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Why Digital Medical Records Are No Panacea

timothy posted more than 5 years ago | from the stop-shaking-the-bandwagon-you dept.

Medicine 367

theodp writes "As GE, Google, Intel, IBM, Microsoft and others pile into the business of computerized medical files in a stimulus-fueled frenzy, BusinessWeek reminds us that electronic health records have a dubious history. Under the federal stimulus program, hospitals can get several million dollars apiece for tech purchases over the next five years, and individual doctors can receive up to $44,000. There's also a stick: The feds will cut Medicare reimbursement for hospitals and practices that don't go electronic by 2015. But does the high cost and questionable quality of products currently on the market explain why barely 1 in 50 hospitals have a comprehensive electronic records system, and why only 17% of physicians use any type of electronic records? Joe Bugajski's chilling The Data Model That Nearly Killed Me suggests that may be the case."

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Impossible!!! (3, Insightful)

Nutria (679911) | more than 5 years ago | (#27744491)

Everyone knows that everything should be computerized, since everyone knows that big, REALLY COMPLICATED data systems always work and always come in under budget.

Like the redesigned FBI data system that works so perfectly!

Re:Impossible!!! (3, Insightful)

Enry (630) | more than 5 years ago | (#27744561)

I'd say that if you want an electronic records infrastructure that works well, check out what the Dept of Veterans Affairs has been doing. Most of their records have been 'online' (at least in a computer) for well over 20 years.

And in case you're worried about the security of the code, almost all of it is available via FOIA and is available online.

ObDisc: I used to work for the VA in the early '90s and worked on their FOIA code release.

Unfortunately for us... (0)

Anonymous Coward | more than 5 years ago | (#27744943)

I've looked through the VA's code for VISTA. What unreadable garbage. MUMPS has supported functions and variables with names longer than a few characters for years now. The spaghetti-code logic is terrible. It's pretty apparent that the software was developed by multiple contract agencies over several decades when, quite literally, the left hand didn't know what the right was doing.

Also, VISTA is basically useless outside of the government-run healthcare system. Why? Two reasons: because there's no Pediatrics module, and because there's virtually no facility for capturing patient charges, since the VA is it's own payor. Unless we switch to single-payor universal healthcare in this country, VISTA is going to remain a niche product, since no one is going to develop financial modules for it. (Are there any FOSS MUMPS developers?)

Finally, my understanding was that the DoJ and the VA forked the VISTA code base a while back, with the end result that our veterans receive a brand-spanking-new, completely blank medical record when their discharged, as the systems were incompatible. That may have changed with the NHIN, but not drastically. The amount of information contained in a Continuity of Care Document isn't really comprehensive.

ObDisc: I work for the vendor of the OTHER major MUMPS-based EMR-- think Kaiser.

Re:Impossible!!! (3, Insightful)

grogo (861262) | more than 5 years ago | (#27745073)

I'm an MD with an IT background. I've used the VA's VISTA system from about 2000 to 2006, with a very positive impression. I second the parent's recommendation: VISTA was solid, useful, and a huge change from the paper records I'd used before.

Re:Impossible!!! (0)

Anonymous Coward | more than 5 years ago | (#27745147)

I worked in a hospital's medical records for 2 years. Outside of cost the reason they never switched to digital was the HUGE volume of paper that would have to be scanned. A dozen file clerks were barely able to keep up.

While digital may be faster, the disruption the change over would cause for 2 years would be huge.

Also paper isn't so great. We were an excellent hospital rated really well but doctors lost patient's charts with a disturbing frequency.

Re:Impossible!!! (2, Interesting)

timeOday (582209) | more than 5 years ago | (#27745235)

There is a huge difference, though: the VA is run entirely by the government. What the rest of the US is going to wind up with is a huge train wreck of competing standards and products by proprietary vendors who don't want to interoperate. By the end it will have cost the industry 10x the price of one or two good products, but what do they care.

Re:Impossible!!! (2, Interesting)

tibman (623933) | more than 5 years ago | (#27745255)

I agree, the VA's system works very well. You can get lab work done in one clinic and every doctor you'll meet from that day forward (no matter where they are) will have access to it. Including X-Rays and all the fun stuff.

OT: I had to get shots in a clinic that still used paper records once... i left that place poked full of holes : / Tetanus booster, HIV, and god knows what else

The only shots i've ever escaped is flu (dodge it everytime!) and the dreaded Anthrax. Worst shot ever is smallpox though, it's like babysitting an open sore : /

Re:Impossible!!! (4, Insightful)

MightyYar (622222) | more than 5 years ago | (#27745157)

My wife works at a hospital with digital records, and it seems to work fairly well - no worse than paper charts anyway.

The major issue that I have is that they use it only to a fraction of its potential. They use it just like they did charts, with no real capability increase other than stretchability and speed.

For instance, they could use it to prevent some medical mistakes by requiring an override if a physician changes an order. Right now one doctor (or even a nurse) can simply walk over and change the order given by another doctor. At the very least, another doctor who is on call should okay the change so there are at least two eyes on it.

Another example is medications. A groggy doctor woken up at 4AM can and will make mistakes, sometimes as severe as mixing mg and micrograms. You can bet that a dosage 1000 times higher than indicated will not be good for a patient, and currently they rely on the pharmacist to catch these errors. The computer could be programmed to require an override by a second doctor before allowing such orders.

Also, due to lawsuits, everything at the hospital is a CYA system, and patient care suffers. Computers could be used to help this situation, too - but I'm getting carried away now :)

Re:Impossible!!! (1)

MightyYar (622222) | more than 5 years ago | (#27745165)

stretchability, lol - meant search-ability. Firefox spell check for the win...

Re:Impossible!!! (0)

Anonymous Coward | more than 5 years ago | (#27745271)

there are programs out there currently doing exactly that and more. Doctors are cheaper than most and you do get what you pay for.

Re:Impossible!!! (1)

MightyYar (622222) | more than 5 years ago | (#27745389)

Sorry, didn't mean to imply that the software can't do this - it quite obviously can, and smarter people than me work in the industry...

The problem is that doctors are loathe to accept this kind of stuff, and hospitals tend to be a big monoculture with doctors straight up through the administration. Doctors are great, mind you, but monoculture is bad... take the congress we have which is full of lawyers, for instance. Lawyer jokes aside, it would be nice to have different perspectives.

Re:Impossible!!! (4, Interesting)

GeckoX (259575) | more than 5 years ago | (#27745445)

Good points.

Any system can only be as good as the people that use it. I can't help but feel while reading 'The Data Model That Nearly Killed Me' that the problems encountered actually had very little to do with the electronic record system at all. It seemed more like an incompetent system was in place as a whole. The data model didn't seem to do anything wrong, it was the people using it, or not using it. Not saying whether it is actually a good electronic system or not, impossible to tell...but enough people had enough direct access to critical information, without even thinking about the electronic system, that this guy should not have had the problems he had.

Is it really the data model's fault that not only did no one use information provided on entry to the er, they didn't even READ it? Sounds to me like the real problem is that new systems were put in place without new processes or training being put in place...and then on top of that the users of the system failed to even fall back on the logical concept of direct communication!

I do not for one second believe that this situation wouldn't (Or for that matter hasn't) have happened even with the use of standard physical medical charts instead of the electronic record system in place. There is really nothing at all in the story that makes the problem specific to the system or the model being used in that system. Can't believe that had a physical medical chart been used that the same mistakes the medical staff made in this case would have somehow miraculously NOT been made on paper as well.

Basically, what I take as most important from this guy's story, is that that is NOT a medical facility I ever want to step foot into under any circumstances, electronic records or not!

Ohh, secrete those enzymes! (4, Funny)

MarkRose (820682) | more than 5 years ago | (#27744509)

Digital Medical Records Are No Panacea... but they are pancreas!

Interesting... (3, Insightful)

paazin (719486) | more than 5 years ago | (#27744527)

Interesting, for certain - and raises some good points for discussion in the how the system is implemented.

But it's anecdotal evidence, as much as it may affect the author, doesn't necessarily prove the point.

