What is the similarity between between Ariel money manager J. Ezra Merkin (who The NY Times 2/14/2009 p. B3)invested $2 billion of his clients' money with Madoff) and a subsidiary of Compushare which sells high-end software in the health care field (p. A13)?
Merkin received some of his telephone advice directly from an "Imprisoned Felon," Victor Teicher, whose federal securities fraud felony landed him in a New Jersey prison.
Covisint, the Compushare subsidiary, is paying $100,000 a year plus commissions, to felon and ". . . former Detroit mayor Kwame M. Kilpatrick . . ." because he is "uniquely qualified" to sell high-tech services in the health care field.
Have you any unease about the safety and integrity of your personal medical information? Or about the types of operators who - attracted to electronic medical records services, as vultures are to decaying carcasses - look upon the federal governments' willingness to pour resources into electronic medical records as an invitation to feast?
Is the Obama administration oversight of electronic medical records to be like the Bush administration oversight of Halliburton in Iraq?
Showing posts with label Electronic Medical Record. Show all posts
Showing posts with label Electronic Medical Record. Show all posts
Monday, February 16, 2009
Monday, February 9, 2009
Physicians As Data Entry Clerks?
Brent Gendleman (president and CE of a software consulting and development company) has written a spirited, apparently self serving, and uninformative letter to the editor of the NY Times (02/09/09 p. A20) supporting electronic medical records. A notch up is Richard's Rockefeller's letter in which he worries about indecipherable handwriting and articulates something that physicians know: "Competing insurers will always find ways to discover patients' health problems and exclude them from coverage." A.G. Krohn, a doctor, writes that office visit documentation time exceeds time examining patients. John J. Frey III (professor of family medicine) demands interoperability rather than Babel. Matthew D. Heller (rheumatology physician) observes that electronic systems spew out useless boiler plate. And Mark Merritt (president and CE of the Pharmaceutical Care Management Association) worries about the risk of a privacy proposal exposing users of electronic records to litigation and red tape.
My observation is that some physicians (perhaps they are "shy") spend more visit time looking at the monitor and interacting with a computer system that they do speaking with and actually examining a patient. You can't find breast or thyroid cancer, or hear a carotid bruit, or pick-up on a patient's depression, when your focus is having an electronic record which meets bureaucrats' needs rather than spending the time talking with and examining your patient.
My practice was, at the end of an office visit, to take about 90 seconds to dictate (for transcription) a complete record of the visit in front of the patient (often in the presence of the person accompanying the patient). This provided all of the information (history, physical, lab, diagnosis and plan) I had in a legible format, gave the patient a chance to hear what I thought, make comments to me or correct my mistakes, and promoted a trusting relationship in which the patient had all relevant information when he or she left. Years later, physicians tell me that those complete paper records contain the details that their computerized systems lack. Today's sophisticated computer voice recognition systems could readily provide hard copy from dictated records and if demanded by the bureaucrats, an electronic accessible record.
Is the use of highly educated and skilled physicians as data entry clerks sensible?
My observation is that some physicians (perhaps they are "shy") spend more visit time looking at the monitor and interacting with a computer system that they do speaking with and actually examining a patient. You can't find breast or thyroid cancer, or hear a carotid bruit, or pick-up on a patient's depression, when your focus is having an electronic record which meets bureaucrats' needs rather than spending the time talking with and examining your patient.
My practice was, at the end of an office visit, to take about 90 seconds to dictate (for transcription) a complete record of the visit in front of the patient (often in the presence of the person accompanying the patient). This provided all of the information (history, physical, lab, diagnosis and plan) I had in a legible format, gave the patient a chance to hear what I thought, make comments to me or correct my mistakes, and promoted a trusting relationship in which the patient had all relevant information when he or she left. Years later, physicians tell me that those complete paper records contain the details that their computerized systems lack. Today's sophisticated computer voice recognition systems could readily provide hard copy from dictated records and if demanded by the bureaucrats, an electronic accessible record.
Is the use of highly educated and skilled physicians as data entry clerks sensible?
Sunday, May 11, 2008
Clinical Competence or Electronic Medical Records?
