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Medicine Technology

Why Electronic Health Records Aren't More Usable (cio.com) 117

itwbennett writes: There are plenty of things wrong with Electronic Health Records (EHRs), writes Ken Terry. Among them: 'The records are hard to read because they're full of irrelevant boilerplates..., [a]lerts frequently fire for inconsequential reasons..., and EHRs from different vendors are not interoperable with each other.' But those are all just symptoms of the underlying (and unsurprising) problem: '[T]hey are designed to support billing more than patient care.' A recent study (login required) found that, of 41 EHR vendors that released public reports, fewer than half used an industry-standard user-centered design process. This despite a requirement by The Office of the National Coordinator for Health IT that developers perform usability tests as part of a certification process that makes their EHRs eligible for the government's EHR incentive program.
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Why Electronic Health Records Aren't More Usable

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  • Uhm, greed? (Score:5, Insightful)

    by BitZtream ( 692029 ) on Friday December 04, 2015 @09:21AM (#51056143)

    They aren't more usable because anyone who deals with them wants to use their own proprietary format, which they of course work with absolutely no other companies to share or interoperate with.

    Until the government steps in and actually does its job, digital records are worthless to the patient.

    This is what happens when companies lobby for stupid laws like we have now ... things like 'requiring X% of your patients use your patient portal ... which means that I don't have a choice any more about my medical records being online ... because now every doctor basically FORCES it ... so they don't get fined for not having X% using their patient portal ...

    Instead what happens is I have fucking spammers calling me about my god damn 2 year old son because my pediatricians shitty web portal had less security than swiss cheese and was hacked, of course it also took involving a lawyer to even get them to admit to the fact they had a damn data breech ...

    And all of this has nothing to do with you getting your records easier, it has to do with companies like AllScrip and its ilk lobbying and buying off congress to get stupid laws passed that do no good to patients but make a fuckton of money for some shitty industry that shouldn't even exist in the first place.

    The reason medical records in digital form are useless is the same reason that Obamacare is a big pile of shit. Its not about the people, its about how entrenched corporations can make more money faster by making you a customer that doesn't have a choice in being a customer, you are required to buy their service no matter how shitty it is.

    Its like your ISP except worse. You can choose to simply not have an ISP. You can not choose to not have your medical records online and you can not choose to not pay for bad insurance.

    • by Anonymous Coward on Friday December 04, 2015 @09:56AM (#51056301)

      about my god damn 2 year old son

      Did you try having him baptized?

    • Re:Uhm, greed? (Score:4, Interesting)

      by cayenne8 ( 626475 ) on Friday December 04, 2015 @10:00AM (#51056319) Homepage Journal

      it has to do with companies like AllScrip and its ilk lobbying and buying off congress

      Sounds like the deeper problem, and the solution, would be to somehow BAN all Lobbyists!!!!

      I wonder if there would be any way to do so...without stamping on freedom of speech issues...?

      If nothing else, maybe make the requirement to meet with your congress critter, it HAS to be in their home state, AND it has to be public, no private meetings?

      That, at least...might help...?

      • by mspohr ( 589790 )

        Follow the money.
        The US has an oligarchy controlled by rich people and corporations. They pay for the laws they want.
        Your vote doesn't matter. All politicians (except Bernie) are on the take and will pass any law you want if you pay them.

        • by KGIII ( 973947 )

          You say that and, at first blush, it appears likely to be true. So... Let me further state that I've accumulated a few bucks and have been told that I'm "rich." (By some degree, I am.)

          Now, I want a law that lets me, without penalty, dance naked on the White House lawn during press conferences that occur on even numbered days. I also want to be able to drive to that event backwards while openly smoking meth wearing nothing but leather chaps and a crash helmet. I think it only fair that I be forced to pay for

          • by mspohr ( 589790 )

            I can see that you are a neophyte in these things (being newly rich).
            Here are a few pointers to get you started.
            First, you may not even need a law. If you are a rich and white, the oligarchy will just let this behavior pass as eccentricity and you will probably get away with it with no consequences. (However, if you skin is darker than lily white, absolutely do not try this as you will be executed on sight.)
            Second, it you want to make this legal your best best to to bribe a single congressman who will quiet

            • by KGIII ( 973947 )

              Sadly, I now do nothing but invest. I don't even do short-term investing (the taxes are kind of high if I do that and I make more doing it my way) and I truly don't even know what I'm doing. Now, even if I did worse than what I'm doing, I have a financial manager who does slower growth, diversity, and stable investments on my behalf. I have a lawyer (two actually and a third on retainer) and an accountant who is a retired State IRS employee.

