News/Commentary

This is a balanced, physician’s account of what he already has discovered about electronic medical records (EMRs) through his hospital experience.

Some of what he describes—-the inability to include personal notes about the patient’s wish to wear her own flannel nightgown in the hospital or the inability to add stick figure drawings to show how a patient should be positioned—-should be able to be easily corrected. Kids practically can make a movie equal to “Gone With the Wind” on their computers. Drop-down options for notes, including sketches or an anatomical “map” to give others instructions what this patient needs and where,  should not be that hard.

That said, he is worried about patient privacy—-as are all people who understand the hazards of any breach.

The author fears doctor-patient confidentiality is at risk with this system.

He is raising questions about how to personalize records and keep them private out of respect for the patient-physician relationship, as well as the patient’s own dignity and privacy as well.

If EMRs are as great as their supporters believe, they need to start answering his concerns about different kinds of quality of care issues EMRs may cause. Quality of care. Patient-physician confidentiality. Patient privacy.

Time

…”Any doctor will tell you the advantages of having lots of patient data on computers: it helps us avoid redundant tests, gather huge amounts of data for research, screen automatically for drug interactions, all with no problems with our famously illegible handwriting. I would be happy if every patient could hand me a digital file of everything about him; it could really save time on first visits. But against our government’s push to get all patients’ records computerized we must keep in mind there will be a cost to this — far beyond the billions to be spent setting it up. Many of us in medicine are concerned that the greatest cost will be in the quality of medicine that we practice. (Read “The Year in Medicine 2008: From A to Z”) (Emphasis added)

“American doctors have not been enemies of the digital revolution. Looking up lab results and x-rays on our computer screens beat out carbon copies and sheet film in an instant. We like e-mail; we shop, take tests and read our journals on line. But the romance, for most of us, began to sour with Computerized Physician Order Entry [CPOE]: entering patients’ hospital orders on the computer. This is when we first confronted the downside to uploading our every medical judgment. (Emphasis added)

What Doctors Can’t Do with EMR

“The majority of us are forced to use computerized orders or risk losing our hospital privileges. But most of us have found that CPOE is a lot harder than writing out orders on paper, takes far more time and in too many ways is just not as good. We’re never quite sure that what we’ve typed is going to be seen by a real, live, analog nurse, that it isn’t just going to disappear. (It does.) We can’t order certain things with those buttons and pull-down menus that we could in writing — things like “patient may wear her own flannel nightgown and underwear” or “please, please get the x-ray I ordered for yesterday”, or “prop up patient’s legs with pillows like this” followed by a little stick-figure drawing. (See pictures from an X-Ray studio.)

What If It Breaks? Who Gets to See the EMR?

“After CPOE grief and the obvious but very important “what if it breaks?” issue, our immediate concern with putting all that medical data on a nationwide computer network is privacy. Who gets to look? How do you limit access to information and respect privacy when managing a disease, like diabetes or AIDS, that affects many organ systems and so involves many different kinds of doctors and services. Doctor-patient confidentiality seems quite likely to be one of the sacrifices Americans will be required to make to get this project going.” (Emphasis added)

Source: Time, March 5, 2009