can work at a high processing cost.
The ADHA want to focus on business deals because they don't understand the technology issues, which is backed up the the long list of failed initiatives on the books. Actually where are the success stories from the $2 billion spend?
Grahame have they implemented, tested and informed their customer of the ‘technical capability notice’ requirement? The governments Blackfoot to encryption.
ReplyDeleteI appreciate that IHE and Australian Standards have open standards to support secure messaging. Not sure it is the same or appropriate to cloud over the ADHA secure messaging initiative which frankly focuses more on warranty language than co-creating value or utility.
Hope they are up to the job Graham. From a simply configuration management perspective there are a lot of interdependencies and a lot still hanging off superseded standards.
ReplyDeleteGood to see FHIR being adopted but careful it is not being seen as the silver bullet. What work is being done on the payload? Have data and semantic requirements for interoperability (sorry better connections) been sorted or look at? I tried to get this from the roadmap but seems ADHAis only able to predict the deceased and NEHTA up to 2013.
It is a shame that this information is not obtainable via the Agency responsible and the community to a large extent relies on inderviduals and open forums such as David provides.
> Good to see FHIR being adopted but careful it is not being seen as the silver bullet
ReplyDeleteIndeed. if you've seen me present you'll be familiar with my mantra that interoperability is all about the people, and also that replacing anything else with FHIR and not otherwise changing anything will lead to the same outcome.
I agree about the need for detailed conformance testing and ongoing maintenance of agreements. See http://www.healthintersections.com.au/?p=2929. it's easy to cast aspertions about failure to invest in it, but if it hasn't happened over decades and over many different teams being involved, I think that perhaps there's a challenge around making the value proposition for that and invective isn't something that helps.
The ADHA want to focus on business deals because they don't understand the technology issues
ReplyDeleteThat is a pretty generous use of the term ‘business deal’ You could just as easily define it as bribery, no for market gain but for a perception of market acceptance and need.
Agree it is not a simple problem to solve, each stakeholder will have different needs and wishes. Still back to the original point, I believe this is all the harder because through ePIP and other incentive schemes those holding the criteria thresholds and money go soft to quickly and too far. This players no this and work it that way.
ReplyDeleteI look forward to be proved wrong. Perhaps the best way is create something of value that will refer SMD obsolete. Maybe FHIR on eFAX?
Look forward to the changing of the guard and a new chapter we’re these things can be thought through in a meaningful way and in the public domain without risking propping up certain institutions.
FHIR is the future (or iterations of it) once this gets standardised across vendors we should start to see advancement in the use of data and a tool in healthcare in interesting ways. Until that comes to fruition my issue with the whole ‘no fax please we are british’ campaign is they attempt to demonise a set of standards that do not deserve such disrespect. Better to educate GPS and Specilists etc.. on how to better incorporate the service so it is a little more automated and you don’t need to - print-scan-send-receive-print-file and forget. Want someone to build and standup the infrastructure? Get NBN or Telstra or TPG, that is what communication carriers do well, even get Apple and MS to work something out. A bunch of power point junkies at the ADHA have little hope.
ReplyDeleteGraham said > "and invective isn't something that helps."
ReplyDeleteI guess that directed at me and its certainly true. I have attempted to politely explain the issues with examples many times, done a lot of work helping to write standards that specifically address the issues with inter-operability and Medical-Objects has developed free tools to check compliance with the known issues.
Last time I met with ADHA they told me that we were holding up inter-operability and that if we didn't just allow people to send their shopping list the government would step in and take over messaging. It was a sort of "Dirty Harry" moment for me because if they did that it would be wonderful as there are a lot of more interesting things to do than maintain messaging services in low reliability environments like every GP surgery. However its laughable as they are not remotely capable of doing it, and sadly, after 20 years, have no idea whats involved.
I appreciate you consult for them Graham, but I do not and I am interested in progressing real eHealth as I actually depend on it to care for patients every day. The ADHA are arrogant, ignorant, evil clowns in an archetypal way. We have all the pieces we need to actually progress compliance in this country and the only people stopping it happen to work for the ADHA. After multiple renditions of national eHealth bodies we have hit rock bottom. Sometimes telling the truth is the only option left, as there is no sign they get anything technical, and they will not listen. I think power point junkies is being kind. The RACGP, DOHA and AMA clearly must think the ADHA know what they are doing, but where is the evidence of any progress?, and every infrastructure service is highly dysfunctional or non-existent. No one will listen, but I have to paint a true picture in the hope that someone in government will do a proper review.
Well stated Andrew. Mr Tim (bloody nice bloke) Kelsey will see you now - "Look into my eyes, look into my eyes, the eyes, the eyes, not around the eyes, don't look around my eyes, look into my eyes … you're under!"
ReplyDeleteAndrew, if the ADHA is paying the cis vendors to comply with the HL7 messaging standard, surely they will be doing rigorous testing before handing over the cheque...
ReplyDeleteHaha - it will be the bonFHIR of the fax machines......
ReplyDelete> "Andrew, if the ADHA is paying the cis vendors to comply with the HL7 messaging standard, surely they will be doing rigorous testing before handing over the cheque..."
ReplyDeleteNo its self assessment, and its only pdf reports, so the "self assessment" does nothing for all the pathology reports going out and the clinical reports that have good data in them...
We basically have every pathology report in the country going out with untested compliance and every system receiving those reports not subject to any testing of display, workflow or even ability to ack the result.
Unlike air crashes there is no true root cause analysis when a critical result is not acted on in healthcare as its one small error leading up to a later crash. The swiss cheese of eHealth has holes that line up for a straight path to disaster, but no one actually investigates the problems.
The reason we know the issues is we investigate every issue to see if we can find a fix and stop it happening again. The list of known issues is very long, its the unknown ones and the new ones in new software versions that are the biggest concern. Surely clinical safety in eHealth is something that the ADHA are responsible for?
Andrew rightly asked - Surely clinical safety in eHealth is something that the ADHA are responsible for?
ReplyDeleteIt would seem they are - https://www.legislation.gov.au/Details/F2016L00070
9 Functions of the Agency
d) to develop, implement and operate comprehensive and effective clinical governance, using a whole of system approach, to ensure clinical safety in the delivery of the national digital health work program;
(e) to develop, monitor and manage specifications and standards to maximise effective interoperability of public and private sector digital health systems;
(f) to develop and implement compliance approaches in relation to the adoption of agreed specifications and standards relating to digital health;
F is interesting, I maybe wrong but is compliance not related to policy? Where as conformance is related to technology (standards and specifications)?
Having read the HIMSS are all excited they discovered a forty layer to interoperability (organisation) I am little surprised that eHealth is faltering at every turn. I wonder if all these MBA claimants attended simple business classes and if any have heard of PESTLE. It is not the best I have seen and the European JOINUP lays it out nicely in all its glory. I am sure they have some very real semantic and syntactic challenges.