              Why do I say that? Well, I now make more money than I've ever made

              • by mspohr ( 589790 )

                You're not greedy.
                Most people are not greedy.
                There are, however, enough psychopathic people who are greedy and exploit the system. It's not an organized cabal, just greedy individuals and corporations. Corporations are (almost by definition), psychopathic so they don't have to feel guilt about bribery and greed. It's just normal business.

        • >Your vote doesn't matter. All pol..
          Bothered? Get your checkbook out. (Someday you will be able to use BTC)

      • If nothing else, maybe make the requirement to meet with your congress critter, it HAS to be in their home state, AND it has to be public, no private meetings?

        That is the best idea I have ever heard of to combat this issue. I am actually a bit ashamed that I never thought about it. The only things that I would add are far stricter bribery laws and rescind the law that allowed them to indulge in insider trading.

    • Re:Uhm, greed? (Score:5, Insightful)

      by TheDarkMaster ( 1292526 ) on Friday December 04, 2015 @10:00AM (#51056323)
      This is real capitalism for you. The model of the books is nice, but the version used in practice is shitty.
      • by jon3k ( 691256 )
        Healthcare in this country is the opposite of capitalism. It's arguably the most regulated industry in the country.
        • by mspohr ( 589790 )

          ... but it's "regulated" by the corporations (pharma, hospitals, doctors, insurance) who have successfully accomplished regulatory capture. They own the government and run it for their profit.

    • Actually EMR are shit because of the government... and yes, corporations. I'm in Canada. EMR are still shitty here.

      I worked in the field and got out as soon as I could. It's a whole stinking mess.

      The number one problem is that everyone (government, insurance, scientists...) main concern is easy categorization. It's just a freakin hard problem to solve. If you thought tech standards are hard to create, just imagine EMR.

      Really, if we look at it from a use-case patient perspective.
      What would work is simply thi

      • by Kjella ( 173770 )

        Really, if we look at it from a use-case patient perspective.
        What would work is simply this:
        1. A container to hold doctors notes in image/pdf/something format
        2. A medical history of things you'd need to know if you end up in the ER. Current medications/allergies...

        To expand on 1. they really should understand you can do more than one format, like PDF/A for display, text/plain for full text search and whatever structured format you want. The one format to rule them all will never fit.

  • No kidding! (Score:5, Informative)

    by Anon-Admin ( 443764 ) on Friday December 04, 2015 @09:25AM (#51056155) Homepage Journal

    I am my no means an expert on EHR. However I have dated a couple of RN's and have several in the family.

    What I can say is that who ever develops this crap does not seem to ask the Doctors or RN's how they do there job.

    There was a different 15digit code for every procedure, option, action and the RN had to key each in for every step and often had to click a "yes that is right" box or have a Dr come over and acknowledge that yes that is the correct prescription, etc. Im not talking about new prescriptions, Im talking about standard daily doses given in a care facility.

    In every case it took 3x longer for them to do the computer entry than it did for them to do the job and add written notes to the charts. Every RN I know complains that it is cumbersome, time consuming, and takes away from their time caring for the patients.

    It really reminded me of some of the time keeping systems I have used. Ones where Accounting laid out the system so you had to enter the time code for each task in no smaller than 15min increments and you had to make sure every min of your day was accounted for.

    • But they ran tests! That means everything must be perfect, and what doctors think is pointless! Right?
    • by Anonymous Coward

      My wife is a radiologist, and we've discussed this. They're having to cover their asses thanks to the litigious society, and the blame-game culture. It has come from above, probably govt or the board. As a dev, I find it bizarre and incredibly inefficient, particularly when you're effectively wasting specialists' time. Having lived both sides of the Atlantic, I can tell you both the US and UK are wasting resources on this, the UK is particularly bad, where resources are already limited.

