Electronic Health Record Quality

Here is the link to a study published in the Journal of American Medical Informatics Association.  First all, the fact that they need a continuing journal with grant funded studies on EHR/EMRs is just how far we have lost touch with humanity.   But below is the first section of the abstract.   Read the objective of the study:

Physicians who more intensively interact with electronic health records (EHRs) through their documentation style may pay greater attention to coded fields and clinical decision support and thus may deliver higher quality care. We measured the quality of care of physicians who used three predominating EHR documentation styles: dictation, structured documentation, and free text.

Did anyone else laugh as they read this?   Just visualizing some doctors intensively interacting with their computer was hilarious to me.  I know some docs who have so intensively interacted with their computer that they broke it.   Others had to wipe off the screen (joking).   Anyway, so the premise of the study is what really bothered me.  They forever in their mind link up that EHR use and clicking “coded fields” will equal higher quality care.   Can you see now why I get so crazy when people throw the term “quality” around?

This study was sent to my by John who said:

 I guess talking and listening to your patients is inferior to having your nurse run a largely irrelevant checklist which provides much useless repetitive information for overdocumentation and overbilling. Patient clinical outcome was not important enough to be addressed in this study.

Thanks for sending this gem in!

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “Electronic Health Record Quality

  1. February 27, 2013 at 6:42 pm

    All of these computerized, electronic health records and their potential for assisting with quality of care hinges upon correct data for that patient being in those records.

    With medical identity theft, information from the real patient and the identity theives can be co-mingled. As a victim of such a crime over a decade ago, the electronic records that exist on me have *3 different blood types* in them, among other things that are not true about me. If I were in an accident and someone relied upon this information to give me a transfusion, they’d have a fair chance of killing me. These seem to be not correctible!

    In going into another clinic with a family member, the records were open on the screen of another patient, presumably one who had just previously used that room. In addition to allowing a patient access to records in violation of a host of privacy laws, the doctor could inadvertently put things that pertained to my family member in the record of this other person. It would not only confuse the record of the other patient, but treatment of my family member would go undocumented as well.

    It would ensure that notes and charts were more legible, which would be a good thing in some cases. But, if these end up touted as a time-saving measure as well, the potential for acting upon wrong information is high.

    In the words of Charles Babbage,”On two occasions I have been asked, ‘Pray, Mr. Babbage, if you put into the machine wrong figures, will the right answers come out?’ I am not able rightly to apprehend the kind of confusion of ideas that could provoke such a question.”

  2. David Grant MD
    February 20, 2013 at 9:38 am

    Anyone who purports to measure “quality” of medical care should be considered a charlatan until proven otherwise.
    Anyone who reports a “quality” measurement with a single number is a charlatan. Don’t waste time listening to some attempt to prove otherwise.

  3. Pat
    February 18, 2013 at 10:34 pm

    And just WHO funded this study? It’s agenda is obvious.

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