I got this link:

 

http://www.syleum.com/2009/03/17/healthcare-data-model/

from a co-worker who thought it would be important for the team to read the article.  We support the concept of an electronic health record (EMR), since we are the IT support for the software that tracks everything to do with the paper version.  We aren’t directly involved with the creation of the EMR for our health authority, which has always been put into question seeing as we would have some of the most useful insight.  But then, that’s part of the problem with large organizations.  Not only do they forget the past ways of doing things while they try to develop and implement the “new way”, they often forgot who maintained it.

But I could go on about this very point forever and still get nowhere.

My point on this article is that the writer is part of IT.  Or at least he has a background in it.  And so with the article and the knowing the person who sent it, I was sort of expecting some good insight.  Unfortunately I got near the end and stopped reading.  The IT dude in the article, who became a patient and watched the EMR fail miserably, failed to grasp the very concept of why it didn’t work.

His experience in hospital was an ordeal and certainly not uncommon.  Anyone can profess to put out why the enormous undertaking of an EMR is a fail in many organizations and the complexity of it.  There are privacy issues, there are many systems to connect – and by that, translate into a common application and correlate all the data.  In his overly lengthy explanation of it (bit of a yawner in the beginning and end), he does illustrate the various challenges and questions the point of pouring billions into creating a national EMR.

Well dear sir.  The EMR can work and does work in different organizations around the world.   The information on patients is there and waiting to be merged, correlated and merged.  There are a ton of challenges and picking a vendor is the least of the issues.  Noted facts that the vendor shouldn’t be picked on their product but more so on their ability to create a user-friendly product is… noble but naive.  Very few vendors are going to create a new product from scratch.  But I digress.  This is a known issue (he’s not original in his idea) but is not the slightest bit why his experience was so bad.  The real problem is the clinicians – nurses, physicians, residents, and specialists.  The EMR is only as good as the people who will use it.

Re-read your own story, fool.  How many times did you mention that the attending, resident, nurse retook a history rather than read the one already on the chart?  How many times was it said that medical staff didn’t read the consult from your specialist?  There was a super keener (good on her) that diligently put every ounce of info on his medical history, problems, and prescriptions into the EMR.  NO ONE READ IT throughout his stay in hospital.

IT staff had implemented a good system from his initial observations.  Staff had access to computers on carts, nursing stations had computers and if I recall, some had pc tablets at the bedside. 

And let me just put it out there – there was also a paper chart.  Which was never consulted either.  So whine away about the expense of an electronic system and what the government will have to do with a vendor to “get it right” – the problem was not that the info wasn’t available in a convenient format, it was that no one could be bothered to look at the chart – electronic or paper.

With the many challenges ahead in creating a national electronic medical record in Canada, there’s still the issue of getting the medical staff to use it consistently when the patient is admitted.  Build THAT into a business plan, my friend, and half the battle is won already.