Re:Interesting... (1)

imamac (1083405) | more than 5 years ago | (#27745053)

In fact, his account proves the opposite of his point. He mentions many times about how papers were filled out by asking questions of the patient. This informations never seemed to make into the right hands according to his story. A properly used fully electronic system would get rid of most all paper. If the VA and DoD can do it... And yes, I'm healthcare IT guy.

Re:Interesting... (5, Interesting)

Chyeld (713439) | more than 5 years ago | (#27745463)

I would go even a step further than that and posit that a good portion of his problem was stemming not from the system as much it came from the active resistance of the people attending him in using the system.

I don't directly work in healthcare, but I do work in a corporate environment for a large healthcare company that recently (in the past decade) made the switch from paper to a 'global' electronic system. At the start, stories like this were common, as people fought the system rather than use it.

Yes, not all systems are equal and it's entirely possible to design and implement an completely unusable one. But there is no avenue for improvement when the default behavior to burrs in the system is to revert to a far more inefficient (and porous) paper method, which, due to the introduction of the electronic system, is not even being monitored as well as it was when it was the only method.

In the end, the improvements that were introduced and enabled by converting to an electronic system far out weighed any of the temporary and transient issues such as this.

Security? (4, Interesting)

svendsen (1029716) | more than 5 years ago | (#27744539)

Major credit card companies either can't or won;t take the necessary precautions to protect credit card information. So what if there is a breach, identify theft, headaches, etc?

Now what makes you think hospitals, private doctors, etc. are going to be able to protect their data any better? They have less money then the credit card companies.

Can you imagine a million patient digital medical record breach? The black mail or power that could be leveraged over people?

Re:Security? (1)

Jurily (900488) | more than 5 years ago | (#27744767)

Now what makes you think hospitals, private doctors, etc. are going to be able to protect their data any better? They have less money then the credit card companies.

They're not rich enough to pay for the same Get out of Jail Cards.

Re:Security? (0)

Anonymous Coward | more than 5 years ago | (#27744861)

Wow. And paper records are oh, so much more secure.

Yeah. And I want a pony with that dream.

Re:Security? (1)

dkleinsc (563838) | more than 5 years ago | (#27744891)

Most of the breaches are not "major credit card companies". They're retailers who didn't take security seriously.

The major credit card companies have, on the other hand, been very serious about card security, and in fact created an industry organization [] specifically to create security standards that are required for doing business with them. Failure to meet those standards opens retailers up to getting sued into the ground.

Re:Security? (0)

Anonymous Coward | more than 5 years ago | (#27745193)

Most of the breaches are not "major credit card companies". They're retailers who didn't take security seriously.


The major credit card companies have, on the other hand, been very serious about card security, and in fact created an industry organization specifically to create security standards that are required for doing business with them.

Well, that's the theory. RBS Worldpay, a major back-end credit-card processor run by the Royal Bank of Scotland, had break-ins with up to 1.5 million cards exposed: [] []

Of course, the IRS still decides to use RBS Worldpay: []

Re:Security? (4, Informative)

Hoplite3 (671379) | more than 5 years ago | (#27744941)

Major credit card companies depend on thousands of small merchants who use swipe machines. To improve security, these would have to be replaced. It'd be a big headache. Besides, the credit card companies have been quite successful at pushing fraud and "identity theft" onto the victims (merchants and purchasers). They are fairly protected against data breach, in a sick kind of way. Their problem has become your problem.

But medical offices aren't like that. They have computers (that are re-programmable). There are fewer doctors than general merchants who take credit cards. And medical data is more difficult to turn into revenue than credit card numbers.

I don't think that the money is the dominant part of what makes a good system. Very capable, secure systems can be built on the cheap. The basic things that need to be used are available in open source software (image manipulation, cryptography, databases).

"Can you imagine a million patient digital medical record breach? The black mail or power that could be leveraged over people?"

Yes, I can imagine such a breach. It'll probably happen eventually. Good use of cryptography can mitigate the damage. But the idea of filtering through a million records looking for good blackmail candidates, then conducting said blackmail ... for that effort, you could start a legal business.

Digital records make sense: they should be more secure and easier to transfer. There will be pain switching, but the new system will be more efficient in the long run. There were pains moving from horses to cars, from gas to electricity, from wood to coal. But they all got ironed out.

Re:Security? (2, Interesting)

Chabil Ha' (875116) | more than 5 years ago | (#27744967)

Put on some scrubs, don a white lab coat, and walk around with a clip board and see how long it takes for someone to notice you at a big hospital. Answer: they won't. In this instance you have physical access to both the hard and soft copies. No, the threat here isn't haxors when the physical security is not up to snuff.

Re:Security? (1)

crmarvin42 (652893) | more than 5 years ago | (#27745363)

Yes, but you have to physically go to the hospital, figure out where the records are, get past the doors, locks, and personnel that are responsible for the records, make you copies and get out without anyone realizing what you are up to, getting you face on a security camera, or leaving your fingerprints where they can be discovered. All easier than it should be, but by no means actually easy.

With digital records anyone with an internet connections can concieveable gain access to the files from anywhere on the planet with far less chance of being caught in the act or figered directly for the crime. Don't get me wrong, I think that digital records are the way to go. I do agree that they are currently being misused, and that their level of utility will be highly variable.

My mother is working with Baystate Medical in MA to get the Psych component of digital record keeping designed and implimented from the doctor/nurse end of things and she's told me a lot of the problems with vendors, management, interoperability, and government oversite. It's a big mess that most hospitals are not paying enough attention to.

Re:Security? (1)

GeckoX (259575) | more than 5 years ago | (#27745491)

Sure, of course that's the situation, and that's probably unlikely to change.

But, which is more secure? Physical patient files on desks, at the foot of beds, hanging on doors, rooms full of them...or electronic files that have at least the potential to require appropriate credentials to be accessed? Yes, both can be broken or abused, but one has the potential to be more secure.

Re:Security? (1)

GodfatherofSoul (174979) | more than 5 years ago | (#27745005)

The difference is that your healthcare providers don't have to make your account intrinsically open. It will be a closed system available only to healthcare providers who by nature have verified identities, not any yahoo with a card scanner.

Re:Security? (1)

daem0n1x (748565) | more than 5 years ago | (#27745071)

Oh, my god! You are right, medical records should be carved in slate stones and carried by mules. That's the only way to be secure.

Isn't all this FUD just an organised campaign from the ones who have something to lose if the USA institute universal socialised health care? Because having a normalised electronic health record format may just be the first step...

Re:Security? (1)

svendsen (1029716) | more than 5 years ago | (#27745371)

No it's not fud. It is a serious concern that many providers have about EMR (electronic medical records). Doesn't mean we don't go down that path but it does mean we have to SERIOUSLY address security this time around.

I've been in the field for many years in various areas (health care, clinical drug trials, pharmaceuticals, etc) and have done several research studies on it for one of my graduate degrees.

In theory it is great access to your medical records, better patient/doctor conversations, ability to easily switch providers. However they are issues (like security) that are not being seriously addressed.

As for your second statement "normalized electronic health record format" we already have started down that road with HIPAA X12 EDI transactions. Standard query and responses for claim submital, claim payment, member benefit and eligibility, etc. Do we have more to do? Yup but standards are coming and guess what I am fine with it!

For those (like me) who have been involved in the HIPAA 4010 rollout (what a "smooth" ride) and now the upcoming HIPAA 5010 and ICD-10 conversion (to catch up to the rest of the world) know they are a lot of issues.

But you are right my whole post was simply FUD

Re:Security? (1)

wwphx (225607) | more than 5 years ago | (#27745497)

There was a recent article about medical records being available on torrents from people installing P2P software on computers in doctor offices, not realizing that they were sharing documents on said computers.

I absolutely agree with your point that if credit card companies can't keep your data private, how do they expect medical records will stay private.

US? (1)

anonieuweling (536832) | more than 5 years ago | (#27744579)

Is this a US-only situation?
Or is it also true for other developing nations?

Re:US? (1)

anonieuweling (536832) | more than 5 years ago | (#27744599)

And yes, I mean no third world references but the big issues the US face currently.

