Arguing For Open Electronic Health Records 111
mynameismonkey writes "openEHR guru Tim Cook, writing in a guest blog at A Scanner Brightly, discusses why Electronic Health Record developers should use open standards. Why are so few doctors using EHR systems? And, as more and more hospital EHR systems come online across the country, what do we have to fear from proprietary databases? It's one thing to find out your social security number was stolen. Now add your mental health and STD results to those records."
What? Me worry? (Score:3, Insightful)
This is Slashdot. An STD would practically be a trophy here.
Re:I seriously doubt it (Score:4, Insightful)
I think much of the problem has to do with legal problems on the storage of data and its dissemination (privacy laws, legal exposure etc) and that doctors have a general distrust of electronic record keeping without a paper backup. Also, arriving at an open standard on storage of health information is very very difficult as it's not a science and there are as many opinions as asses on seats at committee meetings. Everybody quotes easy stuff like pharmacy orders or pathology requests and results, but a health record can come in so many forms, (and if you look at a hospital record, there are so many types of forms in it) that it becomes difficult to come up with a database design that will cope with such diversity and still be usable. Information on a case can be a few scribbles to an exhaustive analysis.
That's not to say it won't happen, but it is taking a very long time and some expensive attempts at standardization (eg: NHS) have failed.
Who owns it (Score:3, Insightful)
A better question is who owns your record?
An unsettling issue is that the doctor or hospital generally considers that THEY own your record. Think about that for a second...detailed records of you and your peccadilloes and someone else thinks they own and have the right to do what they want with your data.
In a world where that little vulnerability were straightened out open standards based ways of working with your personal data would come by default. You should be able to store and deploy your data, under your control, will any medical professional only being allowed to access and add to those records with your permissions. The only way to make that work is for hospital systems to use open standards, no more proprietary systems and no corporate data caches.
OpenEHRs are a sideshow next to that.
Non sequitur (Score:2, Insightful)
So many reasons ... (Score:3, Insightful)
1) They are expensive for a small practice - think that a primary care docs office is rolling in cash? Think again. Most of them are barely scraping by, which is why your doc needs to see 30+ patients a day. Otherwise the rent doesn't get paid and he/she can't make payroll. If a new tool doesn't make the office more efficient, it can't be justified. Sound odd? Next time you visit your doc, ask him who determines how much he/she gets paid. Its not you, its not the market and its not actually the insurance companies. Its the federal government when they set payment guidelines for Medicare/Medicaid which the insurers follow. Free market my ass.
2) They are slower than paper - few docs can type as fast as they can dictate or write. Most of us can take notes on a piece of paper while interviewing a patient - no one I know can talk to a patient and type into a form.
3) Many are designed to maximize billing, not care - we get paid based on how many indicators of complex care we hit. How many "systems" asked about, how many organs examined etc etc - not by our time or skill. So in order to bill we have to document all of these. Some EMRs are designed to force the MDs to check many boxes for billing and audit purposes. Unpleasant and slow.
4) Many are slow and perform poorly - my hospital switched recently from a physician designed an written EMR from the 80s that was text/terminal based and blindingly fast, to a web-based system. The new system is slow, and doesn't really do much that the old system did. The difference was that the first system was built by MDs who ate their own dog-food, the second by teams of very smart, very committed programmers who don't practice medicine.
5) They are the camel's nose under the tent - my hospital based practice was recently instructed to begin doing "medication reconciliation" on all outpatients. That means at the start of the visit I have to type in all of a patient's medications into the EMR. Sounds fine for you, right? Now imagine your grandmother. As a sub-specialty consultant I see most of my patients once to twice a year and they are on 20+ medications, over the counters, vitamins and herbal supplements. It can take 6-7 minutes out of an already short 30 minute visit. Sure its great for safety, but it means we are running an additional 45 minutes late at the end of the day. Not so great for you if you have a late afternoon appointment.
Re:I seriously doubt it (Score:3, Insightful)
The problem isn't impossibility but infancy. There are good systems around but making them work across the board has been the problem. For example, in my neck of the woods the big problem is ignorant and territorial IT departments in both the public and private health systems which do not want to do any work but see their job as shopping around for people to outsource their work to. And because they get taken to expensive dinners by big companies with crappy solutions, they create 'guidelines' which exclude everybody but the companies that pay for their dinners.
And because everybody hates the IT departments, nobody cooperates with IT and all their projects, aside from fixing broken mice and installing windows XP updates, fail.