February 18th, 2018  | Julia Becerra

Love in the times of Electronic Health Records (#EHR)

 

I recently accompanied a relative to a medical appointment.  Upon arrival to the medical office, and to her surprise,  she was given a clipboard with a multi page health questionnaire to complete.   At first she objected to filling it out, since she had been going to this medical practice for the last few years, and all the doctors within the practice have access to her Electronic Health Records (E.H.R.). Nevertheless, the  questionnaire was appropriately filled out and returned to the medical assistant.

After the medical appointment, we stopped by the pharmacy to pick up the prescription medicine ordered by the attending MD.  Out of curiosity, and mostly because of my interest in the well being of my relative, I resolved to read the long Patient Prescription Information provided by the Pharmacy.

My findings were alarming:  Not only the prescribed medicine was contraindicated due to an existing medical condition, but the drug could not interact safely with her current medicines.

This event made me think of the effectiveness of electronic health records in avoiding medical mistakes. After all  the benefits of the E.H.R  are “ …Better health care by improving all aspects of patient care, including safety…”.  How is it possible that after filling out a 5+ page questionnaire repeating most of the information already available in the electronic medical records A.K.A. medical chart, the wrong medicine was still prescribed? What purpose does it serve to write down and type things up like: Diabetes, Liver disease etc on a medical chart, when the software and of course the physician accessing it could still prescribe a medicine that is contraindicated to a person with such medical conditions?

Well, let’s don’t judge too soon.  Let’s look at the facts, in this case at the overall process. An E.H.R. is supposed to contain all the things that are or were in a paper record – medical history, diagnosis, lab tests and prescriptions- as well as data collected like reminders for best practices on treating certain diseases.  The hand written questionnaire is seldom carefully reviewed by the doctors.  Reading through both – electronic and paper data- would take a lot of time. Also, after reading it not all the information may be remembered.

In fact, a study has confirmed that #EHR slow doctors down and distract them from meaningful face time caring for patients. A study published in Tuesday’s Annals of Internal Medicine concluded that physicians are spending almost half of their time in the office on EHR’s and desk work, and only 27% on direct interaction  with patients.

Even more, a recent study shows that the process of checking and updating medical records electronically is counterproductive for the brain.  It turns out that the pathway into the medical brain, like most brains, is far more reliable when it runs from the hand than from the eye.  Force the doctor to ask questions and take notes, and the doctor will usually remember. Ask the doctor to read, and the doctor will scan, skip, elide, omit and often forget.

Now looking at the other component, the non-human one, I found out that one of the main issues affecting medical practices is the lack of systems that talk to each other. Most hospitals and physicians’ offices use some kind of electronic medical record. But those records are tucked in a complex web of hundreds of kinds of software with limited applications that do not communicate with each other. A typical situation is one where the prescription is done on software different than the one holding the medical chart. Also the drug order is transmitted by an application to a Pharmacy that uses a different app.

There is no flagging of a medicine prescription due to pre-existing conditions, and  there is no automatic link between the medication in one app to exactly the same medication and dose in another app.

 

Due to the huge amount of data accumulated in a medical chart the most important information may not be right in front of the physicians when making the decision regarding best treatment, and prescribing a medicine for the diagnosed illness. At that point perhaps a good approach would be to have a quick final interaction  with the patient to ask again for those conditions that could be relevant to the medicine in question.

It may be a redundancy, but it could mean safety.

In the times of  advanced technology and incredible artificial intelligence success, unfortunately there isn’t  a integrated software to support the physicians in something as basic as prescribing a medicine. So until there is one, as part of  the education given to a doctor or physician assistant , a final verbal check with the patient should be taught and reminded as a not-to-be-missed policy.

Like good police work, good medicine depends on deliberate, inefficient, plodding, excessive repetition. Medical care requires dialogue.  No system of data management would ever replace that.

Electronic health records are useful for many reasons, but in this particular case, it would be ideal that once the doctors have a diagnostic, they  could rely on that same software that holds the #EHR to identify any potential treatment conflicts.  It should not be a tool to prescribe, but yes one to flag unwanted medical situations.

In the meantime, out of love for yourself, and true love to your family, and close relatives,  before taking any medicine do your our own diligence work.  Fill out the gap left by the current medical system ( electronic and human), and read the drug interactions/side effects to make sure the medicine was prescribed with your well being in mind.

 

What do you think?  Share your stories on this subject.  I would love to hear from you.

 

Thank for reading my blog.

 

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