Electronic Health Records (EHRs) No Cure-All

-GHOST TRAIN-

Scary Stuff from Electronic Medical Records (EHR) Vendors

Outer Hades, USA – Just in time for Halloween.

Do mandated electronic health care records (EHRs) improve patient safety and the quality of health care delivery between physician/patient delivery? Why are taxpayers subsidizing for-profit corporations to develop error prone software technologies? Shouldn't these funds be applied instead to the much needed skilled physicians and medical infrastructure centers responsible for treating us? Who IS driving this ghost train of a for-profit health care industry that profits from killing us?

LWOH has reported here and here and here about President Obama's designated taxpayer stimulus of $19.5 billion plus to force or mandate the use of electronic medical records. This excellent Washington Post article by staff writer Alexi Mostrous entitled Electronic medical records not a cure-all is based upon interviews with more than two dozen doctors, academics, patients and computer programmers. They all indicate electronic health records (EHRs) increase errors, add hours to doctors' workloads and compromise patient care. One doctor reported his department found that physicians spent nearly five of every 10 hours on a computer. "I sit down and log on to a computer 60 times every shift. Physician productivity and satisfaction have fallen off a cliff."

Something is very wrong when the corporate health IT/EHR industry gains control over the health and safety of hospital patients and their doctors. Since electronic medical records are not classified as medical devices, hospitals are not required by law to report problems. Many health IT contracts do not even allow hospitals to discuss computer flaws, so who is driving this Ghost Train?

The WaPo article describes how doctors using EHRs are forced to deal with “cluttered screens, unresponsive vendors and illogical displays.” Christine Sinsky in Dubuque, Iowa, whose practice implemented electronic records six years ago offers this description of the poor EHR development and vendor support service she is confronted with here:

"I can't tell from the medical display whether a patient is receiving 4mg or 8mg of a certain drug. It took us two years to get a back-button on our [Electronic Health Record] browser."

In addition to compromised public health safety and taxpayer stimulus dollar waste, doctors can be fired for mentioning problems with EHRs as IT-health industry executives and powerful government and health administration officials are shrouded in profitable secrecy. Stimulus dollars should be going directly to support physicians and hospitals and NOT to wasteful and life threatening IT health record development (many from shops who outsource to sub-par “skilled labor” guest visa and green card holders).

One ER physician explains how EHRs are, well, “a complete nightmare” here:

"It's been a complete nightmare," said Steve Chabala, an emergency room physician at St. Mary Mercy Hospital in Livonia, Mich., which switched to electronic records three years ago. "I can't see my patients because I'm at a screen entering data."

A short list of many potential life threatening problems reported that are caused by shoddy development and vendor support service from EHRs have included:

1.  An IT program designed to warn physicians about wrong dosages that was disconnected when the vendor updated the system, leading to misdoses.
2. A software bug that misdiagnosed five people with herpes.
3. Faulty software that miscalculated intracranial pressures and mixed up 
4. kilograms and pounds.
5. A computer system that systematically gave adult doses of medications to children.

David Blumenthal, the head of health tech at the Department of Health and Human Services, acknowledged that the systems have flaws, and over the next tow months he will finalize the definition of “meaningful use” - a term to describe the standard used by hospitals and doctors to qualify health-IT stimulus funds. (Read more about “meaningful use” here with CCHIT's Mark Leavitt.) Blumenthal did not mention whether applicants would be required to submit “adverse event reports”, which are a safety net that many physicians and academic experts demand but health-IT vendors have resisted. Why would vendors not want to stand by their products' quality and submit adverse event reports? Could it be that these IT health EHR vendors are too preoccupied with cost cutting and profit hording to notice the life threatening risks their technology products and services have the potential to pose to the public?

So who IS watch-dogging the high-risk EHR/health-IT industry? Nobody.

David C. Classen is an associate professor of medicine at the University of Utah who recently completed a study on health IT installations and he explained the utter lack of IT-health regulations here: 

 

"If you look at other high-risk industries, like drug regulation or aviation, there's a requirement to report problems. That just doesn't happen in health IT."

What is being done about it? The Senate Finance Committee has amassed a thick file of testimony alleging serious computer flaws from doctors, patients and engineers unhappy with the current systems:

“On Oct. 16, the panel wrote to 10 major sellers of electronic record systems, demanding to know, for example, what steps they had taken to safeguard patients. "Every accountability measure ought to be used to track the stimulus money invested in health-information technology," said  Sen. Charles E. Grassley (Iowa), the panel's ranking Republican. “

Mostous didn't mention the top ten major sellers of EHRs, so yours truly dug up this BNET list. For regular LWOH readers who have reviewed this list of corporations, how many of you want to place your bets that these IT workers predominantly consist of imported visa and green card holders instead of skilled American IT professionals? Why wouldn't these corporations want to ensure the health and safety of the American public by safeguarding their products and services with top notch, local techies?

As physicians confront a government mandate to switch from paper to cumbersome electronic records that reportedly pose higher risks to patients' lives, it comes as no surprise that physicians want to get back to the comprehensive basics of patient care, as many who are using them are uninstalling them, according to a June survey by HealthLeaders-InterStudy. But U.S. doctors are in danger of losing their jobs for complaining about the wasteful and unsafe technology.

Sharona Hoffman, a professor of law and bioethics at Case Western Reserve University in Cleveland, said:

"Doctors who report problems can lose their jobs. Hospitals don't have any incentive to do so and may be in breach of contract if they do." 

 

What is the competency level of these IT health record developers? Are they predominantly outsourced or insourced imported visa holders who are working for a fraction of the pay of highly skilled, American IT developers (many who have been replaced by such imported workers and are currently unemployed and underemployed)? The article noted one senior internist at a major hospital (who requested anonymity because he said he would lose his job if he went public) who described a 2006 installation that provoked mayhem.

"The system crashed soon after it went online. I walked in to find no records on any patients. It was like being on the moon without oxygen. While orange-shirted vendor employees ran around with no idea how to work their own equipment” the internist said, doctors struggled to keep chronically ill patients alive. "I didn't go through all my training to have my ability to take care of patients destroyed by devices that are an impediment to medical care." 

 

Isn't it time to put the control of health care delivery back into the hands of physicians and to ensure Health IT jobs are done by our citizens?

-2Truthy