Electronic medical or health records (EMRs) are the computer programs now in almost every doctor’s office. They have become not a boon — but a bane — for both doctor and patient, and boondoggle to the tune of $36 billion dollars of federal (our) money. This was the assessment of a very well researched article by Erika Fry of Fortune magazine and Fred Schulte of Kaiser Health News called “Death by a Thousand Clicks: Where Electronic Health Records Went Wrong” in a 2019 issue of Fortune magazine.
And this “ain’t news.” An editorial from the Oct. 22, 2015, New England Journal of Medicine by Lisa Rosenbaum, M.D. dissects the issues of EMRs even more clearly. How many of us have been in an office with the doc and the machine with the glass knothole? Who gets the most attention, you or the computer? That is only one of the problems defined by the Clicks research. The term for these computer programs should not be EHRs, as they are sometimes called, but EMRs, because they record not just the state of your health but all of your medical maladies.
A summary article from NPR news service cited five main points made by the lengthy, in-depth Clicks piece. First was patient harm in the form or alarming reports of deaths, serious injuries and near misses (thousands of them) from software glitches and a host of system flaws. A study from the journal Health Affairs calculated 3,243 medication errors were linked to EMR-usability issues at three pediatric hospitals from 2012-2017. Some of the horror stories in the article are shocking, like a 47-year-old woman who had head pain from a brain vessel ready to rupture (aneurysm). The order for a head/brain scan was never sent via EMR to the lab (computer glitch) so it wasn’t done. She died.
NPR next lists opportunities for fraud, where the software can be used to overcharge by “upcoding,” creating fraudulent charges to Medicare and Medicaid. Two software makers have paid a total of over $200 million to settle fraud allegations. I will tell you from my experience with two different Cerner and one Epic computer programs, the up or down coding conflict is far more complex, because it involves “coders,” who read every single note dictated or typed, and charge what they think it should cost, according to their “rules.” This is in an era where privacy violations of computer charts result in firings of nurses and other providers. Charges are by diagnosis, visit time and complexity, and procedure “codes,” which the coders choose, often overrule the provider’s “clicks” (key word).
The third issue cited is gaps in interoperability between and among “systems.” The fantasy was to create a computerized medical history that would be shared seamlessly among computers. But the officials running the program permitted hundreds of competing firms to sell medical records software that was unable to exchange information with other systems! The requirements to be developed and included in the plan were too extensive to get straight in the short time frame allowed before implementation.
The fourth failure was the creation of an incredible time and training burden for doctors to learn the operations, act as data input clerks, and still pay attention to the patients’ problems. Negatives listed from the 2015 editorial included hours consumed by burdensome data entry unrelated to patient care, small practices bankrupted, massive intrusions into the patient relationship and physicians burning out and retiring early. “No other industry has been under a universal mandate to adopt a new technology before its effects are fully understood, and before it has reached a level of usability acceptable to its core users.” No computer company has come to docs to ask them what they need. One study showed that of an 11.4 hour workday, 5.1 hours were with patients and 5.9 with the EMR.
The fifth problem listed a web of secrets, meaning the sellers of the electronic records have imposed contract language that constitutes a “gag clause” to prevent the buyers of the product from speaking out about the safety issues that arise from the disastrous software designs and installations. Some hospitals resist giving and withhold records from injured patients and families. Joe Biden, vice president when the EMR bill was signed, later railed against the infuriating challenge of getting his son Beau’s records from one hospital to another for his stage 4 brain cancer.
Seema Verma, the current head of Centers for Medicare and Medicaid Services, was with her doctor husband, when he collapsed at an airport in 2017 after a vacation. She spent hours calling his Indiana doctors to piece together his records, which should have been in one place. This exposed the grave dangers of the current flawed systems.
Another negative point reported by the TV program “60 Minutes” is ransom-ware viruses. These have been attacking many hospital systems with threats to wipe out all EMR records if money isn’t paid.
Lastly, from the journal editorial, “The purpose of widespread EHR adoption, as envisioned by the Obama administration, was to permit a transition from volume based (how many patients seen) to a value based system.” What the computer note would say dictated the quality of care and level of compensation. My personal bias is and always has been that the bloody mess was contrived by the medical insurance companies so they could pay doctors less and their shareholders more. I could be wrong — or not.
Oh, yes. The Clicks article cited an emergency room study which showed 4,000 computer clicks was the average an ER doc makes over the course of a single shift. If it is death by a thousand clicks, would they lose four doctors each shift? Time to shut it down, clickety-split.
Photo courtesy of: Winona Daily News
Originally Published On: Winona Daily News
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