Electronic medical records

A recent letter to the editor in the Wall Street Journal got me to thinking. Quite an extraordinary feat I admit.

The letter was from a physician who was providing the other side of the story when it came to electronic medical records. His point was that there is a large cost, time and effort in converting patient records and changing physician behavior. Further, entering data into a computer may be far less efficient than hand writing in a patient’s file.

Those of us who are addicted to laptops, iPads and assorted other devices must admit he has a point. As I type this on my iPad there is little doubt I could write it out on a piece of paper faster than hunting and pecking on a touch screen keyboard that can be extremely frustrating as I hit the adjacent key or miss the space bar or the intended word is automatically replaced. I avoid the word flock if at all possible.

On the other hand that piece of paper won’t allow me to check spelling, file it for instant recovery or most important send my words of wisdom to virtually anyone anywhere in the world in seconds. The doctor admitted that over time using electronic records will become more routine, especially after the initial conversion. But for that to happen physicians must invest in and routinely use something other than a laptop with someone transcribing written notes. They must use a smart device as they would a piece of paper with their notes, orders, etc. automatically entered into the data base in one step.

However, all this interest in getting doctors to use electronic records is only half the story. While that objective is valid, it does not address the real issue of transferring information among doctors and other medical facilities. Individual doctors with electronic records is just the start of the required journey.

My very best friend has several doctors and health care professionals; dermatologist, oncologist, plastic surgeon, internist, rheumatologist, gynecologist, otolaryngologist, chiropractor, acupuncturist and podiatrist. None of them talk to one another, they don’t know what tests, scans or x-rays have been used (nobody is concerned about doses of compounded radiation from multiple scans and x-rays); they are unaware of prescriptions each has ordered, (thankfully the pharmacy benefit manager monitors for adverse interactions regardless where a prescription is filled). It is generally up to the patient to make each doctor aware of this information. Many, if not most patients, are ill equipped to deal with this especially when also coping with multiple or serious health issues.

When data is exchanged it is via a letter or fax often not as a matter of routine, but upon request. . . and we think we have the best health care system in the world. This lack of accessible central patent records is inefficient, costly and at times outright dangerous. The growth of accountable care organizations and consolidation of medical groups may help if they have a common data base, but even that is limited success.

In this world of high tech where I get an e-mail three seconds after charging gas, can deposit a check with my phone or create a pdf file by taking a picture to e-mail and every time I use WiFii or a cellular network scores of systems know exactly where I am, you would think electronic medical records in a single database would be a no-brainer. While we fight over stupid stuff like free contraceptives and donut holes and medical loss ratios, we miss the major issues and opportunities that truly can save money and improve health care quality.

Reaching this goal is no easy or inexpensive task, some countries have tried and given up. We must start somewhere even if it is only on a prospective basis building a system that initially sets up a common data base for each newborn.

We hear a lot of talk about infrastructure these days. Given health care is the single budget item likely to bankrupt the U.S. and many companies in the years ahead, it would seem that investing in the health care infrastructure has a higher return than high speed rail between two cities or paving roads for the sake of spending money.

Here is an opportunity for a public private partnership funded by taxes, insurers and health care providers (and ultimately consumers) all of whom will benefit from a functioning integrated health care record system.


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