Surgery Center of Oklahoma Blog

August 11, 2011

Electronic Medical Records Part 2

Filed under: Electronic Medical Records — surgerycenterok @ 6:55 pm

Imagine that you are a cardiologist.  You work at a large hospital in Oklahoma City.  You are about to perform a heart catheterization on a patient.  The “system goes down.”  What ?  You mean that a computer system might fail?  You have no medical records because they are digitalized on “the system.”   You have no idea what this patient’s history is or what it is they need or what you had planned to do for them.  You ask the patient,” you mind telling me what it is that I see you for?”

This would be crazy if it weren’t true.  This happened here in Oklahoma City.  There wasn’t a paper chart or handwritten notes to rely on.

Imagine that you are a surgeon that always prescribes the same thing for patients just prior to surgery.  Eye drops. Antibiotics. Ear drops.  Nose drops.  Everytime.  The system doesn’t post these “standing” orders for one reason or another.  In a world full of human beings the nurse would think, “Dr. X always gives his patients Afrin nose spray and antibiotics prior to their surgery.  I know that’s what he wants even though this order didn’t come through.”  He or she would then give the appropriate meds.  In a world full of robots, however, that have been told not to think, but just do what is on the order list, this medical error would result in the patient not getting what they needed.  This would be crazy if it weren’t true and happening every day at a large hospital here in town.

Imagine that you are  a patient and you have gone to see your doctor whose practice was destroyed by a hospital administrator and is now an employee of the hospital and his computer system is “integrated” with that of his employer.  Your (well…formerly your) doctor types your responses to questions that the computer is prompting him to ask you with his back to you the entire time.  One of your answers is not on the list of acceptable preconceived responses listed by the computer.  The doctor says,”your response is not on here.  I need for you to say that it is one of the three things that are listed here.”  This, too, would be crazy if it weren’t true.

Imagine that your child has had their tonsils removed and starts bleeding the next day (a legitimate medical emergency).  You go to the emergency room where with no code for “acute post-tonsillectomy bleeding” your child’s computer label is “wound drainage.”  This label fails to communicate the urgency of the situation and the staff at the emergency room wait far too long to address this.  This, also, would be crazy if it weren’t true.

Imagine that five years from now your physician has lost his license to practice medicine or has been blacklisted by your insurance company because the treatments he/she recommended (while perfectly suited for you) didn’t match up with the “best practices” paradigm designed by computer testing models.  If a recommended treatment doesn’t match up with the pattern of data in the electronic patient survey (most of us still call this the patient’s chart) that physician is in trouble.  This type of control is well on its way thanks to our wonderful public servants in D.C.

Are you ready for it?

G. Keith Smith, M.D.

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August 10, 2011

Electronic Medical Records

Filed under: Electronic Medical Records — surgerycenterok @ 1:51 am

This sounds like a great idea, doesn’t it?  Have all of your medical information on a disk or a chip so that if you are in car wreck you will receive better care.  Have all of your information digitalized so that if you go to see a specialist they can look at your complete medical history and not miss a beat.  What could be wrong with this?  Doesn’t the digitalization of medical information benefit the patient?

If you have been following this blog you are either laughing or cursing by now.  The federal government is requiring everyone that takes federal money (Medicare/Medicaid) to convert to EMR or accept the punishment of a lower payment.  Why does the federal government care?  What possible benefit could this be to them?  Control?  Do you think?  Duh! That they want this is reason enough to resist!

Once medical information is digitalized it can be analyzed and categorized and, poof!, you’re a statistic!  Once the feds realize that 20% of federal dollars are spent on cancer care for instance, poof!, there’s a great way to save 20%!  You get the idea?  And all for our benefit.

What about patient confidentiality?  POOF!  GONE!  Stories about the theft of laptop computers containing raw patient information have been reported lately.  These patients’ data could be used to deny them care later or used for identity theft…you get the idea. Once the data is on a disk the patient’s medical information is not as secure as it is on a paper chart.

Could end of life euthanasia decisions be made using statistical analysis of this data?  Surely not!  Think again.  All of the national health care schemes have run into bankruptcy scenarios.  You think that with the government’s back against the wall they won’t tell a citizen that it is their patriotic duty to “take one for the team?”

We don’t utilize EMR at the Surgery Center of Oklahoma.  Partly due to patient confidentiality concerns.  Partly because every operating room I’ve ever been in that has computer capability results in a nurse with her back to the surgeon and patient, typing constantly.  Not good patient care, in my humble opinion.

Some physician offices utilize EMR for efficiency reasons.  I have no problem with this if they take confidentiality concerns seriously.  Once the data goes to the hospital computer system, all bets are off, though, I’m afraid.  The worst scenario?  Hospitals networking with physician offices so that they are integrated. Now the patient is an afterthought.  Confidentiality means nothing.  You should ask your physician if their EMR is integrated with the hospital they are working with/for.  If so, I would find another doctor.  You information is not safe.

G. Keith Smith, M.D.

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May 23, 2011

Electronic Medical Records

Filed under: Electronic Medical Records — surgerycenterok @ 3:33 am

The federal government is paying physicians and facilities to convert all of their medical records to an electronic/digital format.  And like any federal program there’s always an “or else!”  If facilities or physicians don’t make this transition, then future Medicare payments will be reduced (there’s always an “or else” clause in any law, federal or otherwise).  A recent article in the local newspaper reported that patient medical records in systems where the hospitals and the physicians share a common network are not secure. What?  That’s right.  Your medical information and privacy are not secure if you see  a physician that shares a common computer network with a large hospital.  And this doesn’t even address the laptop with all of your medical records stolen from the health department employee’s car while they were eating lunch!

But wait a minute.  You say, “if I go to the emergency room they will know about all of my allergies and medications.”  Yes, and they will know about everything else, too….and so will any puke working at an insurance company that wants to flag you with a pre-existing condition clause so that your health insurance doesn’t have to pay for this or that.  And so may your employer.  What?  Why does that matter?  If your employer provides your insurance,  the cost of the premiums is determined by the overall health of their employees.  If you are “unhealthy” (whatever that means) you could be on the short list for the unemployment line if your employer is privy to any sort of potentially expensive medical condition you may have.  Besides, there are several private companies that can provide you with medication and allergy storage ideas/technology so the emergency room physician in a distant town knows your status even if you are unconscious.

We use paper records at our facility.  People in government have tried to get patient records from us.  We sued them.  What?  You sued the government to protect patient privacy?  Yes.  And we won.  What?  What kind of outfit is this Surgery Center of Oklahoma?  An organization that takes patient privacy seriously.  No one will ever have access to your medical records from our facility except…well…you…or someone you deem to have access.  The push for electronic medical records has nothing to do with the delivery of quality health care….it has everything to do with control.  This is one of the most frightening developments of the intervention of government into health care.  Some physicians have found that electronic records make them more efficient in their offices.  My advice….make sure that they share that information with no one.

G. Keith Smith, M.D.

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