It may seem unfair to ask: "do you favor clinical competence over electronic medical records"? But today, the United States doesn't have enough dollars to pay for health care for its entire population. Use of billions of dollars of scarce resources to pay for electronic medical records systems will divert money from training competent clinicians in evidence-based medicine and may have a detrimental effect on health care.
Pysician, nurse, and nurse practitioner training programs stress the mantra: show us the evidence for the diagnosis you make and the treatment you prescribe. Unfortunately, health systems administrators, insurers, politicians and others who control the flow of health care dollars are not required to show solid evidence supporting their rush to electronic medical records. The information technology industry claims superiority for its products. Politicians, bureaucrats and administrators wax enthusiastic about their chance to spend billions of dollars on technology which does not yet demonstrate patient health outcome superiority as compared to traditional paper records and systems. The issue isn't whether a computer generates a pretty report for a mid-level administrator; it is whether the patient lives or dies or suffers severe medically unnecessary complications or pain.
Citing two studies of handheld electronic medical record systems, a 2006 Canadian abstract did not find conclusive evidence of a net benefit from the use of the handheld medical record system. It did report an increase in the number of wrong or redundant diagnoses (http://www.biomedcentral.com/1472-6947/6/26/abstract downloaded 5/11/2008).
Crosson and others reported the effects of electronic medical records on diabetes care in an NIH funded study (http://www.annfammed.org/cgi/content/full/5/3/209 downloaded 5.11.2008). Statistical analyses demonstrated no evidence of an improvement in ultimate outcome. Surprisingly ". . . . patients with diabetes in practices that did not have an EMR were significantly more likely to have received care that met the guidelines for processes of care, treatment, and intermediate outcomes".
There is literature claiming that electronic medical records systems show a good return on investment (http://www.medicalnewstoday.com/articles/76786.php downloaded 5/11/2008). Where are comparable studies demonstrating that the money spent for such expensive systems show a net benefit to patient outcomes. Where is the answer to the mantra: show us the evidence?
Pysician, nurse, and nurse practitioner training programs stress the mantra: show us the evidence for the diagnosis you make and the treatment you prescribe. Unfortunately, health systems administrators, insurers, politicians and others who control the flow of health care dollars are not required to show solid evidence supporting their rush to electronic medical records. The information technology industry claims superiority for its products. Politicians, bureaucrats and administrators wax enthusiastic about their chance to spend billions of dollars on technology which does not yet demonstrate patient health outcome superiority as compared to traditional paper records and systems. The issue isn't whether a computer generates a pretty report for a mid-level administrator; it is whether the patient lives or dies or suffers severe medically unnecessary complications or pain.
Citing two studies of handheld electronic medical record systems, a 2006 Canadian abstract did not find conclusive evidence of a net benefit from the use of the handheld medical record system. It did report an increase in the number of wrong or redundant diagnoses (http://www.biomedcentral.com/1472-6947/6/26/abstract downloaded 5/11/2008).
Crosson and others reported the effects of electronic medical records on diabetes care in an NIH funded study (http://www.annfammed.org/cgi/content/full/5/3/209 downloaded 5.11.2008). Statistical analyses demonstrated no evidence of an improvement in ultimate outcome. Surprisingly ". . . . patients with diabetes in practices that did not have an EMR were significantly more likely to have received care that met the guidelines for processes of care, treatment, and intermediate outcomes".
There is literature claiming that electronic medical records systems show a good return on investment (http://www.medicalnewstoday.com/articles/76786.php downloaded 5/11/2008). Where are comparable studies demonstrating that the money spent for such expensive systems show a net benefit to patient outcomes. Where is the answer to the mantra: show us the evidence?
Sunday, April 27, 2008
What If Your Electronic Medical Record Is Wrong?
The Perspective column, by Robert Steinbrook, M.D. (pp. 1653-6) in The New England Journal of Medicine (N Engl J Med 358:16, April 17, 2008) describes social and medical complexities of computerized online medical records. Steinbrook describes the push towards online records provided by Dossia ("a nonprofit consortium of major employers"), "Google Health, Microsoft HealthVault and other Web services that are seeking expanded roles in the $2.1 trillion U.S. health care system." In other words, there is a lot of entrepreneurial money at stake (consider advertising revenues) pushing this project, which means that profit and return on investment may come first and patient health and well-being may move to lower priority. Since money buys political influence, beware when current Presidential candidates, Senators and Representatives talk about "health reform" and describe electronic medical records as the salvation to our health care systems' ills.
