The Pluses And Minuses Of Electronic Medical Records
http://thedianerehmshow.org/shows/2012-09-25/pluses-and-minuses-electronic-medical-records
As part of the 2009 stimulus package, doctors and hospitals in the U.S. were offered financial incentives to switch to electronic medical records. Three years later, more than one-third have moved to digital. While the change has improved efficiencies and patient safety, there is rising concern about the vulnerability of the system to fraud. One recent study found that hospitals received billions more in Medicare reimbursements following the switch to digital records. And patient privacy concerns remain. Guest host Tom Gjelten and a panel of experts discuss the positives and negatives of electronic health records.
Guests
Dr. Don Detmer
professor of medical education at the University of Virginia.
Fred Schulte
senior reporter at The Center for Public Integrity.
Dr. David Levin
chief medical information officer at Cleveland Clinic.
Dr. Farzad Mostashari
national coordinator for health information technology at the Department of Health and Human Services.
Dr. John Dooley
internist at Foxhall Group in Washington, D.C.
Comments
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What about the issue of security and privacy of a person's medical records? I'm an Army veteran and twice I've received letters stating that my medical records "might have been compromised"; the first time by the VA (a worker "lost" a computer with electronic medical records), and the second - Tricare (computer with thousands of records stolen from a worker's car in Texas). As a result I was given free credit monitoring for a year (Gee, thanks).
If the records are kept in a hospital electronically, will everybody who works there have access to a patient's records? What about the patient's right to privacy? Especially in a psychiatric or substance abuse hospital, it may keep patients from seeking help - if they think their problems will be open for everyone to see.
Have these electronic ordering devices been approved by the FDA as being safe and effective? If not, why have they not been subject to the Federal Food Drug and Cosmetic Act? When the systems crash and all screens go blank, all records vanish and doctors can not even find their paients. What organization is keeping records on this one type of adverse even.
You must be aware that Medicare does not pay for any medical device or medication therapy that has not been approved by the FDA because it is deemed experimental. Have these electronic care record and ordering devices been given an exemption?
I work at an orthopedic surgeon's office, the vast majority of electronic medical records I see are unreadable garbage. Just a pile of phrases with semicolons thrown in.
Computers aren't magical - the old saying still holds: garbage in, garbage out.
Your introduction contains hype from the HHS, ONCHIT, HIMSS, and Congress: " While the change has improved efficiencies and patient safety, there is rising concern about the vulnerability of the system to fraud"
There is not any medical evidence to support your statement pertaining to "improved efficiencies and patient safety". The opposite may be true. The near misses, injuries, and deaths associated with these devices go unreported.
The HHS and Congress have instigated an uncontrolled and unregulated national experiment (something similar was a abject costly failure in the UK) using the patients, doctors, and nurses as unconsented subjects to provide research and development advice to the EHR vendors.
The vendors are collecting $ millions from the largesse of the Congress after lobbying and educating the lawmakers, via HITECH and PPACA, yet have zero accountability on adverse events to assure the safety of their devices that are controlling the care and workflow of care of the guinea pig patients.
Is any one shocked that the additional violations of patient privacy and fraud (by the vendors, too), are widespread?
What baffles me is why it's taken so long to computerize & connect medical records. I guess it's just more complicated than say, your credit card transactions etc.
While much focus has been put on the cost cutting aspects of electronic records, even more should be placed in the life saving potential.
Medical errors are rampant in hospitals and many, many mistakes can be avoided by the availability of accurate timely data for patients. Relying on the memory of patuents, especially at times of severe illness and duress, is folly and dangerous. The mere omission of a drug interaction or allergy or sensitivity can result in unnecessary illness and death. Doctors often decry the lack of specificity in records or the need for an unique layout for a particular specialty or condition. The advent of XML and template driven details can overcome most objections.
One major problem is the resistance of medicos who believe only they have the proper know how to lay out records......as educated and well meaning as they are, docs are NOT omniscient and fail to recognize the abilities of professional information specialists to provide data in the most meaningful efficient manner.
The US government typically is years behind in technical prowess....e.g. the HIPAA regs call for ANSI X12 formats which are at best 1980s technology.
Check out the Paul Newman flick The Verdict for an example where an accurate record would have saved a life and millions in legal wrangling.
The mere fact that one's entire accurate medical history can be stored pruvately and encrypted on a "thumb drive" which that person can carry and keep safe should be encouraging. Getting medicos to agree on formatting and critical content is much more daunting than securing the data or allowing one to have control over it.
For every situation in which records have been compromised, there are literally hundreds in which insufficient information has caused suffering and worse.
Does anybody else get frustrated filling out the same medical history over and over for every medical office one enters.......not to mention that they don't retain the records for long......and even the sharpest tool in the shed forgets dates and specifics sometimes??