Re:US? (1)

Petitjean (1542787) | more than 5 years ago | (#27745049)

Here in France we have the Assistance Publique - Hopitaux de Paris (a groupment of 37 hospitals in the Paris area) that manage to have a centralized electronic medical record for each patient.
Dossier patient unique [] (French)
Assistance Publique - Hopitaux de Paris (AP-HP) selects Agfa HealthCare [] (English)

"The Stick" is typical in business (2, Insightful)

iamhigh (1252742) | more than 5 years ago | (#27744591)

There's also a stick: The feds will cut Medicare reimbursement for hospitals and practices that don't go electronic by 2015.

I know that might seem like a really bad thing at first, but consider this. Wal-Mart, Supermarkets, and any retailer with shelf space to "sell" to companies trying to get their product sold to the end user have major pull. Most all of these stores require some form of electronic invoicing. Many will require you to pay fees if you do not, and some will simply not carry your product.

That isn't much different from Medicare. If you want to accept patients with medicare, and get paid for the service you provide, you need to use *insert desired service here*. The government is the one with the pull (they have the cash), and so they can require you to do this. All I am saying is this might not be a case of the Big Brother, but just simple market forces.

Re:"The Stick" is typical in business (2, Interesting)

phorest (877315) | more than 5 years ago | (#27744865)

Yes but, remember when you have a payor like the omnipresent federal government, they already use that 'stick' almost daily. Case in point, Medicare just waved a magic wand again with a doctor-friend of ours and instead being reimbursed 80% of the Medicare allowable and they lowered it to 62.5% with no explanation.

So, he gets to treat his patients but get less money for the same labor. I do know this: A lot of doctors will opt-out of Medicare/Medicaid patients altogether very soon. They know there will be a market for CASH patients who neither want their demographics or medical records stored remotely.

They seem to like to penalize doctors under the current system, it'll only get worse.

Re:"The Stick" is typical in business (0, Troll)

timeOday (582209) | more than 5 years ago | (#27745433)

Everybody is going to be "penalized," because medical costs in the US are insane and rapidly getting worse. Yes, doctors are overpaid, because the doctors' union (AMA) runs the industry for its own benefit so there are constant labor (doctor) shortages. Then there's the incredibly inefficient bureaucracy of insurance providers. The medical industry has been gobbling up a skyrocketing share of GDP for the last few decades, and it's simply mathematically impossible for that to continue forever.

Re:"The Stick" is typical in business (1)

bittmann (118697) | more than 5 years ago | (#27745097)

With the US government, though, it isn't simply a matter of the government deciding that "all clinics/doctors/hospitals/etc. shall do X, and thus it shall be". Because, if the government MANDATED that all clinics/doctors/hospitals/whatever shall do X, then the government would as a side-effect have to figure out how to ENABLE this mandate to work. Which they can't do right now, because so much of the data in the system is of proprietary origin (drug IDs, care plan information, etc.) By using a carrot-and-stick approach, then they can assert that these requirements are not MANDATES, they're merely "suggestions" that end-users can theoretically determine if they really want to meet -- even if failing to meet the criteria would place the end-user organization under a punitive competitive disadvantage. So, by not being mandates per se, then the government doesn't need to enable/fund/whatever the required effort. So now the end-users get to run around and try to figure out how to meet these requirements on their own, to determine which commercial medical records they feel will be viable in a high-change environment, and to try to pay for all of this technology (software costs of which can easily approach or exceed $5000/year/licensed user, not to mention additional hardware and environmental/logistical requirements), all while attempting to adhere to more stringent HIPAA privacy rules and the upcoming Red Flag [] reporting requirements. A cakewalk, really.

What we say here in our corner of the medical IT world: "Medicare uses the carrot-and-stick approach. First, they beat you with a stick. And if that doesn't work, they beat you with a carrot."

Wouldn't it be better... (3, Insightful)

camperdave (969942) | more than 5 years ago | (#27744601)

Wouldn't it be better to spend that money on diagnostic equipment, and outfitting small town clinics. I would rather have a piece of paper that says "repaired cerebral aneurysm" than to have an electronic file that says "died waiting for MRI".

Re:Wouldn't it be better... (1, Informative)

Anonymous Coward | more than 5 years ago | (#27744683)

The idea is to cut down the wait time for MRI's by getting rid of redundant and unnecessary tests by having complete and easily accessible records.

Re:Wouldn't it be better... (1)

qbzzt (11136) | more than 5 years ago | (#27744823)

Not necessarily. Some patients die for lack of diagnostic equipment. Others die due to lack of historical information.

I don't have the figures, but it's possible that spending x dollars on always accessible medical records will save more lives than saving the same amount on diagnostic equipment.

Re:Wouldn't it be better... (1)

Jonas Buyl (1425319) | more than 5 years ago | (#27744831)

People don't want electronic file systems just 'cause it's cool. A well-designed system will make things way more efficient: e.g. cut the waiting time for your MRI (by implementing a good queue system or something). You make an interesting point but don't miss the opportunities an fully integrated system can provide.

Re:Wouldn't it be better... (0)

TheLink (130905) | more than 5 years ago | (#27744853)

Pieces of paper tend to continue working even many disaster scenarios. I'm not sure if most hospital generators would power _everything_ required to keep the computerized crap up.

Yep skip the 100% digital bullshit. Use paper where it still works better. The computerized stuff is useful too but in most IT stuff you can't quickly read and scribble something on the record and rush off to the next patient. You can do that in paper (ok the minus is the scribble could be unreadable...).

Spending the millions on more staff, better training and protocols[1], MRI, dialysis machines and other things that would really help directly.

[1] For example the handover protocols could probably be improved in many hospitals. That could save a fair number of lives.

See: [] [] []

Re:Wouldn't it be better... (1)

flitty (981864) | more than 5 years ago | (#27745169)

Pieces of paper tend to continue working even many disaster scenarios. I'm not sure if most hospital generators would power _everything_ required to keep the computerized crap up.

On the other hand, Pieces of paper would be destroyed in the destruction of a hospital building. Electronic records could allow for decentralized backups. Also, if a patient is not in his hometown for a disaster, electronic record transfer would allow for doctors to get important information about an incapacitated patient. There are downsides to both sides.

Re:Wouldn't it be better... (2, Informative)

timeOday (582209) | more than 5 years ago | (#27745469)

The computerized stuff is useful too but in most IT stuff you can't quickly read and scribble something on the record and rush off to the next patient. You can do that in paper (ok the minus is the scribble could be unreadable...).

Medical errors are the fifth-leading cause of deaths in the US, with up to 98,000 deaths annually [] . "Medical errors in the healthcare system arise from miscommunication, physician order transcription errors, adverse drug events, or incomplete patient medical records," says David Plow, Senior Analyst at MRG.

Re:Wouldn't it be better... (1)

TomGreenhaw (929233) | more than 5 years ago | (#27745317)

If anybody reads TFA, it would have been better if the health care people had used the electroninc medical records. It wasn't the data model that almost killed the guy, it was the fact that nobody read his EMR.

Can't get a copy of X-Rays? (5, Interesting)

argent (18001) | more than 5 years ago | (#27744645)

When my wife was in the hospital with a broken ankle I tried to get a copy of the X-ray, because it was on a big monitor out of view of the patient. The user interface of the DICOM viewer did not provide a way to print or save the image... presumably to protect patient confidentiality.

The next day I went in to the hospital to pick up the "films" for her doctor, and they gave me a copy of the same files on a CD, completely uncontrolled, and I used OsiriX to convert them from DICOM to JPEG so my wife could see them.

Having the files in digital format is great, but let's have some appropriate level of controls. If the patient wants the images on a flash stick, it's THEIR records, let them have it!

Re:Can't get a copy of X-Rays? (3, Insightful)

Enry (630) | more than 5 years ago | (#27744709)

I'm failing to see the problem here. This sounds no different than photocopying a set of printouts. The HIPPA laws only cover leaking records to people who aren't authorized to see them. Since it's your wife's records, you don't fall in that category and should be allowed to see them.

Re:Can't get a copy of X-Rays? (1, Informative)

Anonymous Coward | more than 5 years ago | (#27744837)

IAABE I am a Biomedical Engineer.

At the clinic I work at, the scanning station is mostly just a dumb terminal: enough memory to hold the images while they are uploaded to a local server. Only the crudest processing can be performed on that terminal, its mostly just there so the technician can see if a shot was dreadful, or potentially salvageable.

