tag:blogger.com,1999:blog-1509187841033628660.post7787993917013121585..comments2024-03-28T15:36:18.707-07:00Comments on Medicine and Social Justice: EMRs and Primary Care: The good, the bad, and the challengesJosh Freemanhttp://www.blogger.com/profile/10248920527894775520noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-1509187841033628660.post-45778470772771361022011-07-06T16:53:37.381-07:002011-07-06T16:53:37.381-07:00Joshua,
Your posting relates primarily to the bur...Joshua,<br /><br />Your posting relates primarily to the burdens that the EMR places on clinicians; this is an important topic. I have several additional concerns about EMR’s.<br /><br />1) The introduction of the EMR was done without a robust evidence base. This is odd for an intervention that has the potential for so vastly altering medical care. We would not, let’s say, introduce a new anti-hypertensive drug without requiring some clinical trials. This is a particular concern with current EMR’s which remain quite primitive and do not talk to one another. Would it not have been better to test and perfect this technology before introducing it extensively? I suspect a lot of companies have gotten rich from this early introduciton (particularly because of its inclusion in federal law) and that we are going to be suffering from the consequences for many years in terms of balkanized information.<br /><br />2) There are major privacy issues associated with EMR's that have been widely discussed in Britain and ignored here. Do you want to discuss the most intimate details of your personal life with your family doctor when you know that the number of people who have access to that information is probably in the thousands (in a large medical center) and potentially much, much bigger (think insurance companies)?<br /><br />3) The EMR essentially codifies what we understand to be the work of the doctor. But who decided what that work was? I remember several years ago hearing the head of Blue Cross Massachusetts interviewed on the BMJ saying: "We know what quality care is and we are not going to pay for substandard care." I marveled at his knowledge of what quality care was (I struggle with the question every day) and am horrified by the idea that the EMR gives him a powerful tool to monitor and control what I do with my patients. Let me be clear, I do not mind having my work monitored and evaluated. But I do want that body to be people whose priorities are the patients and communities I care for and not the economic interests of accumulating more capital. I think there has been a sea change in the locus on control over clinical practice from the professionals (who perhaps weren't doing such a good job) to corporate interests. This has gone largely unchallenged by the profession which has been continually brow-beaten for not following corporate models.<br /><br />4) Finally, think of the implications for the EMR and "social justice." What questions are we asking that might promote social justice? What questions are we asking that might hinder social justice? These topics are not on anyone's agenda as the EMR rolls out. Do we ask about race? Do we ask about abortion? Are abortion protocols easy to access and included in all EMR’s? Is marijuana use a "problem"? Do we require PSA testing? What about questions regarding food insecurity? Or past histories of incarceration? What about immigration status? (Yes, what do we do about immigration status, a major determinant of health?) Do we mention criminal activities, parole status, police abuse? All of these problems were issues with the paper record and they continue to be issues on a larger scale with the EMR.<br /><br />Best, MattMatthew Andersonhttps://www.blogger.com/profile/01160604562315966561noreply@blogger.comtag:blogger.com,1999:blog-1509187841033628660.post-29337579451465554962011-06-15T00:22:45.997-07:002011-06-15T00:22:45.997-07:00Very interesting topic! "EMRs and Primary Car...Very interesting topic! "EMRs and Primary Care: The good, the bad, and the challenges" Glad that you've shared it with us. I enjoyed reading this one. Looking forward for your next post.<br /><br /><a href="http://www.acrendo.com/" title="electronic medical records" rel="nofollow"><b>electronic medical records</b></a>KrishaLivahttps://www.blogger.com/profile/02760868672190859926noreply@blogger.comtag:blogger.com,1999:blog-1509187841033628660.post-26582802721844836662011-06-12T19:59:07.798-07:002011-06-12T19:59:07.798-07:00From Holly Kaufman, MD:
WELL put! 50 percent of my...From Holly Kaufman, MD:<br />WELL put! 50 percent of my note is required by the hospital system but not pertinent to the patient sitting in front of me. New game - patients watch me type while they sit silently "read what I am writing and tell me if I got what you told me right" this doesn't work in Spanish though and depends on education level, then the notes pile up to be typed at home.Josh Freemanhttps://www.blogger.com/profile/10248920527894775520noreply@blogger.comtag:blogger.com,1999:blog-1509187841033628660.post-6957131573206545002011-06-12T05:22:40.027-07:002011-06-12T05:22:40.027-07:00Josh captures much of the possibilities of the EHR...Josh captures much of the possibilities of the EHR and its contributions. However, the most important issue that NO ONE seems to be addressing clearly is interoperability - that my records are available no matter where I am - that is the benefit that is most important. I recently had to see a doctor in another state for an acute situation - there was, of course, no access to the extensive EHR that I had at home and so the value was mimimal and I had to repeat all the data just like in the paper days. Now I have two EHR database that can't communicate with each other. But the same EHR - EPIC - won't work on the other side of my home town if I happen to go to another health system than my home system - and the problem is with the health system, not the EHR. The solution??? Have a cloud based miminum data set for all people in the US that by law has to be populated from whatever EHR one is using. That would be worth it.johnjosehttps://www.blogger.com/profile/02007760329913046351noreply@blogger.com