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Jamie Tobias Neely: Mandate sharing patients’ e-data

Jamie Tobias Neely

If you’ve ever huddled in a thin cotton gown, talking to the back of a grumpy doctor as he furiously types into a computer, you’ve likely wondered: Just who is this amazing new technology designed to serve?

According to Dr. Robert Wachter, a professor at the University of California-San Francisco medical school and author of a new book, “The Digital Doctor” (McGraw-Hill), it’s naïve to think that electronic medical records systems were created simply to meet the needs of patients.

In addition to diagnosis and treatment, these complicated systems are also measuring quality of care, coding and billing, complying with endless federal regulations, and preventing malpractice.

Health records systems have grown so complex that a new category of medical errors has emerged. Wachter’s book tells a cautionary tale of a teenage boy who entered the UCSF Medical Center and received a 39-fold overdose of an antibiotic. The boy suffered a grand mal seizure, was sent to intensive care, and nearly died.

When the case was analyzed, it became clear that the hospital and its staff had placed way too much trust in technology. The system typically threw off so many false alarms that both the physician and the pharmacist ignored the computer’s warnings about the boy’s dosage.

That error propelled Wachter to research these systems for his book. He surprisingly concludes that despite all their flaws, electronic medical records allow physicians to provide safer, better care than ever before.

Wachter talked to me by phone as he drove from Minneapolis to Madison recently. He described the challenges in vivid detail. He and representatives of the two major Spokane health networks agree that digital records are still in their infancy.

Ten years ago, Rockwood Health System started rolling out electronic medical records systems, which chief information officer Brian Jones described as state of the art at the time.

Providence Health & Services spent approximately $700 million over four years more recently to launch a system called Epic, the current industry leader, across the five-state area it serves, says spokeswoman Liz DeRuyter.

These systems can provide new safeguards. If there’s a nationwide drug recall, Providence can locate all of its patients who have been prescribed that medication with a keystroke, says Dr. Jeff Collins, chief medical officer.

He likens the current generation of electronic medical systems to the ATMs of the 1980s, which only took debit cards linked to their own networks.

Electronic records can improve communication among doctors in the Rockwood system, for example, but they often can’t quickly share information with Providence providers, and vice versa. That can lead to doctors ordering expensive, duplicate tests or advising patients to leave established relationships with specialists in a competitor’s system.

Nearly every industry has encountered similar, disruptive change. Wachter concludes that while doctors have good reasons to feel frustrated – patients’ lives can be at stake – ultimately the benefits of digital records far outweigh the dangers.

The analog system, with its scribbled index cards and illegible paper prescriptions, was fraught with errors. Doctors who refuse to navigate the change, he suggests, should take a look at the balance in their Roth IRAs. If they’ve stashed enough cash, it’s probably time to retire.

For everyone else, Wachter offers some hope. He recommends that health technology developers adopt usability testing similar to that used by Boeing engineers. The federal government needs to require that electronic systems be designed to share information across networks, but otherwise dial down excessive regulation. Silicon Valley should design more elegant systems. Clinics should retool exam rooms to help doctors look their patients in the eye once again.

We journalists know there’s no going back. Several of my journalism colleagues nursed their nostalgia for old Underwood typewriters throughout their entire careers, but that didn’t make a dent in the digital revolution.

Earlier this month, the U.S. Department of Health and Human Services reported to Congress that some software developers and medical centers have deliberately blocked the sharing of electronic medical data to increase their revenue. Congress could decide to require vendors to freely share information. It’s more likely to do so if we shivering patients climb off those exam tables and demand it.

Jamie Tobias Neely, a former member of The Spokesman-Review’s editorial board, is an associate professor of journalism at Eastern Washington University. Her email address is jamietobiasneely@
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