      • Re: (Score:2, Interesting)

        by jedidiah ( 1196 )

        Bullshit. Time entry and coding is not nearly as important as the f*cking final lab report when it it comes to radiology. Are you competent to read the scan and not KILL someone in the process.

        THAT is the liability issue with a radiology department.

        Did you miss the cancer that managed to migrate into someone's lymph nodes from their kidneys?

      • by Anonymous Coward

        The UK is far better than the US, if you go by life expectancy, spending per capita on healthcare, and spending on healthcare as a percentage of GDP.

        Its ironic that the NHS is considered one of the worst nationalized healthcare systems, yet if US healthcare costs dropped to NHS levels, every US politician would take credit for the vast amount of savings.

        • Only if you're using each countries metrics (hint, they aren't the same). It also might be indicative that medicine doesn't actually work as advertised. You might live longer with cancer if you forego radiation (because you can't see the doctor, long lines). But how many people want to do nothing when they have cancer, even though that might let you live longer?

    • at least with time keeping system when you put down like 30 min a day just for time keeping then the PHB's get a clue.

    • Re:No kidding! (Score:5, Insightful)

      by Anonymous Coward on Friday December 04, 2015 @10:15AM (#51056425)

      I've developed an EHR system for a small clinical company, and one of the biggest hurdles is preventing mistakes. The prompts for, "Yes, that's what I meant to do," are almost necessary because of industry standards like ICD9 (and, fuck, ICD10 now).

      One digit wrong can mean a completely wrong diagnosis, which means completely wrong tests, and completely wrong results. The patient's life can depend on the right information getting in there.

      So, when developing these systems, we have to balance usability vs preventing errors. Once a system becomes too easy to use, people just start whizzing right through it like it's nothing; second nature. That's when they overlook things, like the fact that they entered 129.4 instead of 128.4, which is prettin' similar at a glance.

      It's this way for most applications, and not just EHRs.

      Having worked for three different health organizations, I find that breaking the task apart is more accurate, but also requires more workers. So, now you have to consider privacy and security into the application design. Doctors require as much info about a patient as possible; RNs possibly less; data entry operators (medical translators, included), require far less. And those people at the front desk, the phlebotomist, who collect pee/oral swabs for testing... need far less.

      There are so many factors to consider: reflexes on tests. What to do with positive STD tests (it's required by law in most states that an HIV positive patient is notified directly and almost immediately).

      People think developers of these systems are the problem, but the real issue is two fold, and it has very little to do with accounting. What it has to do with is ensuring people don't fuck things up for a patient to the point that cancer is diagnosed as low cholesterol or something far less severe... and then the patient drops dead a year later... all because someone had the incorrect keystroke, of one-fucking-character.

      Doctor's don't like to spend their time using EHRs because they already know their diagnosis, recorded it on paper, and need to move on to the next patient. They're already pressured, as there is indeed a shortage of doctors, not just other medical professionals / specialists.

      If EHRs are truly going to be fixed, we need a lot more people, and a lot simpler standards and coding systems. The recent ICD-10 standard that was just switched to two months ago... has throw down the fucking gauntlet holding a monkey wrench.

      • How many modern digital test devices which would push out a number like 129.4 don't provide a standardized way to directly output that to the EHR? Are there even standards to directly couple the EHR to devices running tests?

        In an ideal world digital data wouldn't make a sidestep through manual data entry.

        • by Altus ( 1034 )

          ICD9 codes are codes for problems, not measurements.

          Lets say you come into the doctors office and you have a headache, or a stab wound, or a hernia. All 3 of those have distinct ICD9 codes. Mistyping the one for "headache" might give you the code for "stroke."

          Certainly devices should go straight to the EHR, I used to work for the largest medical device manufactuerer in the US in a division that made an EHR, we spent a lot of time on that... it was a nice looking EHR with a slick interface but still had a

          • by Anonymous Coward

            Lets say you come into the doctors office and you have a headache, or a stab wound, or a hernia. All 3 of those have distinct ICD9 codes. Mistyping the one for "headache" might give you the code for "stroke."

