Samuel R. Bierstock, MD
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President Obama has announced his goal to digitalize our nation's medical record system. If achieved, this wonderful and lofty
notion would reduce medical errors, increase the quality of care delivered, bring consistency of care to our citizens, reduce
costs associated with delivering healthcare, and quite possibly drive the physicians who are supposed to use these records
out of business.
The buzzards are already beginning to circle.
Physicians and nurses are the most pressured of all professionals, with expectations of their performance and its unimaginable
responsibilities beyond the comprehension of people who have never made life-and-death decisions countless times a day. With
every decision and action comes the risk of being held liable and losing not only their professions, but their personal assets.
The very mechanics of using electronic health records (EHR) in their current state has complicated the lives of many clinicians
who use them. Physicians have been slow to adopt EHRs for that reason. With luck, that will change.
What few people realize is that using a computer to document every decision, every action, and the assessment of every piece
of information that streams to clinicians in real time represents a major change in the way clinicians have to think and work.
It also means an audit trail that has begun the salivation process of every malpractice attorney who has finally realized
what is about to be imposed on the medical profession. An EHR system can track how long a doctor looked at a document, if he or she scrolled down to read the entire thing, how long
it took to respond to an alert or notification of an abnormal result, how long it took to answer e-mail, and the accuracy
of every assessment and action. It can track whether their decisions meet the most recent guidelines or research results in
a world where thousands of new papers and research results are published every week.
This may sound wonderful for those receiving care, but how many of you would want to use such a system in your work knowing
that your every thought and action could be audited and evaluated by others who make their living suing you?
The President's plan calls for rewarding physicians who purchase and install EHR systems through a series of financial incentives
over a period of years. Mr. President: Thanks for the thought and the money, but if you really want to see this work, call
off the dogs before the kennel doors open. Instead of pouring more money into another system in an effort to eliminate its
problems, get to the heart of the matter. Reduce liability premiums for physicians and hospitals that install and use EHRs.
Protect physicians who will have their every move, thought, and action auditable at the most granular level. (Personally,
I might like to know that I can finish dinner or brush my teeth before responding to a real-time alert that someone's blood
sugar was a little high without someone suing me because I took too long to act.) Establish standards of expectation for clinicians
who will be working in a world of real-time data that is delivered as quickly as it is generated. Place limits on what audited
user-activity information can be deposed in malpractice litigation, while still providing the opportunity for those who have
been victims of genuine malpractice to seek justifiable compensation.
There is a middle road wherein standards and expectations of how to practice in a whole new world of real-time data can be
established, and it must be addressed so that those who use EHR systems can do their jobs without apprehension and fear.
We have the technology to do wonderful things in healthcare and reform the system entirely through exciting and innovative
technology. Most doctors recognize the wonderful benefits that an EHR system can bring to the quality of care they deliver.
But what we also need is for our physicians and nurses to be able to use these tools without fear of the foxes lurking around
the henhouse. Otherwise, we will end up with a very expensive and technologically advanced universal system with no doctors
who want to use it, and a lot of very rich lawyers.
Samuel R. Bierstock, MD, is the founder of Champions in Healthcare, a clinical IT consulting company. Send your feedback to meletters@advanstar.com
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The opinions expressed in The Way I See It do not represent the views of Medical Economics. Do you have an experience you'd like to share with our readers? Submit your writing for consideration to manuscripts@advanstar.com
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