Just how bad are medical records?

Just how bad are medical records?

Summary: No politician has led on this issue. All we have gotten from anyone is rhetoric.

TOPICS: Health

ICANotes infographicA story this weekend from the Associated Press says doctors who examined their own medical records found them rife with errors. (Illustration from ICANotes, a mental health medical records company.)

The article offers just two paragraphs concerning automation:

A possible fix is to go paperless. But electronic medical records are expensive and sometimes different systems don't talk to one another. Only about 10 percent of doctors nationwide use some sort of electronic system.

While electronic records can cut down on medication and transcription errors, it's not a panacea.

There is, of course, a lot more to say than that.

There are valid objections to automating records. Not all test formats are supported. Standards don't exist. Systems for collecting records don't give proper prompts. All HIPAA problems become chronic once records are automated.

But the lack of automation is also costing the system billions of dollars per year, and is probably costing hundreds of people their lives as well.

Politicians all seem agree on the need for automation, but no one has put forward a medical advisor who can start working on the process, ironing out differences among vendors, etc.

No politician has led on this issue. All we have gotten from anyone is rhetoric.

Vendors have behaved in the exact same way. Proprietary formats, lack of interoperability, and a disconnect between who pays (doctors) and who benefits (insurers) continue to make doing nothing seem like a very good idea.

Having covered this topic for several months now, it's clear the logjam will not be broken this year, next year, or possibly even the year after.

Automation, it seems, awaits the outcome of health care reform discussions that won't even start until a new President is inaugurated. Solutions won't emerge until after the underlying course is set, and the technical questions concerning automation seem irrelevant to that discussion.

So we wait.

Don't get sick.

Topic: Health

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  • Medical records USA

    Of course the records in USA are on paper because the ultra high cost of treatment in USA does not leave any funds for IT in spite of the rocketing insurance bills.
    I pay much much less in tax in UK than I would pay for insurance in USA yet the group practice where my doctor resides has a full IT network which enables him to look at my history over years and thus spot trends. This means that when I go for a blood test, as I do once a year, the results of the tests of the sample are available on his screen when I visit a few days later for my check up. He recently sent me to the local hospital for an Xray to find the cause of a pain. The full results are now in his computer system. He found it was not serious and prescribed treatment. If he is absent any of the other doctors in the practice can access my history and have a sound basis for diagnosis.
    Using paper records a doctor just cannot match the service available when all data is so readily accessible on screen. The USA needs to get over the initial costs of IT and reap the benefits in both cost and service that computer records can bring.
    • Move with the world, the must... or be left behind

      I am a student, in university, in Canada... I get a similar experience with medical treatment here, though, when I am at my home doctor, it's paper, but they keep their own records... and if I make an appointment at my home doctor, they will have the university send them updates... it's secured, and there is IT in place to ease that transfer of information, while maintaining my data's privacy...

      If you compete on price, someone will always find a way to outdo you... walmart will undercut anyone who tries to face them, for instance... but if you compete on quality, like Apple... well, you'll find it easier to stand alone, and do very well for yourself while you do.

      Compete on price, and fight tooth and nail for any real success... compete on quality, and yes, you'll charge more, but people will realize they get what they pay for, and you'll get their money to give a good product.

      Health care isn't much different (well, in canada, it's public, and tax-funded, for the most part... but even so, we aim more for quality, not just cost...)
    • Who pays is part of the issue

      Who takes responsibility is another part.

      We seem to expect doctors to pay so insurers can reap the benefits. And when insurers offer to pay, we become very suspicious of their motives.

      If government offers to pay, Americans go ballistic. But I believe that's what happened in the UK. Please correct me if I'm wrong.
      • Who pays

        Dana in UK you pay a National Insurance charge while you are working. This and some of the Income Tax revenue pays for the National Health service. The cost per head is far less than in USA but the outcomes in health and life expectancy are greater. There is a nominal charge per prescription for medicine but this is not payable by children or the retired. If you wish you can take out private health insurance to get treatment earlier than it is available in the National Health system though the waiting time for hospital treatment is reducing so that the benefit of paying extra is reducing.
  • Why do you think ths is a technical problem?

    Why do you think this is a technical problem? Computer patient records are tricky, as most IT-related things. There are some standards but they are incomplete or obsolete or short-sighed. And then there is the problem of doctors being computer illiterates (that's costly).

    However, this is not only a technical problem. Errors in medical records will happen always, because the problem is the doctor, nurse, pharmacist or technician who make big fat mistakes all the time (just like any other human). If your doctor only have 20 minutes per-patient, do you really expect to receive any quality medical care? Do you really believe a software system will allow your doctor to do it better and faster?

    And then you want politicians in the scene. Why not first the medical associations. The AMIA (American Med?cal Informatics Assoc.) maybe. At least they have a clue. Politicians don't have a clue, specially when the insurance companies love to lobby them.

    HIPAA-like laws will make it worse. Nobody wants to share the patient's data with anyone because of HIPAA. Defensive medicine is costly, defensive record management is costly too.


    • Amen

      People make the mistakes, not the computers. You're absolutely right on that. And people don't want to be caught on their mistakes, so they don't want to share data that might be wrong, or (more to the point) take legal responsibility for it.

      A system that doesn't acknowledge the reality of mistakes, especially an electronic system, is failing to take advantage of its very nature.
  • RE: Just how bad are medical records?

    I have been in health care over 30 years and have read your online publications almost on a daily basis for the past 3 or 4 years. I have not seen anything in ZDNET that would tell me you folks have a clue what is really going on in the field of medicine. Please do some real research before you going diving in over your head. One odd article that is probably a miss quoted is no place to start. Why not go to real experts like The Joint Commission, CMS or Healthgrades.
    ZDnet is completely out of it's expertise and it shows every time you write an article. Do your credibility a favor and just hush.
    • "Do your credibility a favor and just hush. "

      I agree r_bigcat, you should do your credibility a favor and just HUSH.
      Without specific examples of erroneous information or verifiable contradiction, your reply has no merit and is a waste of bandwidth.

      How about you provide some specific example and help be a knowledge partner rather than just a resource drain.
    • I can take the criticism

      The medical beat seems to be the only one where it's assumed you have to be a full member of the profession before you can report on anything.

      You don't have to be a programmer to write about computers. You don't have to be an entrepreneur to write about business.

      I'll admit I'm new on the beat, and will make mistakes. But I also read Talkbacks and try to get better. I'm very glad this is a blog, where folks like Bigcat and others are free to advise, to disagree, and to add to what I write, rather than pretending to be an authority, as most reporters are forced to do by the technology they use.
  • RE: Just how bad are medical records?


    I am the lead software developer at ICANotes. I'm not mad at you for borrowing our web graphic.

    Are you aware of HL7 (www.hl7.org)? HL7 specifically addresses many of the issues you mention here: proprietary formats, interoperability problems, etc.

    I am proud to have implemented an HL7 interface to ICANotes. This means that we can send data to any other entity that is up to snuff with "the standard".