            Well, there's your problem. If you want to type in "headache", you should be able to type in "headache" and not be forced to type in something like "129.4".

            That goes back to what the GGGP was saying - the systems aren't optimized for the users. "Accounting will bill by ICD9 codes. Therefore, we should require the nurses to type in the ICD9 codes." Simple, straightforward, and wrong.

            Sure, you can reduce errors by adding a conformation screen, but you can also reduce errors by not making the user go through c

            • by Altus ( 1034 )

              I totally agree. But when the decisions on purchasing are mostly made by the accounting department the needs of doctors falls by the wayside. After all this system costs money and billing is key (especially where insurance companies are involved.)

              Sadly the customer isn't who you would expect it to be. The customer isn't the doctor or the nurse. The customer is the administrator and they want a cheep solution that gets them tax credits and makes billing easier, bringing in more money.

              Companies that make soft

          • In my opinion the human interface for that should always be plain language first and code second. It's almost impossible for them to screw entering text other than misspelling, it's trivial to mess up the code (or code selection from a list).

            Let them type the plan language description, do a lookup of potential matches and let them pick the code from those (99% of the time). Of course you'd keep the original plain language entry too, so it could always be double checked by someone else.

      • by ranton ( 36917 )

        That's when they overlook things, like the fact that they entered 129.4 instead of 128.4, which is prettin' similar at a glance.

        Ha, that's a minor problem compared with entering 428.4 instead of 128.4, which is quite easy to do.

      • Seems like a perfect opportunity for some kind of AI. Not to diagnose, but check and constrain.

        Why should the pregnancy code be shown or be valid for a 17 year old boy or an 80 year old woman A basic, rules based AI can help catch errors that may not be so obvious because they are one number off, but glaringly obvious because it's impossible or highly unlikely for a patient.

      • Re: (Score:3, Insightful)

        by Anonymous Coward

        One digit wrong can mean a completely wrong diagnosis, which means completely wrong tests, and completely wrong results. The patient's life can depend on the right information getting in there.

        Sure. But this was true before electronic records too. If nobody asked these questions when filling out paper forms - then the questions are not needed for the digital version either. It is the patients life either way - and it worked before.

        Next, what idiot thought it was a good idea to enter codes anyway? The patient takes a HIV test, not "test 129.4". The patient may need "valium", not "drug #132667". And so on. Codes may have their places in the system's internal workings, but no need to expose that to

        • Sure. But this was true before electronic records too. If nobody asked these questions when filling out paper forms - then the questions are not needed for the digital version either. It is the patients life either way - and it worked before.

          And it works better now. Every department, let alone every hospital, have people whose job is to do nothing but make sure that the process and results are better now than before. There is a lot of money in making things better even without talking about lawsuits. The main thing that nurses, and especially doctors, need to realize, is that they are not the only people who make the hospital work. They may have to open that second window and spend three seconds clicking the right button or filling in a field.

    • Re: (Score:3, Interesting)

      by YrWrstNtmr ( 564987 )
      Yup. Some years ago, my ex-wife and daughters were LPN and CNA. A couple of them worked in an elder care facility.
      Proclamation came down from on high that they will be using a new touchscreen system to log patient interactions.

      Said touchscreen was mounted flat to the wall, at a height usable only for someone about 5' 9" or taller. Of COURSE most of these women were not that tall. In addition to the multitude of clicks and verifications to log one scrip or treatment, they literally had to get a stepstool to
      • Yup. Some years ago, my ex-wife and daughters were LPN and CNA. A couple of them worked in an elder care facility. Proclamation came down from on high that they will be using a new touchscreen system to log patient interactions. Said touchscreen was mounted flat to the wall, at a height usable only for someone about 5' 9" or taller. Of COURSE most of these women were not that tall. In addition to the multitude of clicks and verifications to log one scrip or treatment, they literally had to get a stepstool to use the damn thing. Safety? What's that?

