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EMRs are Over-Rated: Top 11 Reasons

Posted on: 12.13.2008 4:14:59 PM Posted by Suresh Gunasekaran

Don't get me wrong, EMRs could be great, maybe even better than the WWW.

When I lived in the Bay Area in the late 90′s, I was struck by the fact that everyone said the Internet and specifically the WWW was earth shattering, game-changing, and would make us forget all that preceded it (in 1998!). The point being that in the 90′s, we could imagine the tremendous potential of the internet age, but the realities were still a far cry from that. A decade later we have come a very long way, but still more is left on the journey.

Keep in mind that I'm a CIO who just went live with many EMR components in the past 2 months so I may be a bit more deluded than usual. I take tremendous pride with what our organization has done and how much better life truly is as a result of the system implementation. However, there is a part of me that feels like some CEOs/CIOs in 1998 that read the press, spent the money, and built a fancy website for their company, and said “Now what?”

Just putting up the website didn't change the world. 1998 was the beginning: putting up a website or paying someone a lot of money to put up the website didn't change the game. However, everyone accepting that they were going to use the Internet over the period of a decade did change the world.

The healthcare industry accepting that we are going to use EMRs and President Obama affirming this direction will change the world.

(To read the posting in its entirety, visit http://www.healthcare-informatics.com/suresh_gunasekaran).

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“The Doctor Will See You Now—Oh, You're Dead?”

Posted on: 12.2.2008 6:21:39 PM Posted by Daphne Lawrence

This really happened to me.

I was at my physician's office for my annual—and had already been there for more than an hour and a half, a typical wait time in his office. Next to me was a very old woman accompanied by her caregiver. They were there when I arrived, so she must have been waiting at least two hours. The receptionist (who books appointments a year out) finally called out the old woman's name, and the caregiver tried to rouse her from what I thought was a doze.

She was completely non-responsive.

The caregiver frantically begged the receptionist to get the doctor. “The doctor is in his office and cannot be disturbed,” was her answer. Really. She would not, even with all the patients in an uproar, go inside and get the doctor—who I'm sure had no idea what was going on. Long story short, EMS quickly arrived and took her out on a stretcher—still unresponsive… and I believe, dead.

Which, though it may seem macabre, has given me the punch line of all times: “THAT doctor? You could die waiting to see him.”

Now, I don't usually talk about ambulatory EMR/PM solutions in this space, but I always try and bring them up with my doctor (who, by the way is a brilliant clinician and for me, anyway, worth the wait.) He tells me that he is a one-man shop and it is just too prohibitive for him, cost-wise, not to mention the down time he says is involved in implementing one. So we wait, and we wait, and we wait.

For at least one of us, that wait was too long.

By the way, it's a year after this happened, time for my annual again, and I'm writing this from my doctor's waiting room.I've already been here an hour.

(Update: I'm home and the wait was only an hour 45. Why do I do it? Because he spends time talking about my life, treats me as a whole person, asks questions about my family, remembers everything about everything I've ever told him, and can make a confident diagnosis using a stethoscope and his hands better than any doctor using an entire a panel of tests. He has oriental rugs in his exam room, art on his walls and is one of the few doctors I know, besides my dad, long gone, who practices medicine as an art. I'll go to him forever.)

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Beyond the Resume—Your Mother was Right about Everything …

Posted on: 12.9.2008 2:42:11 PM Posted by Gwen Darling

About ten years ago I attended a two-day “International Commerce” workshop in Memphis. At the time, I was at the helm of a national skin care company, and we were interested in expanding our market overseas. The workshop was an intimate, exclusive (read that insanely expensive) event, with a very impressive lineup of distinguished and internationally successful speakers and panel members from companies such as Auto Zone, Wal-Mart, Tyson, and a hugely successful pizza conglomerate we'll call… Pizza Shack. The representative from Pizza Shack was a tall, beautiful, extremely articulate, very well-dressed woman in her mid-40s. She literally traveled the world, overseeing the installation of pizza ovens in restaurants spanning 80 countries. As she deftly fielded questions from the audience, I overhead several people whisper, “Wow, where'd Pizza Shack find her?” Of all the presenters at the workshop, she was, hands-down, the one person I wanted to meet, and so I was excited to find her seated next to me at the first day's luncheon (as were the four others who joined us at our table).

The conversation, as expected, was stimulating and thought-provoking, and I barely took notice when our salads were brought to the table. I had turned to answer a question from the gentleman on my right, when suddenly I heard a sound coming from my left that can only be described as the noise you'd imagine a pig might make if starved for a month and finally led to an all-you-can-eat slop buffet. Ms. International Success Story was bent over her salad, holding her fork and knife like a pair of oars, shoveling the food into her mouth while alternately slurping and smacking and (I swear I'm not exaggerating)… snorting. The conversation came to an abrupt halt, as we all tried to make sense of what we were witnessing.

(To read the posting in its entirety, visit http://www.healthcare-informatics.com/gwen_darling).

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What you don't know can hurt you

Posted on: 12.12.2008 9:58:19 AM Posted by Joe Bormel, M.D., MPH

Commercial Secrecy, Scientific Openness, and Public Health

Have you ever asked your doctor whether a symptom you're having may be caused by a drug you're taking? How is your physician supposed to know?

In WSJ (12/12/2008), there's a terrific article by Robert Lee Hotz, “What You Don't Know About a Drug Can Hurt You—Untold Numbers of Clinical-Trial Results Go Unpublished; Those That Are Made Public Can't Always Be Believed.”

Seeking a Balance:

“…researchers, federal regulators, pharmaceutical companies and medical journal editors have sought a balance between commercial secrecy, scientific openness and the public health.”

It's important for HCIT executives to be conversant in major underpinnings if we are to help bring adequate information to clinicians and consumers (including ourselves and families). As Hotz suggests, there are strong economic drivers of what some would call “disinformation campaigns.”

There are legitimate scientific certainty challenges in making valid causal claims between, for example, taking a drug and getting a side effect. And, by the way, we're not just talking about side effects like rashes, nausea and headaches. We're talking about trouble thinking (including dementia), suicidal thinking, profound muscle weakness, and of course, heart attacks and strokes. Very non-trivial side effects. Remember Vioxx?

(To read the posting in its entirety, visit http://www.healthcare-informatics.com/joe_bormel).