Tuesday, December 14, 2010

Safety and the EMR

The NY Times today reports on safety related to the EMR. The Times states:

Only about one in four doctors, mostly in large group practices, is using the electronic record system. A vast majority of physicians in small offices, the doctors who serve most Americans, still track patients’ illnesses and other problems with pen and paper... And the electronic record systems are themselves increasingly attracting concerns that computer errors, design flaws and breakdowns in communication sometimes endanger patients. 

They continue:

Dr. Blumenthal said health information experts like Dr. Donald M. Berwick, the Medicare and Medicaid administrator, and Dr. Brent James, of Intermountain Healthcare, based in Salt Lake City, “agree that electronic health records will improve the safety of care.” 

“At the same time, any time you change the world you create risks,” Dr. Blumenthal said in a telephone interview last weekend. “We want to make sure that implementation is as safe as it can be and all safety benefits are realized.” 

This is what happens when: (i) those who mandate the implementation of a massive systems oriented service do so having never done anything before, (ii) implementation of the whole desired package is done in one step rather than in small incremental steps.

Imagine if Microsoft wanted to release say Windows 10 in 1982. Instead of DOS 2.0. It would have been a bigger nightmare than Vista. As we have noted now for a few years, taking small steps is essential. In addition the record should be the patient's record and not the separate physicians. The patient should have their record accessed by a physician anywhere and thus should be cloud based and related to the patient and thus every provider writes to it. Simple, but writes what and how is it organized.

For example, just having an indexable record would be nice, but having the data processed or processable would be essential yet too little is know yet as how best to accomplish this.

Thus the law of unintended consequences will over-ride all, and the dangers from this new system may exceed any benefit for a while. Probably not a good thing. Welcome to Government mandates.