Based on my past experience as an attorney negotiating related issues, I am concerned about the risk that our medical records will become another commodity. After all, as I have described in earlier blogs, HMOs and PPOs have commoditized health care during the last fifteen years: why should our private medical records be different? Who will own the vital facts contained in your medical record? Will it be you, your doctor, your clinic, your hospital, Microsoft, Google, your employer, an HMO, PPOs, insurance companies or venture capitalists? Who will have the right to sell medical records if, for instance, a major repository goes bankrupt and the court system must dispose of the asset for the benefit of creditors to the highest bidder? What happens if a foreign company acquires the records?
The second April 17, 2008 article, "Off the Record - Avoiding the Pitfalls of Going Electronic," by Drs. Hartzband and Groopman (pp1656-8) takes a seasoned and cautious view of the electronic medical record. It describes the mindless repetition of information: "Senior physicians also cut and paste from their own notes, filling each note with the identical medical history, family yhistory, social history and review of systems." The authors warn that important new data may be obscured. Even the relationship between a physician and patient may be warped as the physician stands at the computer, focused on the screen, providing an impersonal detached experience for the patient.
My experience as a hematologist, taking care of very sick patients, highlights another issue which is scarcely mentioned. Previous physicians may be absolutely wrong in their diagnoses but the momentum developed in the electronic record may make it difficult to understand whether, how or why they went wrong. I saw patients with voluminous paper records from respected instutitions that diagnosed cancer when there was no cancer, that diagnosed essentially untreatable cancer when the disease was relatively benign, that made patients uninsurable because a doctor did not understand the difference between an adenomatous polyp in the colon and familial adenomatous polyposis of the colon and wrote a note which echoed through the chart for years.
Even competent physicians will, from time to time, look at a familiar patient with blinders of past experience, chart entries and sterotyped interactions. Sometimes, the safest record for the patient is no record (except for the list of medications taken and drug allergies provided by the patient) - which requires the physician to start from the beginning, as if he or she had never seen the patient before, with an open mind and challenges to every sacred diagnosis, treatment and prejudice which has affected their relationship and patient care.
Based on my past experience as an attorney negotiating related issues, I am concerned about the risk that our medical records will become another commodity. After all, as I have described in earlier blogs, HMOs and PPOs have commoditized health care during the last fifteen years: why should our private medical records be different? Who will own the vital facts contained in your medical record? Will it be you, your doctor, your clinic, your hospital, Microsoft, Google, your employer, an HMO, PPOs, insurance companies or venture capitalists? Who will have the right to sell medical records if, for instance, a major repository goes bankrupt and the court system must dispose of the asset for the benefit of creditors to the highest bidder? What happens if a foreign company acquires the records?
The second April 17, 2008 article, "Off the Record - Avoiding the Pitfalls of Going Electronic," by Drs. Hartzband and Groopman (pp1656-8) takes a seasoned and cautious view of the electronic medical record. It describes the mindless repetition of information: "Senior physicians also cut and paste from their own notes, filling each note with the identical medical history, family yhistory, social history and review of systems." The authors warn that important new data may be obscured. Even the relationship between a physician and patient may be warped as the physician stands at the computer, focused on the screen, providing an impersonal detached experience for the patient.
My experience as a hematologist, taking care of very sick patients, highlights another issue which is scarcely mentioned. Previous physicians may be absolutely wrong in their diagnoses but the momentum developed in the electronic record may make it difficult to understand whether, how or why they went wrong. I saw patients with voluminous paper records from respected instutitions that diagnosed cancer when there was no cancer, that diagnosed essentially untreatable cancer when the disease was relatively benign, that made patients uninsurable because a doctor did not understand the difference between an adenomatous polyp in the colon and familial adenomatous polyposis of the colon and wrote a note which echoed through the chart for years.
Even competent physicians will, from time to time, look at a familiar patient with blinders of past experience, chart entries and sterotyped interactions. Sometimes, the safest record for the patient is no record (except for the list of medications taken and drug allergies provided by the patient) - which requires the physician to start from the beginning, as if he or she had never seen the patient before, with an open mind and challenges to every sacred diagnosis, treatment and prejudice which has affected their relationship and patient care.
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