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Does Health IT improve care?


. 3 Comment(s)

In a perspective written for Health Affairs, Stephen Parente and Jeffrey McCullough examine whether health IT improves patient saftey.

Although an extensive literature shows the value of health IT at leading academic institutions, its broader value remains unknown. We sought to estimate IT’s effect on key patient safety measures in a national sample. Using four years of Medicare inpatient data, we found that electronic medical records have a small, positive effect on patient safety.

What has your experience been?  Beyond just patient saftey, how has health IT affected the delivery of care in systems you've worked in?

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  1. Jeremy Jaskunas, M.D.

    Permalink

    My clinic has used a comprehensive medical records system for approximately 3 years now. In theory an EMR is a great thing but my experience with it illustrates the unpleasant reality of it. Here are the positives and negatives:

    1) Positives: reduces drug errors, easier to check for med interactions, makes refills very very easy, easier to track medication history

    2) Negative: I have a General Internal Medicine practice dominated by very ill, very complicated geriatric patients. My visits are virtually never simple enough to lend themselves to a formatted template clinic note (i.e. for an acute resp infection). I therefore, continue to dictate every note and see NO improvement in efficiency (in fact, a decline--see below)

    3) Negative: who enters all the past medical history? I do. Rolled out the EMR with no plan in place for entering all the old info. Nurses too busy to do it, so I find myself spending yet more un-reimbursed hours each day on data entry. Clinic finally hired someone to help--unfortunately, they didn't have enough medical background to make a huge difference.

    4) Negative: who enters all the new data? I do. My clinic is 100% electronic. . .but the hospital isn't, the consultants aren't. I get a stack of paper 1 inch thick each day consisting of consultant reports, hosp lab reports, imaging reports, op notes, nursing home updates/questions, procedure reports, d/c summaries from other hospitals, etc. Who updates the medical record--I do. Then all of this paper is sent somewhere to be scanned--an electronic medical record filled with scanned documents is very unwieldy and inefficient.

    5) Negative: terrible notes. Many doctors take advantage of the aforementioned template clinic notes to enter notes that are completely worthless--no real patient info--just a template with a few blanks filled in. Mad libs for the medical field. The notes convey nothing--they fulfill the criteria for coding but communicate nothing to the next provider.

    In case you are wondering, I am 34 years old--I grew up with computers.

    6) Positive: access to the electronic chart from anywhere.

    More to be said, but I have to get back to data entry...and then get back to being credentialed for my new job as a hospitalist--good bye primary care.

  2. KARL FIELDS, MD

    Permalink

    After 18 months of using and EMR, I would echo most of the well thought out comments of Dr. jaskunas. Until better voice activated systems arise many of the notes will be of terrible quality and much worse than the dictation based notes of the past generation.

    EMR has great potential. Unfortunately this will not be a major factor in improving patient care until EMR systems are much better and do not rely on the physician to be a clerical worker.

  3. AndrewBoldman

    Permalink

    Great post! Just wanted to let you know you have a new subscriber- me!

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