Electronic Charts

[QuantumMechanic]

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Why hasn't there been a huge push for electronic charts in our healthcare system? Wouldn't this improve the quality of healthcare while (in the long term, but definitely not short term) probably saving a good amount of money? When do you think that electronic charts will become ubiquitous?

 

[tegs15]

I work at a tech in the ED where we use electronic charting. For the clinical staff (nurses, techs etc.) it is fast and provides infomation easily, but for the DRs it is not quite the same. For one the doctors can dictate faster than they can type. When dictating they don't have to worry about drop down menus and macros. I have spoken with several of our doctors and they are not fans. They think is costs them a patient an hour.

 

[Captain Fantastic]

Around here the push for electronic charting and entry is big. Papercharts are going the way of the dodo. The VA hospital here is electronic. The Univeristy hospital is transitioning service by service, e.g., the nurses in Children's Hospital wrote their last paperchart entry two weeks ago. The IM clinics will stop dictation sometime in the next year.

I think the biggest hurdles to the system is the capital investment needed to field one of these systems isn't small: infrastructure (networking, servers, clients), training (practioners as well as technicians), conversion (getting the old paper chart data entered).

Hospitals will be the first to transition, smaller clinics will be the last hold-outs, but I think in 10 years and you'll be hard pressed to find paper charts.

 

[DeadorAlive]

There is a very strong push. There are also interface problems in addition to the capital investment that's been made - there are hundreds of vendors in addition to home-grown systems. If a hospital uses one, and a physician office another, and they can't connect... what then? Only recently have internet-based modules been introduced that would, theoretically, allow for your record to be retrieved in NYC if you were there on vacation and needed care while your PCP was back home in CA. There are also privacy issues with this, that Regional Health Information Organizations hope to circumvent. The VA is the only example of a national scale EHR/EMR because they are one, unified national system. Others are hanging back to see how their model goes, and even for them it's been difficult. But the push is certainly there...

 

[Beau Geste]

I am for e-charts. When the patient is admitted, they can sign one HIPPA form and be done with it. The e-chart can be sent pretty confidentially (with passwords). If a Dr. can't type faster than dictation, there will always be medical records who can still type in a chart from a dictation. It will just be typed onto a computer instead of a paper file.

It will also eliminate the piles of paperwork. Ever had to carry files for a family practice doc to dictate? Good workout, let me tell you.

 

[gujuDoc]

Why hasn't there been a huge push for electronic charts in our healthcare system? Wouldn't this improve the quality of healthcare while (in the long term, but definitely not short term) probably saving a good amount of money? When do you think that electronic charts will become ubiquitous?

My experience has been that where there are hospitals, most of the records are in the computer even if they do have paper files as well. However in doctors offices such as the family physicians office I work in, as well as my own GP an hour south of here, there are mostly paper charts.

I think you are right that the computerizing method would reduce a lot of stress and headaches. My job, at the doc's office is to file away charts, and that position wouldn't even be necessary if there were electronic charts because you'd be able to just type in a persons name and pull them up on the computer screen.

About 8 years ago, I had shadowed a few physicians through an AHEC sponsored summer enrichment program in medicine for highschoolers. Anyhow, one of the offices I shadowed at was an orthopedic surgeons office and we did some filing for them. All the filing was computerized and just required typing in medication names and what not. It was sooooooo much more efficient. On top of that they had these individual touch pad charts which were hand held, and could pull up the same charts that would be pulled up on the main computer system. If all offices got to that, then there would never be any messes created or disorganization in doctors offices and things would be faster, especially if you are a fast typer (one skill that I'm glad I have, thanks to typing class that was required in highschool).

 

[gujuDoc]

I am for e-charts. When the patient is admitted, they can sign one HIPPA form and be done with it. The e-chart can be sent pretty confidentially (with passwords). If a Dr. can't type faster than dictation, there will always be medical records who can still type in a chart from a dictation. It will just be typed onto a computer instead of a paper file.

It will also eliminate the piles of paperwork. Ever had to carry files for a family practice doc to dictate? Good workout, let me tell you.

Of course they could always get one of those voice things where, what you say gets typed into the computer. I think I heard of such a thing existing a few years ago.

 

[gujuDoc]

Around here the push for electronic charting and entry is big. Papercharts are going the way of the dodo. The VA hospital here is electronic. The Univeristy hospital is transitioning service by service, e.g., the nurses in Children's Hospital wrote their last paperchart entry two weeks ago. The IM clinics will stop dictation sometime in the next year.

I think the biggest hurdles to the system is the capital investment needed to field one of these systems isn't small: infrastructure (networking, servers, clients), training (practioners as well as technicians), conversion (getting the old paper chart data entered).

Hospitals will be the first to transition, smaller clinics will be the last hold-outs, but I think in 10 years and you'll be hard pressed to find paper charts.

Our VA hospital also uses electronic charts. I shadowed in two departments at the VA, and the neuro clinic always had the charts pulled up on the computer in the examination room. That way, the only file was just with one or two papers which were to be given to the secretary on the way out. They were even able to sent the prescription orders directly to the va pharmacy by clicking a check mark by the medication name on the computer system, etc.

 

[QuantumMechanic]

If all offices got to that, then there would never be any messes created or disorganization in doctors offices and things would be faster, especially if you are a fast typer (one skill that I'm glad I have, thanks to typing class that was required in highschool).

👍 Probably will reduce mistakes which will reduce accidents, saving money for all. When I've shadowed doctors, especially in the ICU, the paper chart situation makes me wonder how critical errors are avoided

 

[Beau Geste]

Of course they could always get one of those voice things where, what you say gets typed into the computer. I think I heard of such a thing existing a few years ago.

Oh yeah, that would be a good idea too! The voice recognition software is getting better and better, too so many foreign docs would have less of a hard time, too. I also like the idea of a hand-held touch screen.

 

[gujuDoc]

👍 Probably will reduce mistakes which will reduce accidents, saving money for all. When I've shadowed doctors, especially in the ICU, the paper chart situation makes me wonder how critical errors are avoided

Yeah I agree too. It makes it easier too, when you have computer use because it means that you can just hit a search function to look for a particular part of the charts. Plus they are easily accessible from any part of the hospital. And in the event that you have one doc at hospital A trying to get in touch with someone at hospital B, then electronic files would make it easier to get the information across.