Saturday, February 27, 2010
Safety Oversight for Electronic Medical Records
As reported in the Huffington Post Investigative Fund (subject link) the Federal Government is looking at how best to provide oversight of electronic medical records as they prepare to spend billions on these systems. Doctors and hospitals will receive increased Medicare disbursements if they have these systems, and even more if they show how they are making "meaningful use" of them. In the rush to get the money out the door, someone is taking the time to raise their hand with the suggestion that in the rush to collect stimulus money, doctors and hospitals may not due sufficient due diligence on their purchase decisions. Ross Koppel, a sociology professor at the University of Pennsylvania is one such person raising his hand.
Personally, I think electronic medical records are the key to quality health care for the future. However, I know that whatever the Federal government invests in it will control, overtly or otherwise. While this has both good and bad points, it is not my intention to debate those in this forum. But I believe there is a fallacy in reasoning that bears mentioning and should be closely attended to.
I am speaking of the fallacy known as post hoc, ergo propter hoc, or the fallacy of a false cause. Specifically, Mr. Koppel was concerned (in part) about orders that were written by doctors that are "strangely transformed" in the electronic record. I would ask if the doctor typed in the order, if he used a "template" (that is common among EHR software products) without carefully reading the entire template, or if he actually wrote out the instructions and then had someone transcribe their interpretation of what he wrote into the patients record? These are valid questions, and reading a doctor's handwriting has often proved difficult even for the doctor in question if some time has elapsed between when he wrote and when he is asked to read what was written.
Of Mr. Koppel's comments I have to totally agree that hospitals may rush due diligence and end up with a $70 million- to $100 million-system and will be married to it for some years to come. Taking this into consideration I think it is wise to look to some good examples of good systems - the Veterans Administration and the Cleveland Clinic. Both systems were implemented over decades, not years. Both systems require extensive learning curves for clinical and ancillary staff alike. But both systems are phenominal in the advancement of quality care.
The bottom line, in this writer's humble opinion, is that the Obama Administration is, once again, setting themselves up for failure. The idea of advancing electronic medical records is great. The notion that you can push these out over the next five years without having one disaster after another is incredulous beyond belief. What they will be doing, if they do not back up and slow down, is giving the Republican party all sorts of ammunition to use in 2012. President Obama is liable to find history recalling him as the short pause between the first Regan era and the second.
Personally, I think electronic medical records are the key to quality health care for the future. However, I know that whatever the Federal government invests in it will control, overtly or otherwise. While this has both good and bad points, it is not my intention to debate those in this forum. But I believe there is a fallacy in reasoning that bears mentioning and should be closely attended to.
I am speaking of the fallacy known as post hoc, ergo propter hoc, or the fallacy of a false cause. Specifically, Mr. Koppel was concerned (in part) about orders that were written by doctors that are "strangely transformed" in the electronic record. I would ask if the doctor typed in the order, if he used a "template" (that is common among EHR software products) without carefully reading the entire template, or if he actually wrote out the instructions and then had someone transcribe their interpretation of what he wrote into the patients record? These are valid questions, and reading a doctor's handwriting has often proved difficult even for the doctor in question if some time has elapsed between when he wrote and when he is asked to read what was written.
Of Mr. Koppel's comments I have to totally agree that hospitals may rush due diligence and end up with a $70 million- to $100 million-system and will be married to it for some years to come. Taking this into consideration I think it is wise to look to some good examples of good systems - the Veterans Administration and the Cleveland Clinic. Both systems were implemented over decades, not years. Both systems require extensive learning curves for clinical and ancillary staff alike. But both systems are phenominal in the advancement of quality care.
The bottom line, in this writer's humble opinion, is that the Obama Administration is, once again, setting themselves up for failure. The idea of advancing electronic medical records is great. The notion that you can push these out over the next five years without having one disaster after another is incredulous beyond belief. What they will be doing, if they do not back up and slow down, is giving the Republican party all sorts of ammunition to use in 2012. President Obama is liable to find history recalling him as the short pause between the first Regan era and the second.
Monday, February 22, 2010
New Health Care
The President is putting forward a new "compromise" health care bill that is still going to cost over $1 trillion in the next ten years. Suddenly it seems we have to pass something to earn political points for re-election. How sad that something as important as health care reform is being relegated to the back-burner of politics. Instead, our government should be looking at ways to foster innovations and disruptions to the health care industry that would engender true growth, better quality, and lower prices. That is something only the industry itself can do and government can not even come close with more regulations and more spending.
It would seem that President Obama is heading down the same road as President Carter - a really good man who is certainly smart enough to know what to do, but who has gathered around him the wrong advisors and is listening to them intently.
It would seem that President Obama is heading down the same road as President Carter - a really good man who is certainly smart enough to know what to do, but who has gathered around him the wrong advisors and is listening to them intently.
