The More Downs than Ups of Electronic Medical Records

11 10 2012

Hark back to the thought processes of the 1970s and 80s when the ‘bad’ science fiction movies were filled with technology, robots, were taking over the world from the humans who created them.  This is the sensation that I got from the Oct 8, 2012 article in the New York Times, “The Ups and Downs of Electronic Medical Records” by Milt Freudnheim.

While the title suggests that the article will speak to both the benefits and issues with electronic medical records, the author was much more heavy handed with the downfalls.  The article was fairly gloom and doom about the whole situation.

Don’t get me wrong, I realize that there are definitely bugs to be worked out and that it looks like it will take time to work them out, but downplaying the potential benefits to patients and doctors alike of this new technology is not the answer.  In this case, where neither the software manufacturers, nor doctors, nor patients really have an idea of when and how the technology can really be beneficial, or if it will turn out to be a detriment to patient healthcare, it is much better to present both sides of the argument and let people make their own informed decisions.

The first portion of the article really emphasizes that currently, unfamiliarity with the software systems is bogging down the system, and this is probably true, but wasn’t that also the case with the first computers, where there absolutely was a steep learning curve.  Fortunately, now computers are a staple in everyday life and are making lives much easier and more productive.  This is also emphasized in another article in the NYT on the same date, “Redefining Medicine With Apps and iPads,” by Katie Hafner.  Nurses and doctors alike will likely have to go through hours of training and overcome the habits learned over years on the job and professional training of writing everything down on paper, but benefits may eventually outweigh the problems that are currently being brought to light.

In the middle portion of the article, several good points are brought up about the current state of technology. Dr. Scot M. Silverstein raises a good argument, that indeed testing technology in a live hospital setting is probably not a good idea, much less ethically correct.  This is why there are simulators and even training tools, where a mock system with imaginary patients could be used in training to practice using the system, and where hospital administrators and doctors could determine whether the system that is being tested is correct for the hospital it’s being used in.

Cross talk between systems and apps is also brought up, until either a universal system is created to be used in all medical institutions, or a set of systems are designed to infallibly speak to each other, without translational issues, institutions are going to have to implement safety measures to ensure that what a computer system is transmitting, is indeed correct.  Medical professionals are still going to have to use common sense and not just rely on technology.

The industry will definitely have to design new safety measures to handle these new standard operating procedures in order to protect the patient and ensure the highest standard of care.   This is not new, and new safety measures are being implemented daily, but with technology a new kind of safety measure will have to be created.  People have to be willing to learn and evolve with technology, not let these ‘new fangled electronic gadgets’ stymie them completely.

In the last part of the article, I thought one quote was particularly amusing.  Dr. Scott A. Monteith is quoted saying:

“the diagnosing process can include ‘looking at six pieces of paper,’ he said. ‘We cannot do that on a monitor.  It really affects how we think.’”

I have no idea how old this doctor is, but the quote reminds me of some of the previous generations’ attitudes about technology, that just because it is not the way ‘it’s always been done’ that it can’t be correct.  I’m not sure how much exposure he has to technology, but there are ways to have multiple monitors linked together, to where indeed you can look at 6 documents at one time.  Granted, you can’t read them all at one time, just like with paper, you have to read one at a time, but you can get the same effect as laying them all out on a table to analyze trends and similarities, having them all visible on 2 or 3 monitors that are linked together.

One character in this story, Ms. Burger, president of the California Nurses Association, also brought up an interesting issue, stating:

“‘The problem is each patient is an individual, we need the ability to change that care plan, based on age and sex and other factors.’”

She is absolutely correct, that the software being used to enter records, diagnoses, and order medications should not be plug and chug with just a few options based on standard of care.  Medical professionals should have the freedom to use their expertise and previous experience to treat patients with drugs and treatments that they feel will be the most successful for each individual, as she stated correctly that “each patient is an individual.”

While this paragraph in the story was supposed to bring up more issues about the current state of technology when it comes to electronic medical records, I’d like to bring up the possibility of benefits in the future.  Personalized medicine is thought to be the wave of the future, using individual genetics to customize treatment.  While genetic sequencing is still on the expensive side, the price is steadily dropping and eventually we will probably have a sequence for everyone in their medical records.  This could allow a software system to analyze the sequence and give the doctor or nurse warnings about patient sensitivities to drugs or an idea about which drugs will be effective based only on comparison of genetic sequence or even epigenetics.  Cross referencing previous treatments, genetic sequence, and available treatments via software, could allow for each patient to be treated even further as an individual, making unique treatment plan design much quicker, without some of the trial and error.  For example, current genetic analyses, such as from the website shows when patients have a higher likelyhood of being sensitive to the drug Warfarin, an anticoagulant, even before being treated with the drug and finding out the ‘old fashioned way’ that there could be an issue with sensitivity.  It could allow medical professionals to change drugs or adjust dosages based on the way the patient metabolizes the drug, all found via genetic analysis.

Some other potential benefits that went unmentioned in this article include eliminating the need for double procedures, decreasing the likelihood of being prescribed drugs that interact badly from two different medical institutions, and decreasing the likelihood of drug addicts being able to play the system and obtain multiple prescriptions for the same drug.  All of these benefits require rapid sharing of information between institutions and likely not be implemented or seen for awhile, though the potential is striking.

The lack of need for double procedures, like imaging, blood work, etc would allow patients to be protected from unneeded radiation exposure or more needle pricks if referred from one institution to the next, instead of repeat procedures to get the same results, all the image scans and blood work reports could be rapidly and easily passed from one place to the next (think inter-institutional e-mail) or accessed in a universal system.

Prescription records that are widely accessible to pharmacy, hospital, and doctor alike, with safety measures in place, like the little pop-ups in gmail that remind you that you have not added an attachment if in your e-mail it says ‘see attached,’ doctors could be quickly warned if he/she is about to prescribe a drug that is known to interact with another drug the patient is already on.  A similar system could warn doctors/pharmacies that a prescription for opioids or other addictive drugs have already been prescribed.

While there are many kinks in the development of this technology to still be worked out, I think there is more promise than what this article would have you believe.  It is still really early in the game, but as technology gets better and professionals become more familiar with the options, I think this is the future of medicine and how information will be shared.  The majority of the issues presented are valid and should be taken into consideration and it may be a little early for universal implementation, but I think this industry lends more hope for the future than a need to toss it all out the window and start from scratch, as the tone of this article would lead you to believe.




One response

17 10 2012

Hi, Meghan, I think the generational issues are really an important factor, and it may be that the promise of these new technologies won’t be fully realized until the practitioners that aren’t comfortable with them have retired. I’m personally sold on the idea of electronic prescriptions and medical records–you mentioned the improved efficiency and the promise of reducing medical errors. I wonder how old the author of the article is? It’s well documented that younger people worry less about a universally-accessible record of your life existing than older people, and that carries over to electronic health records. Thanks for a thought-provoking post! Cheers, Cathy

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