In another room there's a beefier computer with a connection to the server and considerable editing and processing options. Not to mention highly accurate grayscale monitors. This is the station from which the technician makes any notes or corrections before sending the images downtown, or prints or saves a copy for patient release.

Having seperate components like this (scanner, server, viewer) introduces more points of failure, yes, but it also reduces the severity of any failure. It's a lot cheaper to replace a single, specialized component than to replace an all-in-one unit.

TL;DR: I wouldn't be surprised if the "big monitor" you tried to download films from has no capability to do so. You probably shouldn't be playing around with that equipment either.

Real Need (1)

Dareth (47614) | more than 5 years ago | (#27744685)

The real need is not multiple, most likely incompatible, electronics records systems. What is needed is a standard for securely storing medical records while allowing for transfer of this information to authorized parties who need it for medical purposes.

With the money, $$$, being thrown around, you know several big companies are already working on making these systems. And I am sure their accountants are already counting the monthly support contracts and other associated profits from these mega systems.

Re:Real Need (1)

SonnyDog09 (1500475) | more than 5 years ago | (#27745117)

There is a great deal of work being done on this. NeHC, HITSP, CCHIT and HL7 are some of the organizations involved. HL7 has a Functional Model for EHR Systems that CCHIT uses to certify products in various care settings. HITSP selects the standards to be used in interoperable exchange of data between EHRs. The stimulus package will reimburse docs and hospitals that can demonstrate "meaningful use" of HIT. They haven't defined that yet, but it will probably include ePrescribing, participating in a Health Information Exchange (HIE) and reporting quality metrics to the feds. There are a lot of smart, well intentioned people working hard to make this happen.

Re:Real Need (2, Insightful)

grassy_knoll (412409) | more than 5 years ago | (#27745423)

Just from the number of organizations involved, it reads like "We like standards so much we're collecting all of them!".

A single standard would permit patients to move from hospital to hospital easier than it is currently. Multiple tests for the same condition wouldn't be required.

Which is why it seems the health care industry is against it.

Patients which leave don't provide more funding. Redundant tests can be a way to increase billing as well, so eliminating those cuts down on hospital income.

Healthcare IT is horrible. (2, Informative)

Bigmilt8 (843256) | more than 5 years ago | (#27744687)

I currently work in healthcare IT (past 5 years). I used to work in food proccessing (3 years) and for a IT provider for various industries (banking, manufacturing, advertising) for 3 years. Of all the industries, I have to say that Healthcare is the worse. The software that hospitals purchase is extremely buggy. Software providers for IT, bank on the fact that the person making the final decision doesn't have any idea about IT. In other words, the doctors and administrators. Every vendor offers an EMR (Electronic Medical Record) in their software and they are different by company. Government oversight of this industry is desperately needed. If people knew the truth, they would be VERY afraid to go to a hospital.

Re:Healthcare IT is horrible. (0)

Anonymous Coward | more than 5 years ago | (#27744975)

What about us who have dealt with doctors and wannabe doctors and are scared from that? Not to mention the in a hospital you have increased chance for infections and from infections with antibiotic resistance. Now you're telling me the whole system is buggy?

I think I'm going to look into faith healing for the standard stuff and lead application between the eyes for anything serous and complicated.

Are you kidding? (5, Insightful)

IP_Troll (1097511) | more than 5 years ago | (#27744747)

This article reads like a lifetime made for TV movie. Heavy on emotion devoid of logic.

The author was repeated asked for his medical information, his doctor's written instructions were ignored and different departments within the hospital did not communicate. Therefore the problem is Obama's computerized data record system that doesn't exist yet.

The whole time I was reading it I was waiting for the author to tie his experience to how computerized medical records are bad. He never did, his experiences were caused by humans that did not care enough about patients to read computerized records OR paper records.

The author fails to explain how his experience proves anything other than that particular hospital is terrible and that the health professionals employed there are less than friendly.

Re:Are you kidding? (2, Informative)

Maximum Prophet (716608) | more than 5 years ago | (#27744851)

You need to read below the graph. Here's a quote:

ncoherent database design isolates patient information from one department to the next and from one organization to the next. This wastes time and increases errors because medical personnel must enter patient information into a unique view of the system that corresponded to user identity and department - this prevents one medical professional from seeing patient information input by another medical professional.

There's not much point in a computerized records system if the information can't be shared, it might as well be on paper, locked in a filing cabinet.

Re:Are you kidding? (1)

raijinsetsu (1148625) | more than 5 years ago | (#27744915)

Read up on HL7. It is THE standard for transferring medical data between vendors.

Re:Are you kidding? (2, Interesting)

Sockatume (732728) | more than 5 years ago | (#27745037)

And it may in fact be worse than keeping paper records, because computer records carry a false impression of authority in that scenario. People often believe things because the computer "says so" or make incorrect assumptions about just where that information came from.

Re:Are you kidding? (0)

Anonymous Coward | more than 5 years ago | (#27745267)

People often believe things because the computer "says so" or make incorrect assumptions about just where that information came from.

That's still not the problem in the second FA, quite the opposite in fact! The medical professionals were ignoring the information in the patient's history and trying to get everything fresh from the patient. How exactly is having the information on paper files going to prevent this attitude?

As to the specific problem you brought up, that can also happen with paper records. Any form of record can have vague or incorrect information, regardless of storage media. What you need is medical professionals who are willing and able to take all readily available information (from BOTH the records and direct patient interaction) and use their discernment to determine a course of action.

Re:Are you kidding? (3, Insightful)

IP_Troll (1097511) | more than 5 years ago | (#27745471)

Your point is irrelevant, the author's doctor gave the author written instructions that were not read or reviewed. The author had his medical information in his hands and nobody looked at it.

Don't blame the computer for human incompetence. The computer system is symptomatic of a broken communication system in the hospital, not causal.

People have the ability to speak and think, none of the health professionals in the article did that. Blaming the computer is not acceptable for their failure as professionals.

Re:Are you kidding? (-1, Flamebait)

Anonymous Coward | more than 5 years ago | (#27745025)

It's clear you idiots that moderated the above post +4, Insightful, didn't read the goddamn article either. The summary and conclusions presented by the author of the original article are spot-on. Get your Obama-apologist heads out of your collective asses and read.

Very good article (1)

js_sebastian (946118) | more than 5 years ago | (#27744753)

I know this is slashdot, but hey... I really encourage you all to RTFA. It's a near-death experience plus an in-depth analysis of the issue, with lots of links to additional information (not on wikipedia...). Worth the read.

Already a system in place - sort of (1)

taliesinangelus (655700) | more than 5 years ago | (#27744757)

There already is a system in place for medical records related to EMS service. It is NEMSIS: []

If you take a ride in an ambulance in many states, the government already knows the details of your treatment. Not meant to scare anyone - just be advised.

You know what would REALLY help lower the costs? (3, Insightful)

MikeRT (947531) | more than 5 years ago | (#27744777)

More doctors. Break the back of the AMA, double the seats in medical school and let the market do more of the talking.

The tired old argument of "fewer, but better doctors" is bullshit. You know what they call the guy who barely got through medical school the day he graduates? "Doctor!"

All of the regulations miss the point entirely. There are not enough doctors, not enough competition. Even the "evidence-based medicine" advocates miss the point about mandating "best practices" when you have people like the orthopedic surgeon who treated my mother. The man was 15-20 years out of date on certain techniques, and did them according to the way he was trained, and screwed the pooch big time. A doctor at UVA medical school had to intervene to get her back to normal.

People like that couldn't exist in other professions that are less regulated and coddled. Imagine someone only knowing C/C++/Ada circa 1995 today and trying to compete in the mainstream software development market for new development work. It's laughable here, but doctors get away with that.

Re:You know what would REALLY help lower the costs (1)

Maximum Prophet (716608) | more than 5 years ago | (#27744883)

Internet informed patients help solve this problem. Of course the Internet also helps people go off half-cocked about the dangers of vaccines and such.

Competence (0)

Anonymous Coward | more than 5 years ago | (#27744781)

In a perfect and honest world this would be a good tool.

