From time to time, we’ve featured post from the informative Health Care Renewal blog on the appalling state of electronic medical records. Many readers have doubted its message, since the assumption that anything computerized has to be better than doctors maintaining handwritten records, often in famously illegible handwriting. However, as HCR stresses, underlying, well-established procedures and practices were revised to conform to the dictates of computer systems, with result being crapification of the activity. Second, the design priority was the money, meaning billing and doctor control in mind, with patient outcomes taking a back seat. The result has been in some cases to worsen medical outcomes. Indeed, HCR has noted that electronic medical records have been found in hospital systems to be a top cause of patient risk.
Confirmation of HCR’s dim view comes via a new article in ComputerWorld (hat tip Chuck L) on how the screw-ups resulting from lousy electronic medical records are large and frequent enough to have caught the attention of attorneys. The interesting twist is that it is the software companies that are the litigation targets.
From the ComputerWorld story:
As electronic medical records (EMRs) proliferate under federal regulations, kludgey workflow processes and patient data entry quality can be problematic…
Keith Klein, a medical doctor and professor of medicine at the David Geffen School of Medicine at UCLA, described four such cases where judgments reached more than $7.5 million because the data contained in an EMR couldn’t be trusted in court…
EMRs require physicians to perform their own data entry, stealing precious face time with patients. What had been a note jotted into a paper record, now involves a dozen or more mouse clicks to navigate a complex EMR workflow…
Data administrators may copy and paste patient information from an older record to a newer one, supposing that the data would remain the same. And the sheer complexity of EMRs pose issues with accuracy, as being able to track who has entered what data, and when, over time can become confusing…
One recent lawsuit involved a patient who suffered permanent kidney damage when he was given an antibiotic to treat what was thought to be an infection resulting in elevated creatinine levels. The patient was also suffering a uric kidney stone, which precludes the use of the antibiotic. Because of the complexity of the EHR, none of the attending physicians noticed the kidney stone.
Detracting from the EMR’s validity was the fact that a date related to a previous intravenous drip was repeated over and over on all 3,000 pages of the record.
While his physicians claimed they’d documented his care properly, the EMR was so complex and filled with repetitive data, the judge found it in inadmissible…
n another case, the physician was accused of plagiarizing data entered from another healthcare provider because he copied and pasted basic patient information.
Rita Bowen, senior vice president of health information management for Healthport in Atlanta, a records audit management and tracking technology firm, said she’s seen duplicate data, erroneous data and copied data in EMRs.
“I’ve seen records where someone has copied and pasted from older records, ‘The IV will be removed today,’ over and over again. Well, was it removed?” Bowen said, illustrating how admins may copy and paste older information into newer records…
But the problem isn’t solely human error. The way EMRs and electronic health records (EHRs) are designed can prompt error-prone entries. For example, drop down menus for diagnoses can automatically enter data if a mouse is hovered over them too long.
“We’ve seen 92-year-old women getting diagnosed as crack addicts because of drop down menus,” she said.
It’s instructive to contrast this data negligence with the eagerness of health insurers to mine medical data when they can make, or more accurately, save a buck though patient monitoring. Consider this story that shows how insurers are starting to reward customers for engaging in prisoner-level all-the-time surveillance. From Fusion (hat tip Dr. Kevin):
The New York Times reports that John Hancock will be the first life insurance company that will offer discounts to Americans who agree to wear an activity tracker:
People who sign up will receive a free Fitbit monitor, which can be set to automatically upload activity levels to the insurer. The most active customers may earn a discount of up to 15 percent on their premiums, in addition to Amazon gift cards, half-price stays at Hyatt hotels and other perks.
Traditionally, life insurance companies have set their rates based on a customer’s medical history and age, among other factors. But with the advent of fitness trackers, they can set rates in real-time, drawing on data about their customers’ lifestyles. Andrew Thomas, a 51-year-old South African who has been sharing his activity with his insurer for years now, including his cholesterol level and exercise habits, tells the Times he gets “points” for good behavior, which translates into money back on his premiums. “Every Saturday morning, just for playing golf, I get points,” he told the Times. (He would probably get more points for a sport that requires serious exercise. For the sake of his premiums, let’s hope he walks the course instead of driving a cart.)
The author points out that these monitoring systems will allow the insurers to know when and where you are having sex, which would also give them an informed guess as to whether you were faithful (sex at a local hotel, for instance). But the more general issue is that insurers seem perfectly capable of doing a good job with information technology when they see a benefit, but too bad of anyone that might suffer adverse consequences.