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Medical Records News
Research suggests computerized record-keeping may lower mortality, costs.
Bloomberg News (1/27, Waters) reports, "Putting patients' health records on
computer systems instead of handwritten paper charts reduces medical
complications, deaths and costs, according to a study of 41 Texas hospitals."
The paper appearing in the Archives of Internal Medicine lends "support [to]
President Barack Obama's campaign proposal that spending $50 billion a year for
five years on technology for electronic records would save money." During the
study, researchers at Johns Hopkins University asked doctors at 41 Texas
hospitals "whether they used computers to keep patient notes, order medications,
list test results, and track the reasons for other aspects of patients' care."
Investigators "found that the hospitals where doctors made the greatest use of
electronic records had lower death rates, cheaper costs, and shorter lengths of
stay."
Furthermore, "when computers replace paper, patient mortality rates drop 15
percent during hospitalization, among other metrics," according to Modern
Healthcare (1/26, Conn). In addition to the lower mortality rates, "hospitals
with higher scores for computerized order-entry systems posted 55 percent lower
odds of death for patients undergoing surgery for coronary artery bypass grafts
and nine percent lower odds of death for patients with myocardial infarction."
Google responds to charge from consumer group regarding alleged EMR lobbying
effort.
Healthcare IT News (1/28, Ledue) reported that "Google has responded
to Consumer Watchdog's call to end a rumored lobbying effort aimed at allowing
the sale of electronic medical records [EMRs] in the current version of the
economic stimulus legislation." Consumer Watchdog "is urging Congress to remove
loopholes in the ban on the sale of medical records and include other privacy
protections absent from the current bill." The "non-profit consumer education
and advocacy organization" alleged that "Google is pushing for the provisions so
it may sell patient medical information to its advertising clients on the new
'Google Health' database." Google officials said that the "claim is 100 percent
false and unfounded." The officials said, "It's unfortunate that they did not
contact us before making [these] unfounded statements, because we could have
told them that their claims were patently false."
In the
Wall Street Journal (1/28) Health Blog, Sarah Rubenstein noted that
"Google's ear is likely fine tuned to this issue, considering some folks in the
medical community have already pointed out the company is not a type required to
follow a federal patient-privacy law called HIPAA."
Study indicates 75 percent of hospital patients may be unable to identify
their physicians.
The
New York Times (1/30, Barrow) reports, "Hospital patients are rarely
able to identify their doctors by name or to describe their roles in the
patients' care," according to a study published in the Archives of Internal
Medicine. The study included "2,807 adults admitted to the" University of
Chicago's "hospital over a 15-month period." Patients were interviewed "about
the roles of the various physicians attending to them and to name the doctors on
those teams," which "consisted of three to four people, including medical
students, residents, and attending physicians." Researchers found that an
estimated "75 percent of the patients were unable to name a single doctor
assigned to their care." Furthermore, "of the 25 percent who responded with a
name, only 40 percent were correct." Some experts, however, disagree on "whether
patients need to be familiar with hospital staff." Dr. Ernest Moy, medical
officer at the federal Agency for Healthcare Research and Quality, questioned
whether knowing about "processes that will help" patients "get at the
information [they] need" is "more important" than physicians' names.
EHR adoption still low among
physicians, hospitals.
The Baltimore Sun (3/2, Kohn) reported that over the
past twenty years, "electronic health records (EHRs)
have been the Next Big Thing in healthcare: a way to
simultaneously improve care and reduce waste in a system
clogged with paper and manila folders." To date,
however, "90 percent of U.S. doctors and more than
two-thirds of U.S. hospitals still use paper for patient
records." According to David Merritt, director of the
Center for Health Transformation, a think tank based in
Washington, "Healthcare is at least a generation behind
the rest of society in terms of technology." While
"almost everyone agrees that moving from paper to bits
will improve healthcare," progress in this area has been
hampered by "a colossal, inertia-filled health care
system, a paucity of good software, no incentives to
adopt new technology, and a lack of government
leadership." In addition, there is concern that
patients' personal data may be vulnerable to hackers.
Despite these concerns and drawbacks, Government Health
IT (2/29, Moore) reported that "New York City officials
said a two-year-old project to deliver electronic health
records (EHRs) now has 200,000 participating patients,
and aims to reach more than one million people this
year." According to Mayor Michael Bloomberg (I), "200
providers have signed on to use the EHRs, and more than
1,000 are expected to join by the end of 2008." Should
New York City meet that target, the city will have the
"largest community network of EHRs" in the U.S., Mayor
Bloomberg noted.
Florida high court widens patients'
access to records.