However I dont trust the governemnt being able to pull anything off on such a scale without a) making non functional, and b) winding up writing legislation that allowis insureres and pharmeceuical agencies datamine to screw us.

Why not start cutting costs by reducing the 30% overhead provate insurance has!?

HIPAA (3, Interesting)

alen (225700) | more than 5 years ago | (#27744801)

the article did point out a lot of problems, but HIPAA is the culprit. It was passed in 1996 and took effect a few years ago. it says medical info has to be controlled so that only the people who need to know, get to know about your condition.

Any electronic data model has to be built around this. and medial people are as scared of HIPAA as other people are scared of SOX and everyone goes overboard

Re:HIPAA (3, Insightful)

GodfatherofSoul (174979) | more than 5 years ago | (#27745031)

Explain how a trusted system is some sort of IT obstacle.

Re:HIPAA (1)

zifferent (656342) | more than 5 years ago | (#27745357)

Mod the parent's parent up. HIPAA goes way over the top, or rather HIPAA implimentations are over the top as this law has health care people scared shitless.

It's not about trusted systems, it's that everyone is scared to share information when what needs to happen is more sharing. It's that the data get's compartmentalized when the physicians need as much information as they can get. Even with the records being electronic the left hand doesn't know what the right hand is doing.

Currently there are secure systems and then there are usable systems. We need to find a way to do secure and usable systems. That will take some time.

Re:HIPAA (4, Insightful)

inviolet (797804) | more than 5 years ago | (#27745153)

I RTFA, and there is a very telling reader comment at the end...

All the IT stuff is just a bunch of chaff that the consultant has to wade through to get to what is really wrong with you, which he could have gotten in a 2 or 3 minute phone call from your allergist. You may ask why this situation has developed in medicine. From my experience, your allergist, as much as he/she may care about you, does not want to have hospital privleges so he/she can have a life and therefore, while the handwritten note was, in your mind commendable, it was inadequate and the allergist probably knows that, but does not want to manage hospitalized patients.

The moral of the story, then, is that no amount of even well-organized information can compensate for a break in the continuity of care. The allergist tossed this guy to the wolves with a post-it note stuck to his forehead. The current system couldn't cope with that, and it's hard to imagine any system that could, because the hospital et. al. can't morally or legally just follow the instructions on the post-it note; they have to start from scratch.

The allergist had to know this, but dropped the ball anyway. Find a new allergist.

Re:HIPAA (0)

Anonymous Coward | more than 5 years ago | (#27745381)

I used to write software for this industry. The issue is money, accountability, and procedure not the model.

The article has a nice link to the wrong data model being used. It also talks to how people were fighting the system. Where *HE* had to track what was going in and out of the room personally or get crap treatment. Throughout the whole thing he thought his data was 'in the system'. It probably was not. That is the sort of thing they punch in/file after they have gone thru the whole floor and have a couple of hours 'down time'. So instead of his data going in right away. It could be up to 2-3 days before his data went in.

There is a strict hierarchy in a hospital/doctors office and it is followed or get another job.

Building a sane model ontop of the dreaded hippa forms is not that hard. It is getting people to actually USE the system. Then having the system TOP to BOTTOM used. Instead of a patchwork of mid 80s/90s systems all spewing forms that do not match. It is making sure the system built actually lets doctors (who can be VERY arrogant), nurses, and administrators to ALL use the system in a consistent way.

These 3 groups have opposing goals too. Administrators care about building more building and getting more money. Doctors want to give good care but only have the info that is in their brains. Nurses want to make sure everything is shuttled to the right spot at the right time.

You need to get the 3 groups to realize that the system (they built and use) is what is holding back good care. The administrators want to know how money is spent they need to give doctors the ability to buy the right things. The nurses need the system to tell them the right things to do.

Just dropping computers in the office and hoping for the best will NEVER work even if it is EXACTLY what they need. The doctors/admins/nurses need to change the way they work. This is not made clear up front so you end up with systems that hinder performance. The admins then need to do more work of data analysis. Figure out what is working and not. It means they need to stop worrying about how much a pencil costs in the front office and start worrying about why they used 200 of them in the past month. Then you can worry about how much they cost. They do not even know the questions they should be asking much less asking the right ones. They just 'know' something is 'wrong'.

Computers are a tool. If you just have a box of tools and no clue how to use them properly they are just a big box of junk.

The plural of anecdote is not data ... (5, Insightful)

Wrath0fb0b (302444) | more than 5 years ago | (#27744803)

... and here we have just a single anecdote about how the system did not work in one instance. If we are playing the anecdote game, I'm sure I can find a similar example where non-computerized health records lead to bad care. Of course, while the anecdote game is very effective at playing at human emotional response (we tend to assign more weight to a story that we can associate with a single person versus aggregate statistics), it's useless as an actual policy question.

Since every complicated system has failures, even the critical ones like hospitals and air traffic control, the important policy question is not whether it works in all instances, it's whether it produces overall better care than the system it's replacing and whether that improvement is worth the difference in price. If the new system actually reduces costs, then it's a good idea so long as it doesn't degrade care (since, ultimately, reduced cost means either more health care or more dollars to satisfy other wants).

I'm not going to comment on the data myself, since you should read the studies for yourself and draw your own conclusions.;jsessionid=7C274D08947B0625B3B540BEF2E70367.tomcat1?fromPage=online&aid=416400 [] []
  (PDF) []

PS. Of course there's no panacea for our medical problem. The question is whether EHR are better than the system we've got, not whether they represent the best possible system. The perfect is not the enemy of the good.

PPS. I have a sneaking suspicion, reading my post (yeah, some /.ers actually read their own posts before hitting submit :-P) that I will be accused of not having the proper sympathy for the guy in TFA. That's not true. I have sympathy for him as an individual, but I'm not going to let that sympathy for him cloud my judgment on the merits of a system.

For example, suppose there was a highway by you that had no center divider, just a grassy median. Suppose also, for the sake of argument, that installing a jersey barrier ( [] will lower the injury/fatality rate in accidents by a statistically significant amount by preventing out-of-control cars from going into oncoming traffic. Now, hypothetically, someone could be in an accident where the jersey barrier caused him serious injury or death (say, by flipping his car even though they are designed to minimize that chance) where the old system would have been just fine (say, because there was no oncoming traffic at the time of the accident). Does someone that still says we have jersey barriers not have sympathy for that guy? No. His death is regrettable but because we can't make a perfect road, we have to settle for the best road we can make.

The problem is that you can point to someone that's injured (and provoke an emotional response related to his regrettable accident) but the only thing the jersey barrier proponent can do is point to the statistics that say there are fewer serious injuries since they've been installed. There's no emotional resonance to the thousands of people that travel without incident each day because they don't make a good story. "Man drives to work safely" isn't news, but because it happens much more often that "Man killed in car wreck", it's actually much more important in the grand scheme of things.

We aren't privy to all the stories where EHR made things smoother, cheaper or helped prevent calamity. Largely, these will be small victories, unsung and undramatic. But altogether, they add up to a hell of a lot more than a single incident (except in the emotional resonance dept).

Re:The plural of anecdote is not data ... (1)

Maximum Prophet (716608) | more than 5 years ago | (#27745427)

I'm sure I can find a similar example where non-computerized health records lead to bad care

I've seen reports that tens of thousands of people are seriously injured or die because the pharmacist can't read the physician's hand written prescription.

I recently took my daughter to the doctor for pink eye. After he had diagnosed it, he used his laptop to send the script to the Target pharmacy without any paper in between. At Target, they know how old my daughter is, and the computer can double check that the dosage is appropriate.

not that expensive (1)

buback (144189) | more than 5 years ago | (#27744845)

it's really not that expensive. it's the retraining doctors and staff. an office that works with paper has to be efficient and highly conditioned. when you take away the paper and reorganize the whole flow of data, it can cripple what was a working system.

it's totally worth it, though. survival of the fittest. I won't go to a doctors office that doesn't use EMR.

Re:not that expensive (1)

SonnyDog09 (1500475) | more than 5 years ago | (#27745483)

Simply installing technology isn't the fix (I know...this is slashdot, and that statement is bad). The workflow changes that take advantage of the new technology is where the big problems are. a significant portion of EHR implementations that fail do so because they overlooked workflow or training (or both).

