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Paper authors fear rush to digital records will result in accidents

The medical information of Americans around the country is currently being eyed as the next step for digitization. Supporters of the move to electronic medical records (EMRs) claims that a large amount of money could be saved by going to electronic records while opponents to the system say that there are significant privacy issues to be addressed.

President Obama and his administration are big supporters of the migration from paper records to EMRs. The Obama administration has put aside $1.2 billion in grants to start the migration of medical records to digital formats. The move to EMRs could save as much as $77 billion per year in America. The fiscal 2011 federal budget unveiled by Obama this week sets aside an additional $78 million [PDF] to help fund further adoption of IT in healthcare.

The grant money has many health care providers and facilities rushing to migrate to EMRs in an effort to grab part of the funds to help pay for the transition. The problem according to Dean Sittig, PhD, and David Classen, MD, is that in the rush to migrate to digital records, mistakes are likely to be made.

Sittig is an associate professor at The University of Texas School of Health Information Sciences at Houston and the lead author of a new paper that proposes better monitoring of electronic health records. Sittig said, "The ARRA [American Recovery and Reinvestment Act of 2009] stimulus is pushing people to take risks. It's like life. If you're late for work, you may drive a little faster than you should. This can lead to accidents."

Sittig claims that evaluation of some EMR systems after installation has found that the systems do not meet the same standards set forth in other industries such as the pharmaceutical and airline industries. Sittig said, "We are building this huge health information technology system that we don't know how to monitor properly. These electronic interventions can adversely affect patient safety and quality of care."

Classen and Sittig say that there needs to be an established organization that practitioners can file complaints with concerning EMR safety issues. Vendors developing software for EMR systems should also have to show that their software is designed for safety and works as designed. The pair also states that organizations should be encouraged to perform self-assessments of EMR use and training on a yearly basis.

Sittig and Classen also believe that The Joint Commission should perform unannounced on-site inspections to check EMR use. A national EMR adverse event investigation board should also be set up according to the pair. The board would work in a manner similar to the National Transportation Safety Board according to the paper.


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By Seemonkeyscanfly on 2/4/2010 12:01:43 PM , Rating: 4
"The Obama administration has put aside $1.2 billion in grants to start the migration of medical records to digital formats."

My company has been working with Doctors offices to get them all electronic and away from paper for at least 7 years because the privacy laws required that they did so. There has been some difficulties in becoming 100% paperless mostly because the Doctors are fighting it. They do not like to spend their own money and some Doctors are just not good with computers; just because you are good at one thing does not mean you are good at other things.... The government has been easy on enforcing the laws because they know and understand it's difficult to change quickly.

Now for the Obama administration to claim they are going to "START" the migration of medical records to digital formats is comical. It means one of two things, they are trying to take credit for other peoples work or they do not understand what is already started.

I would add none of the Doctors we work with are in need of financial aid. The "poor" ones make more then 10 times the average family wage in the USA.

It's a good thing to press forward and expand, but no government financial aid is needed.

RE: Start??
By Seemonkeyscanfly on 2/4/2010 12:08:30 PM , Rating: 1
"work with are in need of financial aid."

Word are important... like that little to letter for "no", sorry missed my typo should be

"work with are in NO need of financial aid"

my bad.

RE: Start??
By Yawgm0th on 2/4/2010 4:18:07 PM , Rating: 2
I would add none of the Doctors we work with are in need of financial aid.

Sir, you had it right the first time.

RE: Start??
By Seemonkeyscanfly on 2/4/2010 6:17:05 PM , Rating: 2
Yea, I re-read it... I'm having a bad brain day.... :(
dyslexia screws with my brain enough but every so often I have a day that I should not make contact with anyone.

I also want to know the name of the jerk who came up with the name Dyslexia and it's spelling. He must have been laughing his @ss off thinking about people with Dyslexia trying to spell their own disorder. Sure it looks like an innocent word but it has all the evil twists from my point of view.

RE: Start??
By Lord 666 on 2/4/2010 12:54:42 PM , Rating: 3
My concern is the administration is investing too much tax payer dollars in desparate and separate EHR vendors. There should be four major choices for versions; Vista, Google/MS, ECW, and large hospital type like Epic/Next Gen. Consolidate resources and efforts and focus on the leaders.

RE: Start??
By UNCjigga on 2/4/2010 1:50:17 PM , Rating: 2
Agreed. Beyond that, simplified access to EMRs for consumers is still missing. I as a consumer should be able to initiate records requests from my mobile device. It should be as easy as launching an app on my phone, generating a one-time use authorization code (numeric or barcode format), displaying that to the admin/nurse, and having them use that to authorize release/gain access to my records. We don't have that power yet because doctors/HMOs are afraid of giving us that power. It shouldn't be their call.

