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60 Minutes EHR Story, EMR Disconnect, and EMR Erector Set

Posted on December 2, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I don’t know how many other people watched the 60 Minutes healthcare story tonight. It will be up on tomorrow if you’re interested in seeing it. While, EHR wasn’t the complete focus of the story, it played a large part in the second half when it comes to trying to get doctors to admit more patients to the hospital. The core of the story was more around whether hospitals should set admission goals.

I’ll leave the admission goals to other healthcare people. When it comes to EHR suggesting admitting a patient, you’re walking a fine line. The future of EHR is going to be more artificial intelligence that works to inform the doctor in the process of giving care. This could certainly include standards of care which could include admitting a patient to the hospital based on an evidence based standard of care. I don’t think most doctors have any problem with this type of EHR suggestion as long as the doctor can also make an informed override of the suggestion.

In the 60 Minutes story they suggested that Health Management Associates (HMA) would “punish” those doctors who used the override when a hospital admission was suggested. Reviewing overrides is reasonable and acceptable, but when punishment is due to hospital revenue it crosses the line. This is what was suggested by the 60 Minutes story.

The other thing not discussed in the story is whether the hospital admission prompt in the EHR was created around evidence based medicine or if it was created around revenue plans. One ED doctor suggested the hospital admission alert was done by a non-doctor with no medical training. I’d be interested to learn more about how the hospital admission alerts were really created.

I’m sure we’re going to see a lot more discussion coming out of this 60 Minutes story on Health Management Associates (HMA).

This was an interesting tweet that displays the need in this highly connected world to be able to disconnect. I agree this is a problem, but I don’t think the technology is the problem. It’s the expectation that’s the problem. Once you deal with the expectation issues, then the technology is a benefit and not a weight on your life.

I heard someone else in the mHealth Summit Twitter hashtag talk about mHealth being a toddler when it comes to how far its developed. We’re probably only a 7-8 year old in the EHR world. So many more opportunities available for healthcare.

Fixing EMR Drawbacks

Posted on October 17, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

FierceHealthIT editor Ken Terry had a recent post on the need for better human-computer interfaces in EMRs. He highlighted a few areas where EMRs could stand some improvement, and I thought they were bang on. These are aspects I’ve thought about a great deal myself, and true to the Steve Jobs dictum of staying foolish, I’m offering some solutions to these oft-mentioned problems. I’m sure there are plenty of people who have already thought of these and better solutions, but here we go:

1) Initial Data Entry – The biggest headache for providers’ offices today is what to do with all those boxes of medical records. Scanning solutions exist but they leave you with unstructured data. Manual extraction is time-consuming and requires upfront investment. I’ve pondered for a while about this. I think on-demand data extraction might be the way to go. Provider offices know ahead of time what their weekly, even monthly appointments are. If a provider’s office digitizes the records of patients with upcoming appointments every week, it should have most of its records digitized by end of year. This is assuming patients make it to the doctor’s office for at least once-a-year appointments if not more. If the office outsources this work, it needs some monetary investment, no doubt, but such a setup might be affordable since it is pay-as-you-go.

2) Templating – Terry states that many doctors hate the templates that come with most EMRs. And templates make it easy to generate pages and pages of verbiage which say exactly the same thing for patients with similar profiles, or say very little that is meaningful. Surely customizable or extensible templates can get rid of this problem. Or speech-to-text dictation that allows the doctor to mirror practices from not so long ago.

3) Alert Overload – Many EMRs are designed to issue alerts for adverse drug interactions, prompts for patients and similar such decision support tools. But too few of these and you risk not asking the right questions. Too many providers just ignore them, or worse, override them. No easy solutions for this one, except maybe to figure out where the fine line lies between lack of decision support and too many alerts.

4) Interoperability – EMRs cannot talk to each other. So a patient who moves from one provider to another is really at the mercy of software whimsies. Or worse. For providers, it’s equally frustrating not to be able to get ahold of the patient records in a format suitable for their particular EMR software. One simple answer – standards. Granted HL7 is still evolving, but EMR vendors need to at least consider offering data exports in this format.