        As somebody who deployed those touchscreens, the most likely cause was that engineering was given no or the wrong specs for setting them up, followed closely by some 5'10" doctor wanting it mounted so he could easily use it, and thirdly, but not uncommon, nobody ever bothered to ask for them to be lowered. There we no shortage of times when some nurse would talk about the years of agony on such a set up while I was dealing with another issue, and I'd just pull out a hex wrench and lower everything on the Er

    • by Anonymous Coward

      That is by requirement. One of the promises of EHR system is to eliminate death due to human error. If checking it 3 times does that, then that is how it will be implemented. Sorry it is not meant to mimic how things are done now, it is meant to do things how policy makers want it to be run.

      There are also a lot of other KYA considerations. The vendor making them system has to ensure that they are not on the hook for anything if there is an audit or subpoena, so they must log EVERYTHING. I am surprised

    • What I can say is that who ever develops this crap does not seem to ask the Doctors or RN's how they do there job.

      It wasn't designed for RNs and Drs. It was designed for analytics for better cost tracking. The problem is, they aren't tracking the real costs (extra office help needed to input all the data that is not needed). I was at the Dr's office yesterday, and the doctor had basically a secretary in the room documenting everything on the EHR system. They spent more time on inputing required but useless data than they did helping me. Ten minutes helping me, 30 minutes each on the computer putting in the records. Tel

  • Seems right - the US cares about everybody getting corporate-provided insurance, not healthcare, so it only makes sense that the systems suport that.

    The models [tomwoods.com] where so-called insurance has been abandoned are where the costs are lower and the care level is higher.

    • The models [tomwoods.com] where so-called insurance has been abandoned are where the costs are lower and the care level is higher.

      If you're going to link to a long podcast without a transcript, you ought to at least summarize the point you are trying to make so people don't have to suffer through it. Are you promoting a single-payer system there, or do you have something different in mind?

    • by DarkOx ( 621550 )

      the US cares about everybody getting corporate-provided insurance

      No they care about all of us participating in some corporate health management scheme, independent of if we need to or not and with the primary focus on profits for the companies with best lobbying capability. Any focus that does exist on 'outcomes' is all based on dubious game-able statistics and not on if anyone is actually satisfied with their care.

      Finally lets remember what Obamacare really did. It did not expand access to insurance. I wish people would stop using that word. It expanded/required a

      • Finally lets remember what Obamacare really did. It did not expand access to insurance.

        That is 100% incorrect. It absolutely did expand access to health insurance to millions of people. Prior to the Affordable Care Act millions of people literally could not buy reasonably quality health insurance outside of their employer. Losing your job generally meant losing your health insurance as well. More people have health insurance not than before the Act. QED it expanded access to health insurance.

        It expanded/required access to health management. If anything Obamacare made actual insurance in the traditional sense of what insurance used to mean illegal for all practical intents.

        Complete nonsense. It imposed penalties for not having health insurance but in no way shape or f

        • Everybody has to use health care so having a system where some people don't or can't participate is a broken system.

          Participation ability hasn't changed. The indigent were never excluded from healthcare. It is one of the reasons why Emergency rooms were filled with coughs and sniffles.

          The system is being torn apart trying to get everyone "insurance" to a system that can't handle more load. And the inefficiencies of man in the middle overhead and government interference is really starting to kill what was top of the line Medical System, and replacing it with third world crap.

          If you like European Healthcare, you should mov

    • by mwvdlee ( 775178 )

      What replaces the insurance in these models?

  • Does this mean the certification program doesn't include some sort of standardization/interop requirement? What the hell is the point of the dang things if they're in incompatible proprietary formats?

    Is this just another example of well-intentioned government action backfiring through sheer incompetence? Did the bill's authors just assume that digitizing the records would be it? Did they even consider establishing a standard? Were any requests for proposals even issued?

  • Everything in the system is set up and optimized so that the insurance companies run most efficiently.

    .
    Patient health is merely a conduit to profit for the insurance companies.

  • by silas_moeckel ( 234313 ) <silas@@@dsminc-corp...com> on Friday December 04, 2015 @10:02AM (#51056345) Homepage

    The VA figured out a universal export that others have picked up. But you can not import to most of them.

