Will the EHR make the physician obsolete?

[Noyac]

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The argument for the Electronic Health Record is that it will limit the amount of malpractice claims due to diagnostic errors because there will be a protocol. The (Ann Intern Med 2006; 145: 488-496) reported that of 307 closed claims cases more than half were caused by diagnostic errors that resulted in harm to the pts. Most of the errors occurred b/c physicians did not perform the necessary diagnostic tests based on a protocol. The EHR has the ability to present diagnostic and treatment guidelines to the physician, reducing the need to rely on past experiences and memorization of symptoms.

This information comes from Feb 2009 AnesthesiologyNews.

Sounds like anyone will be able to practice medicine with the new EHR.

 

[Bertelman]

We've got these protocols in place in my hospital. Order sets for pneumonia, C.diff, etc. It's a great way to maintain compliancy in new federal standards, but it's no threat to physicians in my eyes. It still takes someone to read the CXR, perform a PE, understand comorbidities and a Diff Dx.

The way I see it, with an aging, sick population and a huge move towards evidence-based medicine, protocols like these are inevitable. It would take endless work for each physician to stay up to date with this stuff.

 

[jwk]

The only problem is that many of the claims related to anesthesia are related to procedures, not failed/missed diagnoses. Unrecognized esophageal intubation or other airway disaster and all the evil that comes with them, intra-neural injections, etc. EHR's won't do much to help those.

 

[2win]

We've got these protocols in place in my hospital. Order sets for pneumonia, C.diff, etc. It's a great way to maintain compliancy in new federal standards, but it's no threat to physicians in my eyes. It still takes someone to read the CXR, perform a PE, understand comorbidities and a Diff Dx.

The way I see it, with an aging, sick population and a huge move towards evidence-based medicine, protocols like these are inevitable. It would take endless work for each physician to stay up to date with this stuff.

Your answer is the perfect one in order to say a categorical NO for one of the applicants for my group.
There are so many reasons for that...it is obsolete (almost) to argue with you.
Regards,
2win

 

[Coastie]

Enter the Noctors.

Obama knows what he's doing..

The argument for the Electronic Health Record is that it will limit the amount of malpractice claims due to diagnostic errors because there will be a protocol. The (Ann Intern Med 2006; 145: 488-496) reported that of 307 closed claims cases more than half were caused by diagnostic errors that resulted in harm to the pts. Most of the errors occurred b/c physicians did not perform the necessary diagnostic tests based on a protocol. The EHR has the ability to present diagnostic and treatment guidelines to the physician, reducing the need to rely on past experiences and memorization of symptoms.

This information comes from Feb 2009 AnesthesiologyNews.

Sounds like anyone will be able to practice medicine with the new EHR.

 

[Bertelman]

Your answer is the perfect one in order to say a categorical NO for one of the applicants for my group.
There are so many reasons for that...it is obsolete (almost) to argue with you.
Regards,
2win

It's hard to say, but I'm guessing you are saying that you would never consider me for employment based on my post concerning diagnostic and treatment protocols.

Feel free to list all the reasons for which you would eliminate me from employment with your group.

Knowing your own posting history here, I would guess the next logical question to an applicant would involve who I voted for in the most recent presidential election. Either way, if you choose such topics to screen your candidates, it's not the kind of group I would be looking for.

If you have such strong "dealbreakers" for your potential colleagues, you should probably save yourself some money and post your requirements on Gasworks.

By the way, do you utilize the ASA's difficult airway algorithm? Let me know how you think that is so different than a protocol for treating common medical disease.

 

[cchoukal]

enter the noctors.

Obama knows what he's doing..

+1

 

[aspo]

Will the EHR make the physician obsolete?

Will the Computer make the physician obsolete?
Will the Internet make the physician obsolete?
Will the WebMD.com make the physician obsolete?
Will the Nurse Practitioner make the physician obsolete?
Will the Obama Care make the physician obsolete?
Will the CRNA make the anesthesiologist obsolete?
Will the AA make the CRNA obsolete?
Will the McSleepy make the anesthesiologist obsolete?




