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

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  •  I'm an older primary care doctor (11+ / 0-)

    Some of my worries about EMR:

    The systems being sold are proprietary, I believe.  Combining information from two different companies' record systems will be difficult.  Government hospitals -- military and VA systems -- apparently have made good progress on a standardized system.  I wish that would become the "Linux" of EMR and vendors would be building on it.  In stead, we have more like Windows and Apple's OS.

    Privacy of medical records could be easy to break on a wholesale basis with EMR.  My office uses paper records.  Somebody could sneak in and read a few charts and maybe copy parts of them and we probably wouldn't know it.  But to copy all of all our charts would take days.  If we had EMR, someone with a key drive could probably copy all of every chart in a few minutes.  They might be able to do it over the internet.

    Computer systems go obsolete quickly.  Try getting information off a 5.25 inch floppy that was made 20 years ago.  I have a few charts that date back 60 years, and I can still read the typewriting on paper in the first entries.

    Every year or so, Medicare imposes some requirement for a new bit of information on billing forms.  I still submit claims on paper.  If I were submitting electronically, every time Medicare pulled a new requirement out of its favorite bodily orifice, I'd have to pay a programmer to update the electronic billing form.

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

    by david78209 on Sat Feb 25, 2012 at 09:43:32 PM PST

    [ Parent ]

    •  Valid Concerns (5+ / 0-)
      Recommended by:
      GreyHawk, RubDMC, david78209, Mayfly, Odysseus

      As a developer and as someone working in this area about 20% of my time, I'd have to say that you have reasonable concerns on this.  However, these are of course the primary concerns of anyone operating in this field.

      For companies who are more concerned about security of their revenue stream vs. their data (...GE......NextGen......Siemens......I really should get that cough looked at) it is a difficult situation for everyone.  I can tell you simply that none of this is quite as difficult as it appears but does require a number of highly EXPERIENCED (different than trained mind you) folks to plan, manage, execute changes to such systems.

      That being said, none of this is really difficult development-wise.  What is difficult is the combining of development cultures where usability (which generally comes from a creative and innovative group) and reliability (usually coming from a rigid and structured group) clash.  Companies who don't approach this w/ an understanding of the cultures required for success of each side of these solutions will likely fail in a variety of ways.  Hence the struggling of some of the EMR companies to truly "win" in the marketplace.

      Per security, there are reasonable steps to take, but no way to completely secure your site beyond people just being "careful".  Providing personal computers for your staff in break rooms and time to use them on a segregated network and not allowing loading of software beyond work and a few "friendly" workplace apps onto local PCs that access patient data is the simplest method.  It might annoy your staff in some ways, but providing them some access options is the best way to head off that frustration.  IMHO, putting on a few "approved" apps that aren't directly work related (e.g. Pandora, etc.) will show you're being flexible to their needs while still restricting everyone from loading whatever they feel like on their PCs.  This is the most likely point of entry into your network and primarily a "social" fix.

      Let me also say that you should simply go w/ whatever EMR/EHR company appears reasonable and open to you regarding their standards, gives you free/easy export capabilities of their data (so you can migrate or ditch them later if required) and at least has some level of openness regarding programming.  Tell whomever you're about to buy from that you have a programmer who does customizations for your workflow and that you want their API documentation.  If they stare at you bug-eyed or tell you it will cost you $25k to see it, then walk away quickly w/ your hand on your wallet.

      Also note that there are multiple groups working on a data sharing standard between EMRs for patient flow across organizations (primary->specialist->primary).  So in the next 5 years you'll see at least one or more of those gain some traction reducing inter-office faxing of records.

    •  I know a VA doc and he loves the EMR (3+ / 0-)
      Recommended by:
      GreyHawk, david78209, Mayfly

      that they use.

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

      by DamselleFly on Sun Feb 26, 2012 at 05:23:02 AM PST

      [ Parent ]

      •  When you start in the basement, the second floor (1+ / 0-)
        Recommended by:
        Mayfly

        view seems especially thrilling.

        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 07:46:58 AM PST

        [ Parent ]

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