Divorcing Electronic Medical Records from the Patient’s Paper File Costs Lives and Money

By Greg Bartels posted 09-26-2013 19:08

In June, Bloomberg published a story that put the blame for a hospital patient’s death squarely on electronic medical records (EMR).  
When it appeared that Dr. Scot Silverstein’s 84-year-old mother was having a stroke, she was admitted to the hospital.  Checking her EMR, Dr. Silverstein saw that a drug called Sotalol, which controls rapid heartbeat, was properly listed as one of her medications.  Days later, when her heart condition flared up, he checked again and was stunned to see that the drug was no longer listed.  His mother later suffered clotting, hemorrhaged and required emergency brain surgery.  When she died in 2011, Silverstein blamed her death on the inadequacies of her EMR.  
My EMR experience was quite different.  In 2007, my elderly father also passed away.  It happened a few days after his first chemo treatment – because at his age, the chemo was just too much for him to take. 
A week before the treatment, our family asked one of the foremost doctors at the Dana Farber Cancer Institute for a second opinion. He was glad to do it and asked to take a look at my fathers’ patient records. I remember frantically trying to get the administrative staff at my father’s primary oncologist to provide copies of the files he requested. With all the red tape and backlog of work at the primary doctor’s office, they just couldn’t get it done fast enough.    By the time we received the second opinion – which recommended against chemotherapy – it was too late.  My father and our family paid the price.
Between those two stories, you have the current state of electronic medical records.  Instant access to comprehensive medical information on a patient is clearly of enormous value.  That’s why 69% of US physicians use EMR and the EMR market has grown to $24 billion last year, according to Bloomberg.  The RAND Corporation projects that the health sector will save up to $80 billion a year by going paperless, and that is savings the system sorely needs.
But the application is still immature.   The various platforms are inconsistent and often rely on data entry and confusing drop-down menus, making it easy to input errors.  The typical multi-screen format requires users to fill a huge number of individual fields, toggling back and forth between screens.  As a result, we get medical records full of errors.  We get over-the-top use of the copy-and-paste function, creating incorrect patient information.  
What’s really happening?  The medical community is trying to leap forward to a paperless solution in one giant step, with too little time spent on finding out what really works.  Health administrators like the savings of going paperless but doctors and nurse practitioners are comfortable with their paper systems and resist becoming data entry clerks.  
What’s the solution?  Walk before you run.  Medical record holders should scan and index the doctor’s notes with all the related documents and link them to the patient’s accounting and billing record.  By integrating documents and data, they will gain an essential safeguard against errors that cost money and cost lives.  If my father’s physician had had access to scans of his file, it would have made all the difference. As Dr. Silverstein told Bloomberg News, “If paper records had been in place, unless someone had been using disappearing ink, this would not have happened.”

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10-02-2013 14:57

I have to ask if Dr. Silverstein was actively treating his mother. If not, then didn't he violate HIPAA TPO permissions accessing a record he shouldn't have? Patients generally do not have access to their complete EHR via patient portals or direct access to the EHR itself. If Dr. Silverstein requested access to his mother's EHR, then it should've been at the patient level and not the provider level.

09-30-2013 13:55

I work for a 100% HIPAA compliant company ( whose focus is to digitize records for this very reason. Actually our CEO, Dr. Kuang Chen, started the company because he saw the detrimental effect paper records had for clinics in the third world. It is a big mission, but with out 99% accuracy rate, we hope to change all paper medical records to Electronic Medical Records.