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Merle Bushkin of MedKaz (a secure PHR device) is extremely unhappy with the reality that although we’ve spent years and billions on EMR adoption, the practice of healthcare hasn’t transformed yet. In “Where’s the urgency, the anger, the outrage?” he cites, among other things,

In two high profile examples, both Dr. Farzad Mostashari, the National Coordinator of ONC, and Dr. John Halamka, chair of the ONC–sponsored HIT Standards Committee, recently reported how their mothers suffered serious mistakes in treatment that could have been avoided if their providers had had access to their mothers’ complete medical records. It’s safe to assume millions more have suffered unnecessarily as well.

As the title suggests, he asks why we’re not up in arms about the lack of progress.

Personally, I just know that it’s taken many years to automate much smaller industries than healthcare, so the fact that there’s been no instant transformation is not a surprise to me. Of course I’m impatient and want people to work harder and faster. But we saw in relatively simple industries, like phone bills, that it took years for the systems to become reliable. I expect the same in this industry.

But this is why we must start, and we must push for improvement. Before Meaningful Use there were screams of protest that nobody has time to use the systems; only the financial levers of government policy forced the first steps to be taken. And this will naturally lead to demand for systems that don’t suck so bad. (Sorry to say it, but think back to our post about a big-name hospital settling for “the cream of the crap.”)

I also know that the response to outrage and anger is usually for people to clam up, crawl in their shells, stop listening. Which makes the angry even more outraged – an infinite loop.

And that raises a question I’ve asked myself repeatedly: what can be said (or done) that would make any difference?

A question to ponder: who, exactly, should be working harder and faster?

It’s widely acknowledged that the usability of most EMRs sucks – they really get in the way of clinicians doing their work; it’s acknowledged that almost everyone’s data contains errors; I’ve heard that the systems commonly aren’t reliable at preventing invalid data entries; patients and families commonly aren’t allowed to look in the record. (In one recent post here, SPM member Marge Benham-Hutchins, a nurse, was aghast to discover that when her husband became an in-patient, her normal access to info on the patient portal stopped!  Her ability to engage in tracking his care was reduced when he was hospitalized. How dumb is that, hospitals?)

One thing I do know: hospital policies could be changed, quickly, to allow patient and family engagement in the record.

As for the rest of the puzzle, I can’t see a path for the systems to become more usable rapidly. What do you think? What’s feasible? Who should be working harder and faster? Who, specifically, should be doing something faster than they are?



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