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March 15, 2013 Readers Write 7 Comments

Not Safer!
By Ruth Bowen, MBA, CPHQ, CPHIMS

I’m an HIT professional in Philadelphia who lives in an area that supports multiple competing health networks. I am old enough to have a robust problem history and to have records that span multiple networks.

Having worked in this industry for 30 years, I am definitely a believer in the potential of EMR systems. But frankly, I am less safe.

All of my outpatient providers went from paper to a digital record. There wasn’t an opportunity for a conversion. Each of these practice systems took a different approach in terms of what data would initially populate the EMR. There are no standards here, only guidelines. There can be significant expense in terms of abstracting data from a paper record. Much of the data available in my paper records has just disappeared.

In one case, the paper record was simply scanned. I arrived for a visit with no problem list and no medication history and was treated as a new patient. The practice was dependent on my memory of events over 10+ years. In other cases, there was a subset of data, but in each case, most of the history was unavailable. The paper chart may have been scanned, but physicians do not page through images of paper record, so I consider the information unusable.

None of these EMR implementations has an interface from the laboratory system I use. In most cases, a subset of available laboratory results is transcribed into the electronic record. Although the physician also has a copy of the current paper lab results at the time of visit, the history of results in the EMR is incomplete and likely has transcription errors.

One of my physicians used to manually maintain a paper flowsheet for a subset of results significant to his specialty. That history is gone. His system doesn’t support the view he formerly had and there is no historical data that could populate a flowsheet or graph even if the capability was available.

The result is an increased personal safety risk related to multiple EMRs that are incomplete, each with a different subset of data. As it turns out, my responsibility in terms of patient engagement is record reconciliation at the time of visit, a reconciliation that is totally dependent on my memory. Not, I think, what ONC intended.

Ruth Bowen, MBA, CPHQ, CPHIMS is an independent HIT professional in Chesterbrook, PA.

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Currently there are "7 comments" on this Article:

  1. “The paper chart may have been scanned, but physicians do not page through images of paper record, so I consider the information unusable.”

    I am confused by this assertion. If the clinician was previously looking at paper records, what is the obstacle to looking for important pt care data from those self-same paper records in a scanned format? This sounds like a straw argument against the digitization of medical data, and possibly a rationalization and justification for lazy or (more probably) overbooked, clinicians. I agree that the ideal is to migrate this data into the relevant fields in the EMR, which is currently technically challenging (read expensive), but if the data is important, then one needs to look at the scanned documents (allergy list, problem list, med list)…end of story. While not terribly usable, it is far from useless. And it would be medically inexcusable not to look at data because it was in an inconvenient format.

  2. Did you ever look at a system called Shareable Ink, It uses a novel approach to the capture of data. Their system takes the written form and converts it to structured data. Then moves it into an EHR, or downstream to billing, or to a repository.
    Take a look at their web site.

  3. @Dizzay MD

    It is quicker and efficient to leaf through pages than it is to look at a screen, one page at a time, in which there is not ANY search function.

    She is righteous in her opinion, and, your attempt to denigrate it is obviously defensive.

    These devices, and the alteration of work flows that they cause, is UNSAFE.

    The care can not be trusted under such circumstances, which is commonplace, btw.

  4. I guess all I can say is I look at scanned documents every day (Cerner Millenium) in the performance of my clinical duties (Hospitalist), and I don’t see how it is difficult, intrusive or unsafe. The scanned documents are in clearly labelled folders that are easy to navigate and are about as difficult to sort through as any standard PDF file. If I came off as belligerent, I apologize to the author and to clinicians who may think otherwise.

  5. When my PCP went from paper to electronic the person who was doing the work couldn’t find the correct dx for my spinal cord tumor (which was benign & removed) so they went with a cancerous dx. This was done wtih numerous people were working to get the paper charts into the system when the implementation occured. Who ever is doing the abstracting needs to be knowledgable with what they are looking at. I do not have cancer & really don’t want that in my record.

  6. I think that the key information to take away from this article is that moving forward, in the future of the digitization of health records, it is important for EMR and HIE companies to be cognizant of the fact that true interoperability is necessary between all platforms, as well as making all of the data (past and present) actually usable to the physicians.

    Like Ms. Bowen pointed out, this interoperability needs to include the laboratories and their results. And the data collected from all sources needs to be in a form that the physicians can see quickly – in order to reduce their time spent, but most important – to reduce medical errors!

    There are companies out there that do this. Because of how fast the industry is moving, they do not have the notability they deserve yet.

  7. My take on Ruth’s article is that the EHR program to which she refers was not implemented thoughtfully and lacks interoperability. If I were to become argumentative, I would say that my experience as a patient with my doctor using paper records is that s/he never could remember or find my past records anyway. I have always had to verbally list my previous visits and the diagnoses and treatments that went before. I switch doctors frequently, and I’m pretty sure no one’s got any of my records from more than a year ago, or at least they are unlocatable.

    @Dr. McItkin, the problems you have had with your EHR might just be because it is a poorly designed EHR. Of course there should be a search function for you.

    We have read the articles that many are dissatisfied with their current EHR and would like to change. This may be because there was not enough care taken to analyze the needs of the clinicians and how the EHR would fit in. Admittedly, no one feels they have the sort of time to really do a thorough workflow analysis and a thorough investigation of various EHR products, but it is even more time consuming to go through the process all over again in a couple of years, not to mention expensive.

    I believe the best, last, line is that this is not the vision of the ONC. I found the ONC’s Healthcare Workforce program extremely enlightening, and Ruth was one of the best teachers in my coursework. Following the ONC’s guidelines and structures, instead of applying a “quick fix”, may help practices avoid using a clumsy and disruptive EHR program. As a patient, I look forward to interoperable patient-centered health records that also make the clinician’s duties easier, but I won’t expect it to appear in my immediate future.

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