Modern Healthcare (3/7, Evans) reported, "Florida's
Legislature wrongly denied patients' access to
medical-error and incident records made available after
voters amended the state's constitution in 2004,"
according to a ruling by the Florida Supreme Court. The
ruling stated that "[p]atients may access records
created prior to Nov. 2, 2004, when the amendment became
effective." In the court's 4-to-3 ruling, the justices
"cited a lower court judge's conclusion that the
constitutional amendment: 'heralds a change in the
public policy of this state to lift the shroud of
privilege and confidentiality in order to foster
disclosure of information that will allow patients to
better determine from whom they should seek healthcare,
evaluate the quality and fitness of healthcare providers
currently rendering service to them, and allow them
access to information gathered through the self-policing
process during the discovery period of litigation filed
by injured patients or the estates of deceased patients
against their healthcare providers.'"
New York City announces plan to
help doctors use electronic medical records.
The New York Times (2/26, B3, Santora) reports, "After
two years of planning and a public investment of more
than $60 million, Mayor Michael R. Bloomberg (I) said on
Monday that New York City was ready to equip doctors
with computer software that can track patients' medical
records in order to provide better preventive care." The
new "software package [was] developed with $30 million
from the city and roughly $30 million from the state and
federal governments, [and] would let doctors do much
more than is possible with paper charts by integrating a
patient's medical history, lab results and current
medications into one electronic interface." According to
city officials, "the system will give up-to-date
information to doctors through a series of alerts, like
overdue dates on prescriptions or cholesterol checks,"
and will also "share data with other doctors and provide
information about the current best practices for
treating illnesses." The goal is "to have 1,000 doctors
with one million patients using it by the end of the
year."
Additional Links:
Transforming Health Care: The President’s Health
Information Technology Plan
A recent article in the New York Times
“Many Doctors, Many Tests, No Rhyme or
Reason” reminded me of the distorted
financial incentives that permeate the
practice of medicine in the United States.
In the article, the author, a NY
cardiologist states, “In our health care
system, where doctors are paid piecework for
their services, if you have a slew of
physicians and a willing patient, almost any
sort of terrible excess can occur.” He then
goes on to detail the evidence of excess
both at a national level and on an anecdotal
basis.
Unfortunately, I have
to concur with his bottom line conclusion:
“Doctors are doing too much testing and too
many procedures, often for the sake of
business. And patients, unfortunately, are
paying the price.”
This article reminded
me of my own early experiences in the
hospital. I remember as a third year medical
student I commented to one of my classmates
that my internal medicine hospital rotation
was so easy! All we did was call consults
every morning based on all the abnormalities
we found on the labs and imaging from the
day before. Okay – so I’m being a bit glib
and over-exaggerating. But I do remember the
conversation and sentiment very distinctly.
I felt like we spent a lot of time asking
for consults when maybe they weren’t
necessary. But then again – I was a naïve
third year medical student with no
experience. What did I know?
But I have to say, I’ve
had those same nagging feelings through the
years – that utilization of consults and
testing is driven by financial incentives;
maybe even “throwing a bone” to one of your
medical colleagues. Where I did my
internship, many of the medicine patients I
took care of on the wards were either
uninsured, underinsured or within an HMO
model. In that situation, where there really
wasn’t the willing patient (or matching
reimbursement) I felt we were a bit
judicious and restrained in our testing and
consults. But in other environments where I
have practiced, where patients were more
generously insured, I definitely have felt a
trend towards overutilization and
unnecessary testing.
So what is a patient
supposed to do in an environment of
distorted incentives for testing and
work-up? Some solutions will hopefully come
from our site,
MyDailyApple. Over the next several
weeks, we will be introducing a set of
content, features and tools on MyDailyApple
to assist patients with understanding the
world of medicine and to take action with
managing their health. Some of this is
already there and I encourage you to check
it out.
But even with all the
great Health 2.0 technology, it is probably
unrealistic to expect a patient to look up
information and search on the internet while
in the hospital. So how can an individual
advocate and maybe to a certain extent –
protect themselves within this environment?
Probably one of the first steps, in addition
to all of the technology out there, is an
old-fashioned Health 0.0 solution - engage
your provider in an honest discussion.
Someone has to start the process. And it is
always fair to ask, “Do I really need this?
What happens if we find something – then
what? What if there is a false positive
result? What are the alternatives? Is this
all necessary?” Physicians probably aren’t
used to such pointed questions. But times
are changing – and so should the nature of
the interaction between physicians and
patients. And perhaps this will start the
frank dialogue to understand the distorted
incentives that operate in the American
health care system.
I think one of the
final quotes from a hospital executive in
the New York Times article really sums up my
feelings on this one. “The hospital is a
great place to be when you are sick. But I
don’t want my mother in here five minutes
longer than she needs to be.”
     
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