July 2009 Archives

Regardless of the lawsuit implications, I am not so sure of the benefits of EMRs.

I would be all in favor of a private and complete electronic medical history for each person, but the EMRs I have seen are neither private nor complete, and tend to reinforce formulaic medical practice, as opposed to discovery, discussion, and intelligent understanding.

Broadly, my concerns with EMRs:

First, GIGO. I was enthusiastic about Kaiser-Permanente's electronic medical records until I saw garbage being put into the system by well intentioned folks. This translated into outputs that incommensurable over time.

Second, ownership. I should own my EMR, because I own myself and manage my own care.

Third, format. My preferred EMR would have a wiki template, because I should be able to add my observations to my EMR, and anyone who sees it will know how to access the most relevant information. I would keep mine up to date with a current status report up on top.

Fourth, interpretation. This is fundamental. Regardless of data quality, ownership or format, new doctors (say the harried folks in the ER) will not know how to interpret and use the data from all the other doctors. In fact, I've seen this first hand. It is very hard to practice medicine wisely in the short-run. Doctors disagree with one another on observation and diagnosis of the simplest things. Even when there's agreement, notes are always incomplete and cryptic, many times providing negative information.

If you were to look at my KP medical records, you will have almost no idea of interventions or medications or lifestyle changes that I've ever taken, or why all my basic measurements improved drastically over a one year period.

We should be looking at how patients, doctors, bureaucrats, politicans, and insurance companies use EMRs in the real world. This cannot be a pretty picture. Personally, I now focus far more on the meaning of test measurement, how doctors know what they say they do ( when and why they started believing it as well as causes of justified variance in opinion), and far less the alleged expert opinion that I should just trust.


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