Today I wrote my first e-mail to President Obama. I’m sure he will read and get right back to me on his BlackBerry, or perhaps he will Tweet me with Twitter.
Seriously, I did use every one of the 500 characters allowed on the White House Office of Public Liaison Web Page to e-mail a concern of mine which the president alluded to during his Monday-night press conference.
More than once as well as last night, Obama has touted the need for the use of electronic medical records such as those which have been used for quite some time by the Department of Veterans Affairs. The president apparently feels there can be some linkage between expanding electronic medical records throughout the nation’s healthcare system and stimulating the economy:
“We know that health care is crippling businesses and making us less competitive as well as breaking the banks of families all across America, and part of the reason is we’ve got the most inefficient health care system imaginable. We’re still using paper — we’re still filing things in triplicate. Nurses can’t read the prescriptions that doctors have written out. Why wouldn’t we want to put that on an electronic medical record that will reduce error rates, reduce our long-term cost of health care, and create jobs right now?”
Why wouldn’t we? Well, I am not totally sold that electronic medical records can do all three of those things for one. Do they have the potential? Just making a half-assed educated guess I would say yes. However, my concerns with computerized medical charts are more fundamental.
My own VA medical records have been computerized for somewhere around eight years or so. As I mentioned in my e-mail today, my guestimate is that in somewhere around 70 percent of my interactions with VA medical personnel, the practitioner doesn’t bother to look past the first or second page of the chart. My primary physician is a younger, Indian-educated and board-certified internist. He is much better at navigating around the pages, thus he is able to explore more of my electronic chart than some of the people I have encountered previously.
On the same page, pun intended, and — my oh my do I know about this one — a computer is not going to prevent a nurse or doctor or mental health counselor from making a mistake on your record that could conceivably be perpetuated for the patient’s life (or death if that mistake is sufficiently serious).
It’s like my old computer programming friends from way back in the 70s used to say: “GIGO.” Garbage In Garbage Out.
Plenty of reasons exist as to why electronic medical records are the kitty’s PJs. The fact that someday a paramedic might be able to see your records on the scene of an accident or a heart attack could be a fantastic advance in medicine. It also could be a nightmare. I have known instances of VA personnel accessing medical records who really — at least in my opinion — didn’t have “the need to know.” I know that because I asked those people to look something up pertaining to my own medical records even though those people I asked really were not medical personnel. Plenty more concerns exist depending on your proximity to patients. Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine said a study of private practice physicians revealed their own reasons for not adopting electronic records:
“Some other statistically significant, stiff barriers reported by physicians who do not use electronic medical records include:
* Uncertainty about the yield of electronic medical records on a physician’s time and financial investment
* Finding a electronic record system compatible with an individual practice or tailored office setting
* Concern about a loss of productivity during the transition from paper to electronic records
* Concern that an electronic medical records system will become prematurely obsolete.”
Finally, electronic medical charts also have features which may fall both toward the positive and negative sides depending upon where you are sitting. The computerized systems provide various reminders and alerts which are less dependent on human memory. “The good news is it’s time for your prostate exam. The bad news is it’s time for your prostate exam.”
Eventually most U.S. medical practitioners will use electronic records within the next 20 years, by my guess, but I am a nobody when it comes to authority. It’s just a guess and Joe the Plumber might come closer guessing than I would although I seriously doubt it. As long as doctors, nurses, other medical professionals and patients remember that such records are tools and not a miracle cure then everything should be pretty cool. We just have to remind ourselves that computers are only as good as their operators. That, as those who have any sense at all knows, is pretty scary as well.