The sky is falling!!!

 

[Mman]

The argument for the Electronic Health Record is that it will limit the amount of malpractice claims due to diagnostic errors because there will be a protocol.

I have heard lots of arguments for an EHR. I have never heard that argument.

We need an EHR to reduce medical waste. There are tens of thousands of tests ordered every day in hospitals in the US because the results of the same test from a different institution were unavailable at the time they were needed. I probably order 2-3 EKGs a week because I can't get my hands on one preop that was done somewhere else.

It also prevents the problem of not being able to read illegible records.

The VA has a very simple and easy to use electronic record and it has improved the quality of care at VAs across the country.

 

[periopdoc]

The VA has a very simple and easy to use electronic record and it has improved the quality of care at VAs across the country.

Hahahahahahahahahahahahahahahahaha. That was a good one there

We need an EHR to reduce medical waste

You mean like how the nurses and pharmacists at the VA order seemingly every random test or drug they can think of under my name in such a way that it appears that I directly entered the order myself? Or more like how the anesthesia preop template wastes my time by requiring me to discuss and document multiple irrelevant details with every patient in order for the record to be complete so I can sign off. And don't even get me started on how many patients have misdocumentation (ie patient listed as having an amputation but still has all 4 extremities) that gets copied and pasted thereby being perpetuated within the medical record.

If CPRS is the model EMR, then count me out.


-pod

 

[Mman]

Hahahahahahahahahahahahahahahahaha. That was a good one there



You mean like how the nurses and pharmacists at the VA order seemingly every random test or drug they can think of under my name in such a way that it appears that I directly entered the order myself? Or more like how the anesthesia preop template wastes my time by requiring me to discuss and document multiple irrelevant details with every patient in order for the record to be complete so I can sign off. And don't even get me started on how many patients have misdocumentation (ie patient listed as having an amputation but still has all 4 extremities) that gets copied and pasted thereby being perpetuated within the medical record.

If CPRS is the model EMR, then count me out.


-pod

Having rotated through 3 VAs in 3 states as a medical student and a resident, you are the first person I've ever seen with major complaints about the system when you compare it to hospitals without electonic records.

Are their better electronic systems out there? Of course. But having access to every record nationwide on a patient from the VA is nice. I never got the chance to use the anesthesia part of the VA system. Our VA was still doing paper charting in the OR.


Using electronic records and order systems compared to paper records and written orders is like comparing smart phones to rotary dial phones.

 

[periopdoc]

The one good thing I can give you about CPRS is the ability to (most of the time) obtain all of the patient's historical records from other instituitions without filling out multiple HIPPA release forms. This will not be a benefit of adding the EMR to other institutions as interoperability is non-existant and the ever present threat of running afoul of HIPPA will likely keep hospital systems from allowing any true interoperability.

My experience has been quite the opposite of yours. One of the biggest complaints I hear from my residents is dificulties with CPRS. There are better implementation of EMR than CPRS. Perhaps the current generation of physicians is just spoiled.

Personally, I would rather have to deal with the problems of the paper order book where I could easily prove whether an order was mine by examining the handwriting in the order book. Even better is one of the superior EMR implementations where it is always evident who has entered an order an whether it has been approved by the MD or not.

How about it? Anyone else like/ dislike CPRS (the VA implementation of the EMR)?

-pod

 

[proman]

CPRS was so good at reminding physicians to do cancer screening exams that I had to click through the colonoscopy reminder every time I checked the chart on my MICU patient bleeding out from his Stage IV colon ca.

Medical records should belong to a patient, not a physician or a hospital (thereby making it accessible to everyone who truly needs it without release forms etc).

 

[2win]

It's hard to say, but I'm guessing you are saying that you would never consider me for employment based on my post concerning diagnostic and treatment protocols.

