Electronic Health Record and Eficiency (2)
Part 2.
..Why such inconsistency? Physicians might resent the loss of professional autonomy or have limited tolerance for on-screen prompts. In one survey, 75 percent of physician respondents admitted ignoring reminder icons, and more than half seldom or never acted on the information. The Electronic Health Records also impedes addressing other immediate patient needs in a time-limited office visit.
Electronic Health Records advocates also point to errors of commission. For example, important information might be missing from paper records, including radiology or laboratory tests Accordingly, if inaccessible records are responsible for costly retesting, reductions should be readily achievable. This was not the case at Kaiser Permanente, where "use of clinical laboratory and radiology services did not change conclusively" over a two-year transition to the Electronic Health Records .
Excessive testing could be more a function of defensive medicine, ease, or fear of uncertainty. Electronic Health Records decision support tools—including peer management, guideline promotion, and alerts about cost or redundancy—might reduce this. However, an Electronic Health Records -based decision support system that is cost-saving, generalizable, and sustainable remains elusive. Finally, ancillary testing is an important source of revenue. "Profit center" laboratory or radiology departments will not necessarily welcome Electronic Health Records -based interventions that lead to fewer tests and less revenue.
Storage of other encounter data.
Medical records are notoriously vulnerable to damage or disappearance. Hurricane Katrina’s destruction of Gulf Coast physician office practices has been cited as an example of the need for electronic medical information storage. Yet Hurricane Katrina’s cost was not factored into any of the previous savings estimates; in fact, the president’s endorsement of the Electronic Health Records predated this disaster by more than a year. Furthermore, the history remains a time-honored and reimbursable feature of every physician-patient encounter. Aside from the few situations in which patients are too ill to communicate, patients’ recall of past medical facts is accurate across a wide range of conditions. It is also far cheaper than remote storage. (countinued..Medication error avoidance..)
..Why such inconsistency? Physicians might resent the loss of professional autonomy or have limited tolerance for on-screen prompts. In one survey, 75 percent of physician respondents admitted ignoring reminder icons, and more than half seldom or never acted on the information. The Electronic Health Records also impedes addressing other immediate patient needs in a time-limited office visit.
Electronic Health Records advocates also point to errors of commission. For example, important information might be missing from paper records, including radiology or laboratory tests Accordingly, if inaccessible records are responsible for costly retesting, reductions should be readily achievable. This was not the case at Kaiser Permanente, where "use of clinical laboratory and radiology services did not change conclusively" over a two-year transition to the Electronic Health Records .
Excessive testing could be more a function of defensive medicine, ease, or fear of uncertainty. Electronic Health Records decision support tools—including peer management, guideline promotion, and alerts about cost or redundancy—might reduce this. However, an Electronic Health Records -based decision support system that is cost-saving, generalizable, and sustainable remains elusive. Finally, ancillary testing is an important source of revenue. "Profit center" laboratory or radiology departments will not necessarily welcome Electronic Health Records -based interventions that lead to fewer tests and less revenue.
Storage of other encounter data.
Medical records are notoriously vulnerable to damage or disappearance. Hurricane Katrina’s destruction of Gulf Coast physician office practices has been cited as an example of the need for electronic medical information storage. Yet Hurricane Katrina’s cost was not factored into any of the previous savings estimates; in fact, the president’s endorsement of the Electronic Health Records predated this disaster by more than a year. Furthermore, the history remains a time-honored and reimbursable feature of every physician-patient encounter. Aside from the few situations in which patients are too ill to communicate, patients’ recall of past medical facts is accurate across a wide range of conditions. It is also far cheaper than remote storage. (countinued..Medication error avoidance..)
