Tuesday, June 30, 2009

Order your Edsel

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The past two weeks seems to further elaborate on the issues creaging a  tightening of the Gordian Knot of Health care which

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threatens to overwhelm and bring our healthcare system and even our economy to a grinding halt.

Physicians are rightly frustrated and outraged at the incursion of well meaning pundits, experts, health policy gurus and others, who have meddled with the patient doctor relationship. It may never be restored. 

The new wave of HIT and EMR adoption foists upon not only providers but misguieded taxpayers who are being sold a bill of goods akin to the "Edsel" of the 1960s.

Rick Weinhaus MD  writes in The Health Care Blog about the folly of today's unproven CCHIT certified EMRs. Here are some excerpts from his letter to David Blumenthal, ONCHT .

am writing to you on the need for user-friendly electronic health record (EHR) software programs. As a practicing physician with first-hand experience with hard-to-use CCHIT-certified EHR software, I would like to share with you a solution to this vital issue.

The CCHIT model for EHR software certification is fatally flawed because it mandates hundreds of required features and functions, which take precedence over good software design.  This flawed CCHIT model takes valuable physician time and effort away from patient care and leads to increased potential for errors, omissions, and mistakes.

As a clinician, I have had first-hand experience with a top-tier CCHIT-certified EHR.  Despite being computer literate and being highly motivated, after a year and a half of concerted effort, I still cannot effectively use this CCHIT-certified program.  The poorly designed software constantly intrudes on my clinical thought process and interferes with my ability to focus on the needs of my patients.

Just this year the National Research Council report on health care IT came to a similar conclusion. The report found that currently implemented health care IT programs often

provide little support for the cognitive tasks of the clinicians or the workflow of the people who must actually use the system.  Moreover, these applications do not take advantage of human-computer interaction [HCI] principles, leading to poor designs that can increase the chance of error, add to rather than reduce work, and compound the frustrations of executing required tasks

It is astounding that physicians would be willing to accept inferior technical tools for administration and record keeping when we insist upon medical diagnostic and therapeutic equipment that must pass muster and require regulation by the FDA, and other healthcare regulatory organizations.

We absolutely need standards for data, data transmission, interoperability, and privacy. There is no need, however, to specify the internal workings of EHR software. To do so will stifle innovative software designs that could improve our health care system. If CCHIT is allowed to mandate the meaning of the term “certified-EHR,” the $17 billion allocated for EHR adoption and use will largely be wasted.

HL 7 guy explains our current conundrum:

There are real and tangible reasons why Information Technology as it exists is of very little help to many clinicians.

Gathering the information to feed into the systems is obtrusive and disruptive to the clinicians workflow.

For an hour of clinician and patient interaction there is approximately an hour of data input as most EMR applications are currently built. This is extremely inefficient.

Clinicians aren't secretaries or clerks that can be typing away all day. They have to cure and save the lives of their patients.

Frustrations imposed by improperly built software have created an apathetic attitude from most clinicians towards technology.

Until technologists understand this and start building solutions based on use cases and that fit seamlessly into the clinicians workflows, adoptions will be scarce and the failure rate will be high.

 

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