Feel free to list all the reasons for which you would eliminate me from employment with your group.

Knowing your own posting history here, I would guess the next logical question to an applicant would involve who I voted for in the most recent presidential election. Either way, if you choose such topics to screen your candidates, it's not the kind of group I would be looking for.

If you have such strong "dealbreakers" for your potential colleagues, you should probably save yourself some money and post your requirements on Gasworks.

By the way, do you utilize the ASA's difficult airway algorithm? Let me know how you think that is so different than a protocol for treating common medical disease.

Bertelman - I chose this profession (physician) because I had the freedom to use my free imagination (besides the knowledge) to heal my patients. The algorithms aren't for me.
They are good for education and if I chose to follow them - it is MY CHOICE....
I like creative people. The one that step out from the algorithms.
I work only if I am paid.
I give a ....s....t on star recognition programs.
The ASA difficult algorithm is good - do I have to obey it?
NO.
Regarding the Gaswork....It will take some time for my business to need it.
And BTW - after a personal interview I could change my mind.
I am sure that you'll find a great gig.
You are smart,
what you need is some real life lessons.
2win

 

[Bertelman]

Bertelman - I chose this profession (physician) because I had the freedom to use my free imagination (besides the knowledge) to heal my patients. The algorithms aren't for me.
They are good for education and if I chose to follow them - it is MY CHOICE....
I like creative people. The one that step out from the algorithms.
I work only if I am paid.
I give a ....s....t on star recognition programs.
The ASA difficult algorithm is good - do I have to obey it?
NO.
Regarding the Gaswork....It will take some time for my business to need it.
And BTW - after a personal interview I could change my mind.
I am sure that you'll find a great gig.
You are smart,
what you need is some real life lessons.
2win

We all need real life lessons. That's what happens when we become attendings. Just understand that my "real life lessons" may not exactly shine through on an internet message board.

When I say that I support the use of algorithms for patient care, it's for things like antibiotic selection for Medicine or ER docs. We had them when I was an intern, and I used them. For the twelve months of my internship, I could have never memorized all the facts that I needed.

I'm not talking about a computer algorithm to tell anesthesiologists what to do. The best computer algorithms SUGGEST what the physician should do, not dictate. Just like that difficult airway algorithm you can deviate from. I would actually say that anesthesiologists are pretty much insulated from that type of interference from EHR, because we don't have the volume of EBM to dictate our practice like Cardiology or IM. When I occasionally do still have to use an algorithm to select a drug, such as sedation protocols in the ICU, it irritates me. But I'm glad it's there for the IM and OB and ER docs that rotate through the unit for only 2 months of their residency. There is no way those people would have a clue about which drug is most appropriate.

When you think about the terrors of algorithms and EHR, remember there are thousands of residents struggling every day to take care of these patients. We're not all slick, resourceful PP guys. And unfortunately, not all doctors are well-read, dedicated, and up-to-date on current standards.

 

[Mman]

The health care world will be a better place when patients have completely electronic records that are available nationwide to providers.

It won't be perfect. But that small slice of our world that deals with trying to decipher illegible writing and obtain test results from "outside hospital" will be made infinitely easier.


I HATE hospitals that don't have electronic record and order systems. One little podunk hospital I rotate through does things on paper and it makes my life hell when I go there.

 

[durlvlbeacoo]

The health care world will be a better place when patients have completely electronic records that are available nationwide to providers.

It won't be perfect. But that small slice of our world that deals with trying to decipher illegible writing and obtain test results from "outside hospital" will be made infinitely easier.


I HATE hospitals that don't have electronic record and order systems. One little podunk hospital I rotate through does things on paper and it makes my life hell when I go there.

If you hate the EMR at your institution and your institutiton feels the same way, you will never get it changed. If the standard is nationwide, there is no hope of reform for you. You are the little man versus the government, and like the house, the government always wins.