RE: Start??
By Lord 666 on 2/4/2010 2:12:08 PM , Rating: 3
Thinking about what you suggested, like an RSA app that creates a unique rolling key. That could work, but per HITECH, there needs to be a business agreement between anyone who shares information. So that iPhone app would have to be registered to a clearinghouse of some sort that insurance carriers would subscribe too or even the insurance company provides the service as their own app which would make a lot of sense for medical home reasons.

There is a study that showed the fastest growing demographics for iPhone users were in the $50,000 or less median income homes. The idea is eventually the smart phone segment will be the primary Internet access as the mobile access charges will replace home Internet access connections. Since the market segment I work for is not-for-profit that serve the underprivileged, have been focused on modifying our systems to be mobile phone friendly. There are some basic security concerns that will have to be addressed on iPhones to make them more secure, like mandatory passwords stronger than 4 digits once these Medical Home Apps get installed and/or remote wipe capability.

However, HMO's and managed care companies would LOVE to adopt any technology or information sharing to reduce fraud. Its the agencies management that are grappling with funding cuts and have to juggle other projects. This goes back to the standardization of EHRs to reduce cost and adoption time frames.

RE: Start??
By Seemonkeyscanfly on 2/4/2010 1:57:57 PM , Rating: 2
As much as limiting the amount of competition goes against every bone in my body, I believe you are correct in this case. It will make it easier for a Doctor to go from one Hospital to another, or a clinic without having to learn a new software and transferring data issues and everything else that comes with too many options.

Well one type would even be better.... However, how would you say which one is the best. The only fair way to come up with the best is to let the market place pick the winner (normally works).

RE: Start??
By mooncancook on 2/4/2010 1:23:21 PM , Rating: 2
Same here with my company. Doctors and computers, it's frustrating to work with both at the same time.

RE: Start??
By Lord 666 on 2/4/2010 1:30:24 PM , Rating: 2
The providers I work with here in NYC are mostly Mac users. Sort of a hassle because everything has to be Mac friendly for remote access.

RE: Start??
By BZDTemp on 2/4/2010 5:17:41 PM , Rating: 2
Here in Denmark We are just about done making everything digital. Going the computer way has not been the big problem as the really big problem is common standards so data can be shared. We are getting on with that also but it is a long trip.

Still everything in Hospitals are pretty much shared and patients can even go on-line and see their many of their own data if they want. Next up is for all the doctors in private practices to integrated their data systems with the rest but in a couple of years that should be done also.

The whole thing saves load of money, helps ensure better treatment for patients and also helps making sure all doctors are up to standard.

If putting some government money in this to help things move along it will be a good investment. Just a "simple" thing as letting patients see their own files has shown to make many communicate better with their doctor. It really is a thing were everybody can win if allowed.

RE: Start??
By Seemonkeyscanfly on 2/4/2010 6:22:51 PM , Rating: 2
Oh, I agree with you 100%. The Doctors are the biggest hurdle here... while giving respect to the doctors it's a kind of teaching and old dog a new trick issue more then anything. Younger Doctors tend to be easier to work with, but everyone has to be on the same page.

RE: Start??
By BZDTemp on 2/5/2010 3:57:20 AM , Rating: 2
For some Doctors it is not just having to deal with IT that is an issue. It goes much deeper with the electronic forms and so requiring them to do their job in a certain way. I some types of medicine that is a none issue because many things are about following procedures but for others it may be huge.

If interested here is more information on how we are doing things:

Redundant ?
By Zuul on 2/4/2010 12:04:01 PM , Rating: 2
After reading thru that article, i'm surprised there is no mention of CCHIT. CCHIT currently provides national standards for patient safety, privacy, auditing, interoperability, etc. for EMR vendors in the US. Medical practices that use a CCHIT certified vendor already receive significant funding from the government (even before Obama's push for EMR/EHR systems).

I'm not saying the points are invalid - there are points he makes that CCHIT is lacking on. However the author is proposing 8 new institutions - at a high level to me, it looks like a lot of bureaucratic processes that will be redundant and an inefficient use of recovery dollars.

RE: Redundant ?
By Lord 666 on 2/4/2010 1:50:29 PM , Rating: 2
While CCHIT is a great start, there are other emerging standards for Medical Home (NCQA) that take greater significance to meaningful use.

Additionally, while there are HIPAA and HITECH for security, I have always looked to PCI as a more stringent and reproducible guidelines to augment the healthcare specific ones.

here's a question...
By FPP on 2/6/2010 1:35:54 PM , Rating: 2
Why? Private enterprise has already done this in countless industries, without a lick of public money. The military, considering who they are, has already done this in countles examples.

Why? Why is the federal government sooooo interested in this???? Why do they want this so badly? What is their interest in YOUR i.e. private citizen records???? Sure, the publicly insured?...OK but why PRIVATELY insured folks? The government does not pay for the inefficencies.

Why indeed.

By Drag0nFire on 2/4/2010 2:08:12 PM , Rating: 1
I'm sure Google can come up with a solution that solves all the problems at the expense of privacy.

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