You know what the problem is? (0)

Anonymous Coward | more than 5 years ago | (#27744877)

Computers are great but the likes of IBM and Accenture and all the other d**khead system integrators can't design and build a business system with a UI for toffee.

Let's keep them, and by extension, computers, out of important things like healthcare...

Not the end of the world... (0)

Anonymous Coward | more than 5 years ago | (#27744931)

Prior to bashing an entire industry due to the fact that GE, Google, Intel, IBM, Microsoft have not put their own software into the frenzy is bull IMO.

Look at some of the offerings from leading companies, and look (or contact) hospitals that use them for EMR. You'll find a rather productive and happy group. The issues with EMR are:
1) often these hospitals/private practices are coming from a proprietary EMR solution (COBALT ftw) and are stuck in an outdated inefficient work flow (that is hard to change b/c doctors are so busy)
2) sales is eager to make a sale, and can promise delivery a bit early in relation to the amount of customizations that the CUSTOMER requests (requires) in this market highly specialized offerings are commonplace.
3) Legacy EMR systems have endless duplicates and junk records put in them to get around various insurance/billing problems forced upon the provider due to lack of insurance regulation.

To say you want to have a doctor keep everything in a paper file is the dumbest thing I've ever heard. Clearly you don't live in an area where a natural disaster could ever occur. I've moved 4 times in 5 years and am most thankful my records are highly portable and the fact that if I'm ever in need of urgent care in an area outside my town/state I'm confidant my records and medical history can be quickly and easily retrieved (and read by anyone versed in the English language.

for info on a solid EMR solution check out

Just because it's not a panacea... (1)

TomGreenhaw (929233) | more than 5 years ago | (#27744973)

Nobody should think that EMR is a cure-all, but that's no reason to not use it. It will save a tremendous amount of our money and be a major health benefit once implemented in a "good-enough" way. In IT we discredit the serurity by obscurity model, and that's exactly the kind of privacy/security we have with paper records. The government can't and shouldn't guarantee privacy, but they can sure as hell make people or companies pay dearly for their privacy crimes regardless of how they stole or used the information. We should be talking about privacy laws and standards, not nonsense about meaningless what-ifs and paranoid hysteria about misuse.

HIPAA Request (2, Interesting)

Thunderstruck (210399) | more than 5 years ago | (#27744987)

To prevent this problem, you might try contacting your regular health-care provider right away. Assuming they fall under HIPAA, you usually have the right to make requests to the provider regarding how they will handle your medical records, and who can access them. Make a request that your records not be stored in a shared electronic database.

The provider can refuse the request, but few do.

(Of course, 15 years from now, when your new doctor at General Hospital does not realize that you're the ONLY patient who still has paper records in that filing cabinet at the back of the server room, there could be a problem...)

Probes limit of representational technology (1)

tjstork (137384) | more than 5 years ago | (#27744991)

The problem with medical records is, essentially, that our present ways of representing data lack sufficient abstraction to let us manage all of the complexity.

I've worked on systems that track what goes into just -buildings- for insurance and those have enormous interoperability problems compounded by terrible standards. Just imagine what a field like "building type" could mean across vendors. I can't even imagine what a medical records system might look like, and, it probably doesn't help that the taxonomy of medical data is not well aligned for computerization, and, doctors would probably be resistant to encoding their knowledge into an information schema of some sort. But, in fairness, the domain expertise is so well, intense that one wonders if the programmer as a generationalist of information actually fails in this case.

Bottom line is, its going to take more than a push from any administration before we really get this right. We're going to need better technology, and more progressive doctors. I think what it really means is probably some funding for academic programs that examine the fusion of medical training for IT people and vice versa.. like, maybe you could be a programmer with a specialty in medicine such that you aren't a doctor per se, but you know enough about how medical information is organized so that you can represent things.

Nebraska and EHR's (3, Informative)

GeekZilla (398185) | more than 5 years ago | (#27745011)

I saw my doctor last week and was presented with a new form to sign to opt-in or opt-out of putting my records into an electronic format. Being a paranoid, tinfoil-hat wearing, "I remember Diebold voting machines" kind of nerd, I opted out. The form explained what EHR's are and espoused the benefits of them. I'll continue to rely on good old fashioned paper records for now, thank you. This is very new because I lost saw this doctor four weeks before then. They also mentioned that psychiatric information will not be stored in the EHR.

In other related news:

This 2-page PDF [] from the Nebraska Medical Association and Creighton University Medical Center dated June 27th, 2007 gives some numbers on offices that have adopted or thinking about adopting an EHRs.

If you are a Nebraska health professional or just have too much time on your hands from hiding from the pending Swine flu pandemic, you can go to this website [] whose tag-line is, "Enhancing clinical practices through the adoption of health information technology in Nebraska".

Here is a letter [] (blog entry?) from the office of the Governor of Nebraska posted on April 10, 2009 talking about the pilot EHR project in Nebraska.


I've used them both in the US & UK (2, Informative)

Critical_ (25211) | more than 5 years ago | (#27745033)

I've used electronic medical records in both the NHS (UK) and the United States. Cerner is the big player here and it is one of the most ugly, inefficient, and convoluted interfaces I've ever used. It makes some more famous UI messes discussed on Slashdot look line the Mona Lisa. For those of you who don't understand how electronic systems work and why there is so much resistance let me explain how a basic patient encounter works for me:

1. Do a history and physical (H&P) on the patient and record the results on paper.
2. Enter in pertinent information into the computer system about the type of management I want started.
3. Dictate my history and physical for transcription.
4. Wait several hours for the dictation to show up in the EMR. Until which time all other doctors and nurses must refer to my hand written notes.
5. Heaven forbid I have to call in a consultation from cardiology, GI, or some other specialty in the hospital. If I do, then we use our text-based pagers to figure out when the hand-written note has been dropped off because every specialty has to go through steps 1-4. As they follow these patients, they too have to physically recheck the chart since dictated H&Ps and progress notes take time to show up.
6. I can very easily see how a mistake could be made in drug dosing because computers are another step in the way. Plus dosages are selected via a regular dropdown box. All dosages of compounds are rechecked by pharmacy anyway. We can get quite a few calls from pharmacy if something is non-standard or rare.

The EMR is a few extra steps in the management of a patient and does not guarantee that mistakes won't be made. Management plans are checked and rechecked as are drug dosages.

The places where EMR is helpful is getting lab results, radiology results, and study-based information on a computer. However, we have several different systems for viewing different sorts of radiology films that can't be viewed in some types of EMR. Then there is the problem of making sure the COW (computer-on-wheels) we take on rounds has a working battery back and the Cerner database hasn't taken a dive into the deep end. If its all working then it's very helpful that old notes can be looked up without giving medical records a call to haul up a 10 volume chart on a chronic COPD patient we see every other week. Unfortunately, coding for billing is still a pain. The system is so complicated that professional medical coders are needed to maximize profits through proper billing to insurance companies and government agencies.

Another problem not addressed by EMR is the fact that every hospital and practice uses a different system. If I need records from an admission at another hospital then I still have to get a Release of Information form filled out and then hope to god the other hospital can fax over copies of the chart to me. These faxes are huge sometimes, completely disorganized, and at times illegible because notes are hand written. There is no electronic transmission. If I need radiological studies then I better pray the patient or ambulance brought copies on a DVD for us to view. Then we better hope a computer system with sufficient privileges and the right Microsoft Service Pack can run the disk. The NHS system tries to address this but I left long before the system was full operational.

The current crop of EMR systems aren't fitting in with our workflow and our IT teams aren't drawing up a way for us to deal with all the variety of systems we may need to deal with in a streamlined fashion. If a consulting company could come up with a system that worked from point of admission through discharge and follow-up (and billing) of a patient with "it just works" simplicity without forcing me to add tons of different steps then we'd have a reason for EMR. Until then, its just a disaster.

This is one place where a computer alone isn't a solution. We need a solution from start to finish that works with us. A government deadline won't solve this problem. However, if a consulting team made up of a group of doctors, programmers, UI designers, and device integrators/manufacturers got together to attack this problem in an Apple-esque way they'd be billionaires.