    Fun issues like well you only see lab work done by x y or z even though that doctors office has the results in there electronic system. For those of us that detest quest it's fun.

    Some you can export calendar events some even have a calendar you can link to. They still insist on robocalling to remind you till you press a button to let them know you got said robocall.

    You can send emails etc, one took more than 30 days to notice the message and get back.

    Healthcare in this country is still working on voicemail and faxes. If the government wants to provide incentives it should be to connect to the provider of the patient's choice for all medical and related scheduling information the existing va blue button XML format is a good basis to start with. Make it clear under the law that all patient records data etc are the patients property and make not be resold etc without explicit consent every time.

    • by Anonymous Coward

      Nthing this.

      I've had to work with several EHRs, both public and private, and the VA system BY FAR was the most usable, not by virtue of it being ideal realized, but everything else out there sucks that badly to a point paper records were kept on top of the EHRs since vital information couldn't be associated with each other the way it is actually used. The paper records became the most accurate source, which raised hell when being accredited.

      Right now I work with a a newly developed government system that is

  • by VDM ( 231643 ) on Friday December 04, 2015 @10:25AM (#51056475) Homepage

    The study described in the web page accessible from the login-protected link (which is not the primary source) has been published on the Journal of the American Medical Association: http://jama.jamanetwork.com/ar... [jamanetwork.com] (protected too, but at least is the real thing).
    Here the AMA news release about the results, sufficiently informative: http://media.jamanetwork.com/n... [jamanetwork.com]

  • This despite a requirement by The Office of the National Coordinator for Health IT that developers perform usability tests as part of a certification process that makes their EHRs eligible for the government's EHR incentive program.

    "We did perform usability tests. We found it unusable."

  • by Anonymous Coward on Friday December 04, 2015 @10:41AM (#51056559)
    Resident MD here and use EHR extensively. They are a royal pain in the ass for even daily users like me to read, due to things like:

    1) Lack of standardized reporting format. There is extensive variability between records from not only different hospitals, but different departments within the hospital. Different companies uses different formats, which of course aren't interoperable (probably by design).

    2) Lack of streamlining for user experience. There is a lot of "unnecessary data" that a user sees, whether you're a physician, nurse, patient, lab, lawyer, etc. Imagine your car's dashboard spewing every OBD sensor data on the dashboard. Is it important? sure or maybe. Does every one need to see every bit of generated data? certainly not.

    3) Lack of instantaneous access. Patients have the right to see their data more easier than: figure out the process for records at each provider > submit a records request at each provider > receive 10-1000 papers > sort through #2). Physicians deserve be able to access their patient's data relatively fast even if the patient went to a different hospital system (say traveled to a different state for thanksgiving), without having to call the office > find out the fax number > fax a request (find the patient to sign the request) > wait for 6 hours to several days while the recipient processes the request. What do you tell the patient while they are waiting in your office? Banks manage to do both #1 secure financial data and #2 make instantaneous transactions, but healthcare IT is lagging.

    The way it currently stands, EHR system is a net negative experience practices, and in some cases outright dangerous (think of missing important information with data overload). The hope among physicians is that as the technology matures, the problems will get worked on and turn EHR into a net positive.
  • by pr0t0 ( 216378 ) on Friday December 04, 2015 @11:04AM (#51056691)

    There is a standard for transferring medical information between and within medical facilities called HL7, or Health Level 7. It's a fairly simple text protocol with fields designated for particular types of data separated by pipes ( | ). Those fields are sometimes then further divided. This standard is meant to ease the flow of data between disparate systems. Within a hospital you may have a radiology information system (RIS), an EHR or EMR, practice management software, scheduling software, PACS archive, lab software, interface engines, emergency department systems, and a whole host more. These are systems are made by niche companies you've never heard of, and large corporations that everyone's heard of. All of these systems need to talk to each other to some degree.

    Here's the dirty little secret that makes my job more difficult...

    NO ONE FOLLOWS THE STANDARD!

