this post was submitted on 16 Aug 2023
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Physician and Chief Medical Officer here. I started my practice on the tail end of paper records and I have been through, and led, several different renditions of electronic medical records. Like any other software, the technology has evolved and matured over the last 20 years. Electronic Health Records are just about patient information anymore either. They incorporate patient info, clinician orders, billing, and also provide numerous cross checks and safety systems to improve patient care.
The article discusses the issue with digitizing handwritten notes. This is always problematic as they are not searchable, indexed, etc. and can be very difficult to work through. The system where I work has been on the same medical record system for over 10 years. This provides an efficiency that I didn't have when I was working in a paper system. The entire chart is searchable. Medical history sections are filled out and robust.
From a safety perspective, these systems give us so much more than we had. One prime example is bedside scanning. When a nurse administers a medication in a hospital environment the medical record plays a pivotal role. As a physician I enter and order for a medication. If there is an allergy, medication interaction, or a host of other things, the system will alert me to it before the order is signed. Once signed, the order then goes to a pharmacist to review and approve. The patient's nurse will then be notified of the order and be able to pull the medication from an integrated medication storage unit with multiple drawers and compartments to ensure the right medication is taken. Finally, the nurse must use the EHR to scan the patient's armband and the medication barcode. If there is any discrepancy, the medication is not given until the issue is resolved.
From a user perspective, I can now create notes and write orders faster than I could in a paper world, even with dictation. Most docs use a combined template/voice recognition approach which works well. There has been a great deal of work in the Epic world (one of the largest EHR systems) to increase efficiency and improve the user experience.
Are these systems perfect? Far from it. But things are better now, at least where I work, than this article makes it seem.
Side note: I get the impression that medical professionals are the core customers of Dragon.
We use Fluency Direct, but you are correct. Dragon is quite popular too.
This sounds great in a bubble where it works.
Over here there is no standardised way of sharing such info between doctors/hospital/care givers. I have been through multiple GPs because some stopped working, some where to far away after a move and so on. I had to bring my data to them and good luck to me if I hadn’t gotten a copy of something when it happened. I had to stop medical personnel from giving me paracetamol (I have asthma and shouldn’t take any of that or anything like aspirin), the GP of my SO had to basically partly roll back a medication plan he had gotten from the hospital after being in the ER and those are mild cases where nothing did actually go horribly wrong. My SO got two incompatible medications about two years ago because the tool that crosschecks the database did not throw the relevant warning correctly. It messed with his brain chemistry a lot. His GP wrote the programs makers to have them remedy that asap, since it was pretty bad.
I actually use the health app medication reminder/tracking now and have seen that the app can theoretically store data from health professionals about me. It looks like it is completely unused in the country I am in and I can’t manually add in data at all. This would be super helpful in some cases where I could use it to quickly convey key points about my health, especially when I am not as present (high fever, accident or some such).
The issues you bring up are well known and I couldn't agree more. Interoperability needs to be better. See my comment further up.
I am across the pond from you and as far as my knowledge goes laws are even more strict here.
I am not a medical professional, but I did accounting for a lot of them and from what I have seen them pay for the relevant authentication hardware and software it seems to be nightmarish to navigate.
While I am very pro data security and people being the owners of their own data, this goes the other way for me too. I own the data about my health, so I should be able to decide that I am fine with having it on my phone.
The medication rollback I mentioned would have been completely unnecessary if that option existed. It was Ibuprofen, which my SO shouldn’t due to an already stressed kidney. Now that I know that I can look out for it too, provided I am allowed to go with.
One of the issues you are touching on is what we refer to as Medication Reconciliation. At least in the US, the standard of care is to verify the current medications a patient is taking at every visit - whether it be an office visit, ED visit, or a hospitalization. Our local pharmacies also play a part in checking for medication interaction. This does not extend to over the counter medications however.
The US is the same in that the patient owns their own information. However, private entities are charged with the responsibility with holding and securing that data. Unfortunately, there is no central repository for it here.
More advanced systems in the US do allow for data access via phone. But it is not uniformly available or applied.
Just wanted to add that event digitizing older records these days is better. Some hospitals do make old scanned notes indexed and searchable through OCR now.