Re:I've used them both in the US & UK (1)

backwardMechanic (959818) | more than 5 years ago | (#27745257)

I have no experience with EMRs, but I am always surprised that this seems to be a big deal. What am I missing here? I have always assumed EMRs are about recording information in a way that other medics can access. It sounds like current offerings are far too restrictive. It reminds me of those hideous electronic job application sites that just don't work if your CV is slightly different to the shape the site programmer imagined. Are the packages just trying to do too much? I was about to jokingly suggest a wiki, but I'm begining to wonder why not...

How (1)

hey (83763) | more than 5 years ago | (#27745045)

I suppose electronic records are inevitable.

I wonder how it will be done do capture useful info.
If its just a PDF of a doctor's hardcopy scribbling ... its not very useful. But a list of every drug you have ever taken with dates and times could be useful. For detecting side effects.

Re:How (1)

GeekZilla (398185) | more than 5 years ago | (#27745287)

Every time I have a prescription filled that I have never had before, I always ask for a consultation with the pharmacist to go over possible side-effects, warnings and possible negative reactions with other meds I am currently taking (trust but verify). The pharmacist eventually explains that they go over that information in the computer when they are filling the prescription. So as long as I stay with the same pharmacy in the same retail chain (like Wal-Mart pharmacies) my drug history records should be available to the pharmacist. I have to call and ask that my information be transferred from one Wal-Mart to another though, it appears that it isn't a shared database. I have switched between different WM's twice and the system appears to work fine as far as patient drug history is concerned-but I haven't had a chance to actually view my records on their computer screen of course.

Having that information easily available to my doctor would also be useful because then you would have the doctor doing his personal "brain check" of possible negative interactions, a computer telling them if there are potential dangers and then the pharmacy would be doing the same thing: a mental check by the pharmacist and an "AI" check by the computer. Plus, doctors see so many people and it may have been months since I last saw him/her, I can't really expect them to remember my what he prescriped to me three months ago. Guess that's why we have medical records-electronic or otherwise.

Integrated vs. Best-of-Breed (0)

Anonymous Coward | more than 5 years ago | (#27745075)

Almost universally, the development model for the major EMR vendors has been to acquire smaller companies with "the best" niche product, and then try to stick them all together with magic glue to make a full-scale enterprise EMR. They call themselves "best-of-breed", and, frankly, it's amazing that they work at all.

But they don't work well. Since most of the components of the system started out as seperate, independent software packages, they're all reliant on seperate database backends, or they don't structure data the same way. For instance, in one major vendor's product, your primary care doc has to enter your allergies in the ambulatory module, and then if you go to the ER, they'll ask you and enter it again in their Emergency Department module. Being admitted to inpatient? It won't pull in-- they ask you yet again. It's ridiculous.

Here's the shameless plug part: there is an EMR vendor [] out there that built their own product from the ground up in the past 30 years, so it doesn't suffer this problem. KLAS (an industry rating agency) consistently ranks it #1 [] . Plus, really amazing corporate culture. [] Obligatory disclosure: yeah, I work there.

Not Microsoft (1)

hey (83763) | more than 5 years ago | (#27745081)

I think all Slashdot users can agree it would be terrible if Microsoft got in this game.
If this might happen, show me where to protest!

Re:Not Microsoft (2, Informative)

PyroPenguin (827234) | more than 5 years ago | (#27745111)

I think all Slashdot users can agree it would be terrible if Microsoft got in this game. If this might happen, show me where to protest!

I have bad news for you...they already are []

Doctors who wont use Electronic records (2, Interesting)

frith01 (1118539) | more than 5 years ago | (#27745095)

This guys rant about the medical system is more just a problem with over-worked health care professionals, and physicians who are used to doing it their own way, and has very little to do with the electronic records system in use.

One we have physicians in place that have used computers their entire lives, and are comfortable with their electronic systems then we will start to see the benefits provided by automation.

There are already organizations that are planning complete open-spec systems, it's just a matter of ensuring that the proprietary systems comply with the specifications (

It can be done wrong, it can also be done right. (4, Interesting)

goodmanj (234846) | more than 5 years ago | (#27745115)

Like all software, digital medical records can be done badly. But they can also be done right. Joe Bugajski's story is gripping, but I want to compare it with the story of my mother.

My mom was in her mid-50s when she became ill, apparently healthy but in fact hiding a serious alcoholism problem. I'll skip the details, but suffice to say that a lifetime of drinking can destroy your body's natural blood-clotting system, leading to internal bleeding. So don't drink, kiddies.

Anyway, once she was medevaced to Queen's Hospital in Honolulu, we never saw a single obvious piece of paper. Everything was recorded digitally. But the key difference between my Mom's story and Joe Bugajski's is that the data was *available* once entered. I got a chance to look over the doctor's shoulder as he reviewed her chart. He was able to look at blood tests, x-rays, up-to-the-minute vitals, every piece of data the hospital recorded, at his fingertips in seconds. And he drove the software like a pro.

In the end, my mother died, but it definitely wasn't because of bad recordkeeping software.

Medical Records MUST Be Computerized (0)

Anonymous Coward | more than 5 years ago | (#27745125)

Just look at what it did for our favorite cooking recipes! We now manage our kitchens more efficiently as a result.

My Experience (1)

raijinsetsu (1148625) | more than 5 years ago | (#27745145)

As someone who works in the medical information technology industry, I have to say that placing the blame on the software is very misleading. Software is a tool that enables doctors and nurses to better communicate by removing the cause of common errors and making patient data more readily available. The issue in the article appears to be that doctor's refused to look for the patient records, either electronic or paper.
If that hospital's CIO was uninformed enough to purchase software that does not allow different departments to communicate, then shame on the CIO of that hospital for purchasing that software and shame on the doctor's that did not go down the hall to get the records from the other department.
Having worked with Doctor's, I know that they DO make mistakes. Whether this is because they are under huge workloads (which they are, most of the time), they just do not care (I hope this is not the case), or they are lacking in training, I cannot say. However, it has been my experience that whenever a doctor does not understand a process or makes a mistake in a process, they automatically blame the software and then they do not tell anyone. This is not to say that all doctors are like this, but these are the cause of the serious errors.
The issue is not the software alone. Even if the software has bugs (and it always will) the users are ultimately responsible for the patient's care, just like when records were on paper. The software can be improved to prevent errors, but it cannot prevent the doctor from ignoring error and warning messages or from taking an ice-pick to the platters of the hard-disk.

Billing drives EMRs, not medicine (4, Informative)

margaret (79092) | more than 5 years ago | (#27745177)

I'm a resident physician, and so I've used various EMRs in different hospital and clinic settings, and they pretty much all suck in different ways. EPIC, which is based in Internet Explorer of all things, is the worst, but seems to the the one that's being adopted at the most hospitals.

The UI design is just horrible, but beyond that I had a hard time putting my concerns into words until I read an article somewhere that talked about something called "cognitive support to the physician." That is what most EMRs lack.

As a physician, I want an EMR that lets me rapidly get at important clinical information and give me targeted alerts that I need to make a decision. Instead, the systems are centered around billing and cover-your-ass medicolegal documentation. In the paper chart word, these issues had already diluted the meaningfulness of the chart. (Ever see a hospital chart - maybe 10-20% of it has meaningful clinical data in it, the rest is full of useless legal/billing/redundant crap.) Many EMRs just translate the same troubled paper chart system into electronic format, but then the ease of electronic data entry means that even more useless information is included/required, making it that much harder to find the info you really need to make a clinical decision.

I have to say that the best EMR I have used is still good ol' CRPS at the VA. It's not as slick looking as the newer ones, but the data is easily accessible and I have never had to waste my time looking up a billing code. It's been chugging along for over a decade, sharing data between hundreds of sites across the country. (And the issue in the first article about the EMR causing more deaths because you can't put in orders while the patient is en route - not an issue in CPRS, we do this all the time at our VA.)

My understanding is that the code for CPRS is open and free to anyone who wants it. I would gladly choose CRPS over the ability to type my notes with colored fonts in EPIC. They were considering adapting it for the large county hospital system where I work now, but in the end went with EPIC because... wait for it... it was easier for billing.

