Things Wrong with Electronic Medical Records: Part ONE: Why can’t we communicate?
Electronic Medical Records (EMR) could have been implemented correctly. Instead, thanks to the skill of lobbyists, snake oil salespeople and inept government officials, we have an incredibly complex and expensive mess that harms patients and anyone working in healthcare.
Let’s click through the problems, in no particular order, limited to just a few issues (more coming in Part Two).
There are a gazillion incompatible different systems. “It’s not a defect, it’s a feature!” we were told. This selling point, coming from people in the Obama Administration, claimed the amazing energy of the private sector, start-ups, and computer programmers would most efficiently work out the kinks. Don’t worry. The energy of the private sector will fix this. Look up the name “Aneesh Chopra” and cringe.
UPDATE!!! MORE THAN A DECADE LATER, THE CONFUSION AND INCOMPATIBILITY REMAINS”!!!
The confusion is actually way worse than anyone outside of healthcare can imagine. Even when two hospitals or healthcare systems are on the SAME EMR (usually EPIC), the systems are not able to communicate back and forth. When patients travel from our local hospital system, here in Fredericksburg, to VCU Health System in Richmond or to UVA Health System in Charlottesville, the EMR is all EPIC. Yet, except in the most rare of circumstances, the information does not flow between the health systems. When I am in Fredericksburg, accessing EPIC, I can, at most, see a patient encountered UVA Health System, but none of the reports, clinical notes, radiology studies, labs, etc. are visible and there is no way to quickly access that information. I am still blind to “the stuff that matters” from the other system. We revert to faxing hand-signed release forms and waiting for a faxed response. We briefly had access to VCU Health System’s EPIC, but it required different unique sign-ins, passwords, websites, and even separate training such that it was basically a stand-alone system.
HIPAA is the buzzword that administrators and EMR vendors use to kill patients. It’s the reason given that EMR’s don’t talk to each other. The real reason is: If all of the EMR’s could talk to each other, vendors would not control patients, hospitals and doctors. It would allow competition which is bad for ridiculous EMR prices and brutally airtight vendor contracts. No! Healthcare communication is just bad for business!
Bad EMR’s are EMR’s that don’t talk to other EMR’s. Based on that definition, I can’t find an example of a “Good EMR.” None of them seem to talk to each other!
Bad EMR is killing patients. When I can’t see what happened at VCU Health System, I have to try and make phone calls to people that are probably not available. I have to interrogate the patient and the family to get even the most minimal of details, which are often incorrect. When patients land at any hospital, my EMR does not talk to their EMR, leaving ER doctors and hospitalists in the dark
Did you look up the name Aneesh Chopra? He was the first Chief Technology Officer of the United States. The two of us spent time at a University Healthcare Hackathon. I knew who he was and I did my best to explain the incredible harm when EMR’s cannot work together and cannot communicate. The EMR mandates and incentives at that time all failed when it came to communication issues. My concerns were dismissed. Since then, more than a decade has passed and nothing has changed.
The UK National Health Service tried to create a system wide EHR – “Spine”. They are having the same problems we find, and at great expense.
…….All the more reason to retire as soon as one can. I know some specialty docs and surgeons who hung on but that was due to the fact the community wouldn’t have coverage for the specialty as it would take a long time to get a replacement if ever. I was an F.P. who did office, hospital work and call. EHR was the reason I retired at age 64 and was glad I did. No regrets about it. If paper records had continued on, I would have likely continued practicing as I enjoyed it. Turning a physician into a secretary is the biggest waste of time and I hope Obama roasts in Gehenna for foisting this on medicine. I feel sorry for the younger docs who are stuck where they are. I believe many F.P.s now only do office work or if they get away with it, work in E.R.s if they aren’t required to be “board certified” E.R. docs. Regular hours here.
Perhaps it’s a good thing that EMR systems won’t talk to each other. Consider the results if they did with such things as described at https://authenticmedicine.com/2023/04/privacy-is-a-joke/ Rather than one hospital or hospital system, it could be everyone who has sought medical care over the past couple of decades.
The systems don’t communicate because this stuff is all proprietary now. The promise of an interactive medical record which would be fully available to any doctor failed miserably. Apple or Google no doubt would have done a better job, but I really think they should have given it to Amazon.
“Electronic Medical Records (EMR) could have been implemented correctly. Instead, thanks to the skill of lobbyists, snake oil salespeople and inept government officials”
Sadly, you can’t leave out a degree of naivete on the part of physicians and their leaders that bordered on incompatibility with intelligent life.
Ultimately, we did this to ourselves.
Without EMRs, it would have been impossible to turn physicians from professionals into assembly line workers, and for profit-seekers to take over all aspects of medical care.
Fait accompli!
The early electronic medical records generally had extremely high price tags and they sold several made a ton of money and two years later found out they had absolutely no income and folded. So now electronic medical records are all about residuals and ongoing fees. I know I absolutely dread update days. They are awful. I am convinced that updates are only an excuse for IT people to continue to be IT people and now I pay a monthly fee, truth be told my records are much better than when they were on paper. But I spend so much longer on each note – all the efficiencies that were touted were flat out lies.
I cannot wait for all this computer crap to be hacked. Think of all the money the feds can rack up in HIPAA fines for each release of protected medical information.
Consider what happened to me: https://www.kevinmd.com/2023/04/breaking-the-silence-on-the-harmful-effects-of-the-emr.html
Wow! I am so sorry this happened to you. Sounds like the specialist was a bad apple and sadly those exist in medicine like everywhere else.
The simple truth is that EMRs were NEVER intended to have anything to do with providing better medical care.
They are about 1. monitoring and controlling physicians in order to extract trillions of dollars from the medical system, and 2. collecting data to be resold, again for trillions of dollars.
This was glaringly obvious thirty years ago.
Our truly moronic medical societies (the AAFP being the worst) swallowed the lie hook, line and sinker.
Physicians and patients have been paying the price ever since.
Thankful every day that we’re still on paper in our office.
It’s actually 15 years later. The owner of epic was Obama’s largest donor.
I’ve been using computers for over 50 years. I’ve been doing medicine for over 40 years. I’ve been told I have a fairly high IQ. Yet it took 20 hours of training to be able to use the versions of the electronic record poorly. It doesn’t take 20 hours of training to use your phone.
The system should be a row of charts and you click on the chart. Then you click on the tab that says orders or notes. You should dictate into the note. The orders you should be getting the right and it recognizes it. You should be able to save that set of orders just by a button on the right of recorder.
The evolution of the medical records the last 15 years essentially means we have been paying huge amounts for them to have a usable addition.
What should have been done. The government should have given a billion to Apple, Google, Microsoft, Oracle each to develop a prototype. Prototype. The best prototype should have been picked and then rewritten with the best features of all of them. A 10-year contract should have been given for the entire United States with a condition that it be backward and forward compatible forever. It then would have been given free to every provider in hospital, probably for a total of 20 billion for the entire system, a fraction of what was spent.
And we had an amazing candidate which already worked okay but needed improvement. The VA’s ancient VISTA system, at its core, worked, but was left to languish in the 1990’s and missed the user IT wave due to never being improved. Because it was dowdy and clunky in use, it lost out to the inability to compete with mythical systems from the sales department’s fantasies.