    Seriously. Here's how a call between me and a vendor might go (simplified):

    Me: Where is the scheduled datetime?
    Vendor: It's in field C.
    Me: But that's where the observation datetime should be. So where's the obs time?
    Vendor: Oh that's in field A.
    Me: Field A is for completed datetime. So where that then?
    Vendor: We put that in field B.
    M: Are you messing with me?
    Vendor: Uhhh...no?
    Me: Grrr. Field B is where the scheduled datetime should be!!! Why is it built like this?
    Vendor: Mmmm...not sure. I'll have to check with one of the engineers and get back to you.
    Me: You may want to give them the HL7 specification while you're at it. It's published. Online. Freely accessible. You want the link?

    It'd be like every web browser and web server all agreeing upon a standard markup language, HTML for instance; then each rolling their own version anyway. So Chrome looks for a HEAD tag, but IE calls it the TOP tag, Apache calls it the BEGIN tag, and IIS uses a FRONT tag. You may be thinking, well since IE and IIS are both from Microsoft they wouldn't do that. And my answer would be, you obviously haven't delved into the world of SharePoint.

    • Re: (Score:3, Informative)

      by wanchic ( 4360831 )

      OMG, someone else that knows HL7!!!

      Yes, pr0t0, I've been doing this for over 25 years and I have to agree with you for the most part. However, in my line of experience, I've seen some more variations to this example than the one you gave.

      One example is: What is HL7? That's right. Companies with programs that are NOT even familiar with HL7, or an API

      Another example is the different forms of medical practice. When we think of medical, we typically think of a clinical/hospital setting. But there are more case

    • by Anonymous Coward

      Sounds like processing EDI 835 reconciliation files from medicaid. No two states do it the same way, and none of them do it the same way as any of the insurance companies.

  • I had orthopedic surgery a few years ago and at followup office visits, my surgeon had a dedicated data entry person with a laptop who followed her around and did record keeping for her.

    At the time, I wasn't sure if this was a statement on willful ignorance, her elevated partner status or the sheer lack of usability of the record keeping system.

    • This is common practice. The specialized data entry person is known as a "medical scribe". Physicians (especially certain specialists) are so highly paid that hiring a separate employee to do data entry can actually save money by allowing the physician to see more patients in a day.
    • by Anonymous Coward

      The healthcare IT term you're looking for is a "scribe." They are not uncommon. It is more a statement on modern recordkeeping systems not being compatible with how physicians and surgeons were trained x years/decades ago.

      All three surgeons at our office have been physicians since long before EHR was an idea (one of them has been a surgeon thirty years.) None of them are touch typists (which would have helped greatly...)

      All three of them have literally decades of experience to see the patient then dictate

  • I work for a private non-profit mental health provider and we use an EHR that is supposed to be an "industry standard". However, in order to share records with another agency we have to print the records and fax or mail them. I use a fax machine every day. Even when I'm sharing records with a facility that uses the same system, I'm unable to send them electronically. We can't even email records because there doesn't seem to be an industry standard for "secure" email. The secure email system we have basicall
  • It's much worse:

    Garbage In, Garbage Out.

    I am a physician. Physicians are not particularly good at data entry. Most notes in the EMR I use (shared by ~80 physicians in a hospital) has a lot of garbage in the individual notes. The notes pick up the mistakes that others entered into the EMR and propogate them into the next note, so long as no one fixes it.

    I make it a point to clear up the notes when they get to me, but I could be the only one in my system that does that. Getting rid of redundant diagnoses,

  • by Anonymous Coward

    While it is fun to rag on the lousy user interfaces of EHRs, we need to be realistic. In the past few years we have gone from 20% EHR use to 80% EHR use. That amount of tax payer money spent to move this huge industry is less than the Goldman-Sachs bonus pool over the same period. So we have actually done a lot with a little.

    We should also realize that in most industries, computerization occurs roughly a decade before the real benefits of computerization, in terms of efficiency, occur. This is because.

  • This is my job. I've built EHR software with exposure to the internals, interfaces, and connectivity with external systems. I'm now a healthcare analytics consultant and considered and expert in my field. I feel the need to point out that patient-centric EHR systems are very good for system usage by the physicians and staff at the hospitals because they are optimized to retrieve and work with an individual patient's records (orders, results, etc). The flip side of this coin is that the system which works we

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