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View Diary: Electronic Medical Records: A Primer (118 comments)

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  •  The VA has been using EMR for years (18+ / 0-)

    It started in the mid 90's at the VA. The electronic record has proven to be extremely useful in improving safety, efficiency, and coordination of care. It also has provided the backbone for groundbreaking large scale research into how to improve medial care. Most of the providers love it, because it gives them a full range of information, including xray images, at their fingertips when they need it. The VA has already dealt with a lot of the security and HIPPA issues, although the latter is probably always going to be a challenge. The security and backup systems in place mean that during hurricane Katrina, when all the other hospitals in the area lost their records, the New Orleans VA was able to transfer their patients to other facilities with their medical records intact.

    •  beautious (9+ / 0-)

      that's what we're talking about!!!

      “Quickly, bring me a beaker of wine, so that I may wet my mind and say something clever.”-Aristophanes

      by karma13612 on Sat Feb 25, 2012 at 02:13:50 PM PST

      [ Parent ]

    •  We had a case like that last year (11+ / 0-)

      A hospital using our software was basically destroyed.

      They were up and running again (in tents and mobile buildings) within a day or so, with no loss of data.

      Not that it wasn't a lot of work..

    •  Do they make their system available to other (4+ / 0-)
      Recommended by:
      ladybug53, GreyHawk, dotdash2u, Odysseus

      facilities?  This doesn't strike me as a good place for proprietary software or systems, but something that should be based on common protocols and open sourced to catch bugs more easily.

      •  There have been calls to open source some of this (2+ / 0-)
        Recommended by:
        ladybug53, GreyHawk

        If I was making a decision on which EMR system to buy for a hospital, though, I'd be wary about an open source one, because it means that if patient information is illegally exposed, there's no vendor to take on the liability. I imagine that open source projects would also have more difficulty keeping doctors on staff to verify that the system works correctly.

        There are communications protocols available for transferring data between systems, but I don't know the details; it's not my area.

      •  Not sure, but here's more on VISTA... (7+ / 0-)

        Veterans Health Information Systems and Technology Architecture (VistA)

        More from WSJ article 2008:  An Affordable Fix for Modernizing Medical Records:  

        ...To help speed adoption, Sen. John D. Rockefeller (D., W.Va) last week introduced legislation calling for the government to create an open-source electronic health-records solution, and offer it at little or no cost to safety-net hospitals and small rural providers...
        •  Hah. Sounds like Sen Rockefeller and I were (4+ / 0-)
          Recommended by:
          kurious, ladybug53, karma13612, GreyHawk

          thinking along the same lines.  Thanks for the links.

        •  Ok, liking what I'm seeing of Vista so far. (3+ / 0-)
          Recommended by:
          kurious, ladybug53, GreyHawk

          Going to bookmark that link, seems like a useful starter page to start reading up in EMR under gov't auspices.

          •  In my experience (as a Med. Record... (7+ / 0-)

            QM type) the EMR at the VA evolved into a good system.  It wasn't always easy getting people to make the switch from paper to electronic--especially the doctors.  But they now enter in their own progress notes, orders, discharge summaries and operation reports.  

            The fact that patient data was readily available to caregivers was the biggest benefit, IMHO.

            •  That's allegedly the puropose of the record (0+ / 0-)
              The fact that patient data was readily available to caregivers was the biggest benefit, IMHO.
              The people who want to use the patient's chart to "justify" keeping him in the hospital, "justify" payments, argue about how the diagnosis should be ICD coded, or measure what they pass off as "quality" of care are all using the chart for something other than its original purpose.  
              Before all those folks with other 'uses' (misuses?) of the medical record started clamoring for access to it, it was rare that more than one person at a time needed the patient's chart.  

              We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

              by david78209 on Sun Feb 26, 2012 at 06:03:22 AM PST

              [ Parent ]

              •  And, my Dr. accessing my x-ray in her office... (1+ / 0-)
                Recommended by:
                Tinfoil Hat

                and my lab results, my current medications, the details of my last office visit, all of which she quickly accesses during my office visit and then discusses with me.  She then determines current treatment based on this information.  

                Having worked in medical records/ quality management for 30+ years in the times of only paper records, and then of electronic medical records, the record always was routinely was sought after by multiple people: Drs--often doctors in different departments involved in the patients' care, nurses, ward clerks, auditors (yes--even in the olden pre-electronic record days)  --utilization, case management, quality management, medical records, etc.--all needing access to the record, often at the same time.   (yes--even in the olden days).  

                Obviously, since only one person at a time could have the record, there were often times that the person who was currently treating the patient and who needed the record wasn't able to locate/ obtain the record when it was needed.

                The "red-tape" people who currently use patients' record have always been there--though people likely weren't aware of the number of people who accessed their records for various medical, administrative, and documentation reasons.

                These administrative types eventually got access to the records, but the delays in getting access to the records often resulted in inconvenience to the patient, by delaying their obtaining information they wanted from their medical record.

                Electronic records are far from perfect, but they do offer some advantages (and, of course, some disadvantages) from the paper record.  

                BTW, I was originally a highly suspicious Luddite who was very leery of the switch from paper to electronic.  But over time, I've come to see the real advantages to the patient.  For example: A patient's record being instantly available to caregivers--even if the patient is seeking emergency treatment at a facility within the system but hundreds, or thousands, of miles--away from their primary care facility.

            •  Except for the fact that when it comes (1+ / 0-)
              Recommended by:

              time to make a printout, as when a patient is being transported by ambulance, the typeface is damn near unreadable because they are trying to save money on the printer ribbons, ink, toner, etc.

          •  Well, I represent a vendor too (2+ / 0-)
            Recommended by:
            GreyHawk, 207wickedgood

            So I obviously think people should be able to make money writing software.  We are trying to implement HL7 interface to several VISTA based Hospital systems.  Sometimes it works, sometimes it doesn't -- there is no 'other vendor' so if the staff has the expertise or knows someone who does they can get it done, if not they are out of luck.  People with commercial systems call their vendor.  It costs money, but then so does maintaining a staff to write and develop your free system.

            •  Well, it wouldn't be machines writing and (2+ / 0-)
              Recommended by:
              GreyHawk, Tinfoil Hat

              maintaining the code, after all.   The government would still want to hire good coders, debuggers, testers, etc to do the same thing that vendor is doing.  Heck, most of the time now, they contract out anyway, so the only difference to you in such an instance might be ultimately how the code is used, and whether or not outside coders are sometimes suggesting or providing new features to integrate.  'Open source' doesn't automatically imply 'free', just that the code is open for review and bugfixes provided by a wider community.  There are all sorts of licensing options.

      •  Yes, they've offered it for years (1+ / 0-)
        Recommended by:

        with very few takers...

    •  And it does no good (1+ / 0-)
      Recommended by:

      A VA patient cannot sign any release requiring their treatments to be automatically forwarded to any non-VA doctor. If our patients have their labs done at the VA, the patient cannot request that the results be automatically sent to us. The patient must get the results ON PAPER from the VA, bring them to their office visit, and give me all of 2 minutes to make sure I can accurately get them into the system before the provider sees the patient.

      From a medical records standpoint, I HATE THE VA.

    •  I think part of the reason that there can (2+ / 0-)
      Recommended by:
      GreyHawk, ban nock

      be improvement in care at the VA is that they aren't having to deal with a for-profit insurance company to submit claims.

      EMR will only work for a patient's benefit when we take the profit motive out of the equation.

      I fall down, I get up, I keep dancing.

      by DamselleFly on Sun Feb 26, 2012 at 05:27:00 AM PST

      [ Parent ]

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