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ED Physician Executive Slams EHRs

Scott Mace, for HealthLeaders Media, January 28, 2014

One solution Tom offers, for vendors to pay 100 percent of the costs of implementing a pilot technology at a healthcare system, may appeal to too-busy or the too-habituated health systems, and probably plays well to an AMA-type crowd.

But here's where Tom and I part ways. Again and again, I see health systems willing to risk investing time and money in some iffy technology. It may be that the emergency department, with its immediate demands, would naturally be risk-averse. But for the risk-takers, there are payoffs—although not guaranteed ones.

But that isn't stopping innovators within the healthcare system from taking risks, even as the physicians of CEP America go about the business of saving lives. Healthcare technology is multi-faceted, and to simply expect change to be underwritten by Silicon Valley or other tech companies is as unrealistic as expecting Silicon Valley to send every health IT product developer to medical school.

There will be, and are, middle ways of innovating. I hope the next two years of health IT innovation give Tom a reason to have a less scathing assessment by 2016.


Scott Mace is senior technology editor at HealthLeaders Media.
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8 comments on "ED Physician Executive Slams EHRs"


Dr. Cynic (2/7/2014 at 11:07 AM)
It is absolutely clear that electronic health records are good for medicine. 1. They eliminate the horrendous variability in handwriting as an obstacle to reading old notes. 2. They make it very easy to look up old labs, imaging, and notes by subject or date of service instead of wading through piles of paper. Now, which EHR is another question. The field is littered with products from the outstanding ED-Pulsecheck EHR, to the below average Meditech, to the absolutely horrendous Cerner. The problem is not that EHRs are bad, but that people who don't understand IT or medical practice are making these decisions for large organizations which then see suboptimal results.

steve jacobs (1/31/2014 at 4:39 PM)
I'm afraid that the speaker is looking at a conventional EHR as used in most hospitals. The reality for me at Kaiser Permanente is much different. We're using Epic like everyone else, but we're a complete group[INVALID] Inpatient and outpatient docs, labs, xr, etc. How would the speaker like to have instant access to the outpatient ecg done 2 wks ago when he sees a chest pain patient at 2AM? The problem isn't EHRs per se but rather the lack of interconnection. I can see all of my patients' records, even when they're admitted at tertiary centers far away. I can see all the labs, consults, etc. As for usability, Kaiser spent a lot of money and time customizing EPIC for each specialty. So at least for me as a pediatrician, it is far quicker than using paper. And readable. If you are practicing in a hospital ED with no data connections to the referring docs then his point about the documentation being primarily for billing has some merit. But if somehow EHRs can interconnect, then they will really show their promise.

Anne Creamer (1/31/2014 at 2:02 PM)
@cascadia, I don't understand your point. What was the physician's specialty? Did he have any training in workflow, documentation, user interface and functionality issues? And Dr, Geraci, your assumption that "an ideal product for Family Medicine would easily satisfy ER use" is not true. The ER needs documentation structure for all specialties, since we see it all. Do you have the need to document on OB/GYN, trauma, peds, psych, urology, just to name a few? The attendings and residents of all those specialties work in the ER on a regular basis and they need their specialty-specific terminologies and order sets in the ER module. That's what makes the ER unique among all the EHR modules: we need to be able to document for the universe of medical specialties. Therefore, it is very difficult to retrofit an outpatient system, or any other specialty unit for the ER; the ER needs to develop its own module and this needs to be done by ER doctors and nurses who understand its workflow and have at least a basic understanding of database design issues.