The current paper-based system is an outrage (2, Interesting)

grogo (861262) | more than 5 years ago | (#27745211)

I'm an MD with an IT background. I'm a Radiologist now (you can take the nerd away from the computer....), but I was a med student in the late 90's and intern for a year in the early 2000's, and personally witnessed the days of the paper charts. I worked in a large university institution in California, which has since converted to an electronic record.

Here's how an admission would go in the middle of a typical call night: I'd get called at, say, midnight to admit a patient from the ER. I'd go down there to examine the patient and admit them, which means find out what's wrong, formulate a plan of action, and stabilize them for the night.

We actually did have a primitive EMR, which held any recently (within a year or so) dictated discharge summaries -- those are a lengthy summary of what brought the patient in last time, how it was handled, what meds the patient was sent home with. Those were available to us about 1/4 of the time, and were a goldmine of information.

The remaining 3/4 of the time, we had nothing except the patient's memory (they're ill, it's the middle of the night, majority of patients don't keep track of their long lists of meds and dosages). So I'd request the patient's chart to be found. Usually, I'd hear the following from medical records:

A) The chart will be here in the morning: they're understaffed right now (they'd have 1 clerk in there at night)
B) The chart is off to some doctor's clinic from a recent visit, and hasn't come back yet. It'll be a couple of days
C) We have no idea where the chart is.

So I'd have to rely on the patient's recollection of what meds they are taking, what their medical history is, what their allergies are, etc, etc. If you've ever had to go to the ER in the middle of the night, you know how hard it is to remember that stuff about yourself, and how annoying it is to be asked the same questions by the clueless medical staff over and over again.

When I saw patients in my own clinic, it was just as bad. The records were often gone -- to the hospital for a recent admission and still being processed, to another doc or clinic, etc.

I bought a Vaio subnotebook and as an intern kept my own notes on my patients, and carried the notebook with me everywhere. I was ridiculed a lot, but I always had critical info about my patients at my fingertips.

Then I went to another hospital system for residency, and spent some time at the VA, which had an early EMR called VISTA. It was just fantastic! It had usability problems, and required a lot of typing, but it was amazing to see a patient's current medications, list of major problems, past history, etc, all instantly, integrated over hospital and clinic visits, and even across different VA systems across the country if the patient recently moved. It revolutionized care, in my opinion.

So no, it's not a panacea, but a damn sight better than what we have now in many instances!

VistA (1)

pilsner.urquell (734632) | more than 5 years ago | (#27745279)

But does the high cost and questionable quality of products currently on the market explain why barely 1 in 50 hospitals have a comprehensive electronic records system, and why only 17% of physicians use any type of electronic records?

Yea, right. The Veterans Health Administration has a computerized record system called VistA [] that is quite successful. The U.S. Department of Veterans Affairs (VA), the largest integrated health care network in the country and has been using VistA successfully for at least 10 years.

The software, being developed by the United States Government, is in both the public domain and open source versions.

I read part of the Newsweek article I and I don't have a clue what they where talking about, except wasting taxpayers money. VistA or any of the Supporters of variants of VistA software are not mentioned.

It would be great if Doctors used the computers (1)

tg123 (1409503) | more than 5 years ago | (#27745321)

When I worked in a hospital records department the computer systems for keeping records digitally were available.

I asked the boss why the hospital has not bought a system and was told "the doctors like to use paper and would not use the computers".

Different generation maybe ?


There's an opportunity here (0)

Anonymous Coward | more than 5 years ago | (#27745383)

Most EMR systems are terrible. As a post above pointed out, they're driven by accountants, not physicians. And what works for, say, a family practice doctor may not work for a physical therapist.

There's an opportunity here for two programmers, two people with medical experience, and a lawyer to create a system that will capture the entire market just by because usable by all interested parties.

Anybody want to quite whining and start fixing it?

Healthcare is the last computerization holdout (1)

brentrn (1542805) | more than 5 years ago | (#27745397)

Every other business in the world uses computers to track its business. Healthcare has used it for the financial portion of the business but has been slow to track its most important function. Healthcare at its heart is information communication. You tell the doctor what is happening, he or she makes a diagnosis and a plan of care, others in the system help carry out that plan. Electronic health records aid that communication. They also facilitate the bigger job of analysis of patient problems, care, and outcomes with larger groups of patients. With a paper system it is nearly impossible to do a retrospective analysis of care. The issue of privacy is cited but the biggest issue for the general practitioner is cost. It can be hard to see a ROI in the short term for the large investment in hardware and software. We need flexible open source xml-type language that can be then used by developers to create applications that meet the needs of individual practitioners.

Some big issues with EMR... (3, Interesting)

ErichTheRed (39327) | more than 5 years ago | (#27745401)

I agree that medical records should be electronic for the most part. However, there are some big challenges that our current IT business model can't solve:

1. How do you prevent Oracle, IBM, SAP or some other large vendor from getting a permanent lock on the market for EMRs? If this happens, a closed standard will develop and mo one will ever be able to make changes without paying mullions of dollars.

2. Opposite problem -- if there is no standard, or it's so loose that it might as well not exist, what's to prevent a million small companies from developing EMR, EMR 2.0, OpenEMR, StarEMR, YetAnotherCoolEMR, and so on? How do you get providers using different standards to share? (The answer, I think, is open protocols, but that way lies 800 MB XML files and crappy J2EE applications written by developers who don't understand optimization.)

3. Privacy. In the US, healthcare and insurance are for-profit businesses. How much do you think a life insurance company would love it if they were able to see your entire birth-to-present health history? Insurance would be even less affordable than it is now. In countries where everyone's on the hook for medical costs, privacy is much less of an issue. But when it can cost you the ability to get treatment that doesn't bankrupt you, it's a big problem!

4. The huge "obfuscated mess" problem -- Go look at the system the Veterans' Administration uses for EMRs. It was written years and years ago in a language called M, and the source code (publically available) looks like line noise. It works fine from the front-end, but I can imagine it's a disaster to administer, make improvements, etc. How do you prevent a system from getting so stale that no one knows how to modify it anymore?

From what I've read, EMRs work well for the VA, precisely because they have to keep costs lower than for-profit hospital systems. Their patients are also ex-military. When you join the military, you give up the right to privacy.

JAVA Improving Healthcare in Brazil (2, Informative)

seb42 (920797) | more than 5 years ago | (#27745413)

Brazil seem to have an amazing electronic healthcare system using Java. Maybe that pushed oracle to buy sun. [] /xml/brazil/index.html

The Author Sounds Like A Partisan Hack (1)

darkmeridian (119044) | more than 5 years ago | (#27745449)

The author loses a lot of credibility by starting off the article with snarky remarks about President Obama. ("The law makes a job for yet another bureaucrat to oversee the vast program - is this change we can believe in?") He initially attacks the creation of a standards-creating body for electronic health records ("It defines rules for health information standards by designating a new standards board - everyone desires more data standards and standards groups"), but concludes that we need to create a uniform standard for the development of an electronic health record infrastructure. It seems as though his bias overwhelms his sense.

He blames Obama's proposal before it even started because he had a bad experience. It makes no sense. His anecdote only shows that his doctors were ignoring him. That had nothing to do with the electronic health record system. His allergist wrote a memo that no one at the hospital read. That is not a failure of the EHR.

Fishy survey data (1)

peter sisk (899316) | more than 5 years ago | (#27745451)

I worked for about 20 years writing EMR systems of one sort or another. There are about 6000 hospitals in the US. The company I worked for had systems in at 1500 of them. That's 25% right there. Users generally seemed to consider their EMR's to be essential and to contribute significantly to doctor productivity and patient safety. For instance, an electronic prescription is easier to produce, much more legible than a handwritten one and checks automatically for allergies and drug interactions, rather than relying on the doctor's sometimes fallible memory. There are usable data interchange standards for medical information: HL7 for text, DICOM for images plus various specialty coding standards (pathology, etc). It is true that the standards are not perfect and also, not every vendor's information is 100% standards-compliant. Still, systems are relatively easy to integrate and are usually able to talk to one another without too much difficulty. More and better automation in medicine can only be a good thing, as far as I can tell. I call BS on TFA.
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