The Time I Wrote About Electronic Health Records
So, I don’t usually tackle serious topics on this blog, unless you consider severe anal trauma to be a subject of national importance. But I’m going to go ahead and break my informal rule.
Full disclaimer: I work in the field of electronic health records (EHR, also known as electronic medical records, or EMR). I’m not a vendor, and I’m not a provider, but rather I work at a nonprofit advocacy group for the modernization of American healthcare.
The USA is behind in so many ways. Most of our citizens’ health records are still on paper that must be schlepped from office to office, from hospital to hospital. Perhaps if you don’t have a chronic health issue, you don’t realize the inconvenience and incompetence this systems fosters. Imagine having cancer and having to carry a stack of files taller than 15 iPads stacked on top of each other to every specialist you see. Picture having to trust your medical records to a family member because you are too ill to take care of them. Wonder how a doctor will ever be able to read the horrible handwriting on a an old, yellowed piece of paper from 1992 that nonetheless may hold the key to diagnosing your condition.
Paper health records slow down a process that is already painful enough on its own. If you are admitted to an ER after a horrible car crash, how will the doctors and nurses on staff know about your allergies or past medical conditions? Yes, you could carry a flash drive or something on you at all times, but who’s to say it didn’t get crushed in the crash? What if the nurse on duty doesn’t have access to a computer that can view your files? In short, the system is FUCKED.
But this is not only a problem for John and Jane America. As Jon Stewart has recently brought up on The Daily Show it affects our veterans as well.
(I would embed these videos, but that feature apparently doesn’t work on WordPress. Lovely.)
Watch those two videos (er, assuming you have an American IP address, and try this app if you don’t), and tell me that those veterans don’t deserve better. That they should somehow be expected to wait over a year to hear a decision regarding their benefits. Benefits they never would have been eligible for had they not been wounded serving our country. To have recently returned soldiers grappling with their physical and psychological trauma with NO assistance from the government or anyone else is criminal.
The barriers to implementation are two-fold. One is the resistance of the old guard to change their ways. Though this sector is rapidly decreasing, it is still there, and it is full of providers who performed their jobs just fine on paper since the 1960s, and see no reason to change to a newfangled electronic system now. Why fix what ain’t broke? The second is the sheer cost of purchasing and using an electronic health record system. Imagine a room full to the brim with paper records. As Stewart pointed out, the weight of them can be enough to collapse through floors. Now think about the work and time required to transfer all of those to an electronic system. Is it impossible? No. But for many smaller practices, at least, the prospect of closing a practice for a week or more to perform the switch is simply unthinkable. The lost revenue alone makes it a nearly impossible scenario. Then of course there is the cost of the EHR system itself (not cheap), and the training needed for staff to actually use the new technology. There are government incentives available to qualified small practices to help subsidize this huge cost, but for doctors close to retirement, the benefits simply do not outweigh the investment.
However, for Veterans Affairs? What is their excuse? They are not a single doctor practice. They are not even an urban hospital. They are responsible for ALL US MILITARY SOLDIERS. The thought of them spending money on a new hand-crank filing system rather than investing in EHRs is laughable. They have the means, they simply seem to lack the will.
Though of course, even once you have an EHR system, there is still the difficulty of having each system talk to each other. That is what the first Daily Show clip addressed. Two systems, though electronic, cannot speak to each other unless the same vendor supplied both. This is one of the things my organization is currently working on – how to get all these disparate systems to talk to each other so that information simply FLOWS instead of becoming bogged down in red tape and misery.
Yes, there are many complexities associated with EHRs. What of privacy issues? What of security? What about the records of minors? But we have to face it – the future is coming, whether doctors, patients, or government bureaucrats want it or not. And to spend resources fighting against it rather than working to ensure its success dooms not only our generation, but the next to the medical inadequacies of our forefathers.