I just started my AmeriCorps year of service working at a Community Health clinic that helps the homeless in Baltimore. I work exclusively with Medical records making referral appointments and tracking them. while there are many potentially slower steps (such as scanning records onto a computer trather than just throwing them in a folder) it is inifintely easier and quicker to find consultation reports and track correspondence with the patient using Medical records. instead of having to look through endless physical charts I can very easily search for documents to see if our system has the documents I need.
as for secuirty anyone who works with medical records must abide by HIPAA. It is also just as easy to lose a physical chart as a hard drive of medical records so I don't see how that is an issue (outside of an organized attempt to hack electronic records).
from the physicians point of view I know that my father, a nephrologist, hates hates hates medical records. he believes it slows down his ability to write perscriptions and deal with patients. however, just because it slows down physicians ability to write perscriptions, it actually makes it easier for everyone else to track perscriptions and recieve the perscriptions.
I think the most challenging issue is how to make it so that electronic medical records can be shared across many different platforms and software. how can we solve those issues so we no longer need to have the cumbersome process of (secure) faxing and scanning records
Please, it's not "electronical" records, it's ELECTRONIC!
EMR is not up to what it could be since no one at the federal level has standarized the software language, like having 65 different railroad widths. Hence no one can send information other than their office. R Forbes Syracuse
BZZZT!!! LOGIC ERROR ......LOGIC ERROR
Electronic medical records are leading to fraud.
NOTHING in your guest's statement supports your assertion that the increased billing is fraud.
It could just as well be that electronic records are more thoroughly capturing the doctor's work & previous billing was shorting the doctor for the work they performed.
I am an oncologist at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and am a Professor in the School of Medicine. My experience has been that conversion to an EMR, while providing some efficiencies, has not served the best interests of patient care and physician training. Many or most of the EMR software packages are optimized for compliance and billing, and not for patient care. An enormous amount of information is often automatically dumped into patient notes, making the record difficult if not impossible to read and understand. On the inpatient side, notes are often "copy forwarded" to minimize the amount of typing required, and information is often not updated or corrected. Misinformation may be propagated. The format and amount of information does not promote synthetic thinking, but rather parroting previous information. Thus, particularly for medical students and resident physicians, less thinking seems to be reflected in the patient record.
In terms of safety reminders, we suffer from reminder fatigue, where the EMR is always flagging more and more. Physicians in the interest of time often hurry through these reminders, dismissing potentially important notifications.
Finally, it is clear that the programs have been designed to maximize billing potentials, which likely accounts for some of the fraud reported by your guests.
Steven D. Gore, MD
Patient comes in with a sore throat...also needs to be checked for their diabetes.
Only problem is medicare & all insurances refuse to pay for appointments that address multiple problems. Picking the pockets of providers once more.
We already have a tax payer funded emr that is being used in hundreds of facilities currently..It is called CPRS and is used in the Veterans Administration facilities.I last used it in 2003 and even then , one could see records from across the country and this really helped taking care of the patients.
Why can this not be released for use across the US ? I can guarantee that you will get over 80% adoption by outpatient practices. It would save billions of dollars by coordinating care and avoiding needless duplication of tests.
Over the last five years of being up close and center with my aging parents health care needs we have been so appreciative of the V.A.'s electronic records system. BUT
In one case at the Dayton Ohio VA we took my WWII father into get a second opinion about nervous shaking that the nursing home that he was in was not dealing with appropriately. My mother and I were both in the room when the attending physician asked him a few questions about his age, service etc. He did not ask him once whether he wanted the test that we were requesting. The Doctor turned down our request for the test. Later that day my mother and I requested the Doctors records on his meeting with my father. The Doctor had reported that he had offered my father (has dementia) four different nervous disorders test and that my father had turned them down. THIS WAS A COMPLETE AND UTTER LIE. We appealed what he had reported and his claims were removed from the report. Of course the Doctor knew it was not true and there were two witnesses to his lies. Should we have pushed this further? I kept wondering how often this happens.
In another recent situation as I went through my mothers medicare knee replacement records I saw charges from a rehabilitation center Maria Josephs in Trotwood Ohio. As I went through the records I found charges for physical therapy that she never received on the days they claimed. I was there during the time they claimed they had treated her. We are talking about in the thousands of dollars. Had a difficult time reporting this to a relevant office or those who would monitor this type of fraud.
Is there such a electronic service to monitor this type of fraud?
are there electronic ways to report fraud in the medicaid and medicare systems that is efficient and productive ?
My husband is an internist whose pracatice, hospital owned, had converted to EMRs. He tells me that he and his colleagues spend more time taking care of the computer and less time with patient care. Frequently the computer doesn't work correctly. One day it was telling him things like, "Diabetes is not a billable diagnosis." He says he wastes a lot of time on the computer that he would rather be using for patients.
As a RN with a certificate in Informatics (use of technology in healthcare) the issues are being entangled between issues in healthcare-payment, quality and fraud- and the use of EHRs. The problems that are being discussed have existed since the payment of healthcare services is the priority over the care of the patient. There are positives and negatives to the use of EHRs, one that I have not heard mentioned is the unintended consequences that are a direct result of the use of EHRs. These range from breaks in security to death. EHRs have not caused the fraud in healthcare that is directly related to the providers actions, which will be profit driven as long as the system is based on volume and not outcomes.
I am listening to the broadcast and I hear a lot of rhetoric that has been promulgated over the last few years regarding why EHRs are "great". There is a place for electronic storage of information and accessibility. But as an auditor of medical records I have been trying to get the industry to listen to the "downside issues" for more than 10 years. There are serious problems with EHRs, beginning with the EHR software itself. The companies that have designed and sold these systems to physicians and institutions with complete knowledge of their ability to create fraudulent records should be held accountable for their actions. In fact, many advertise to and train providers to use these systems in a fraudulent manner. There is not enough room or time to list all of the issues I have personally seen with EHRs, both from a billing and a patient safety perspective, in this forum, but please know, they are not the "be all and end all" some of your guests have intimated in this program. I am not against electronic record-keeping, but the right now we have a dangerous system. Thank you Fred Schulte for shining a bright light on this problem!
I don't know about for patients, but from the doctor's side, NOTHING is efficient and productive about medicare (administratively). Kind of like driving a car from the back seat, using sticks to work the controls while wearing mittens!
Amen, Dr. Gore. My husband, an internist, says the same things. He now serves the computer, not the patient.
Your issues listed are common with the use of systems, but are directly related to the usability of the system and the design of the system.
There are two aspects of Electronic Medical Records (EMR) that I would like to address. I am the wife of a primary care physician and I have watched husband work his way through this major change in practice.
First, EMR provide excellent documentation when used correctly. Diligent physicians have vast amounts of info about their patients readily available and protect themselves medical/legally because records are time locked into the record; thus, no one can accuse them of going back to amend the records. This benefits both the patient and the care giver.
Second: Regarding coding charges -- many physicians were not coding their services correctly from the start and were woefully under compensated. There has been a surge of education about the importance of coding properly -- which is a beast unto itself -- because most doctors wanted to focus on care - not billing. People need to keep in mind that if physicians are under-compensated then we will have fewer and fewer physicians to provide primary care to us overall.
Regarding filling out the billing information, isn't that usually done by office staff? What kind of communication is there between the doctor's diagnosis, office time or treatment procedure and the person responsible for submitting the electronic forms?
And, does the doctor really know which "dx numerical code" is needed? There are hundreds.
Lenore
Presumably hospitals and reimbursement systems have adjusted billing formulas for different services so that the outcome provides profit for the providers.
If electronic records facilitate more accurate billing, what is the likelihood that the formulas can now be adjusted to pay less per service for some services so the total bill is both accurate and sufficient?
I'd like to respond to the person who said that EMRs are more secure. Yes, there is the possibility that someone would break into my doctor's office and steal my chart, but that possibility is extremely remote. With EMRs, any decent hacker can break into the system at my doctor's office and have access to all my information. I don't like my private information being accessible to anyone with a computer and some hacking abilities.
I'm a physician assistant and a previous IT professional. It is quite a leap to say that the increase in costs since IT expansion represents fraud. I say that it more likely represents improved billing due to capturing of more accurate information such that we are not more appropriate capturing bills and were previous underbilling. I work in a hospital and an outpatient clinic. With paper charts I know there was much we were doing that was being unbilled either due to lack of information or unreadable documentation. What many people do not realize, is that the current information requirements by insurance companies is daunting. It is very difficult to achieve the proper "level" in order to reach an appropriate billing level. I spend easily 2/3 of my time on charting just so we can adequatly bill.
What do I need to do to protect my EMR from their destruction by the inevitable massive CME?
My husband is a family doctor and was excited about emr. Now he has second thoughts. He finds he over-bills because the system forces him to code certain things when he feels a lower code is more appropriate. He used to back track to lower the code but has given up because he spends hours trying to back track to make less money. He spends more time correcting what the computer thinks rather than what is reality.
I'm an Emergency Department nurse in a health system with 7 hospitals. We are just now implementing a system-wide EMR system. So far, I like it for the most part. I'm not used to charting by exception, so I still click all of the buttons and then write a narrative note - it's just the way I was trained. I like that the patient's medical history and medication history will be all in one place. Before installing this system each department had a different system. So, in the ED we couldn't see the patient's last inpatient visit or a visit to a physician's office (if they're in network). So, the new EMR will be great from that perspective! I don't see a big difference in billing either - we do what we did before - review what we charted and click a button...