tag:blogger.com,1999:blog-3503957686158274288.post2157458486576503447..comments2024-03-12T12:32:15.598-05:00Comments on On Health Care Tech & Policy: Do EHRs Kill People?Margalit Gur-Ariehttp://www.blogger.com/profile/08777722834145614546noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-3503957686158274288.post-14697812886989212042010-06-11T09:22:07.949-05:002010-06-11T09:22:07.949-05:00I absolutely agree, Glenn.
We should use EHRs and...I absolutely agree, Glenn.<br /><br />We should use EHRs and we should strive towards HIT adoption and we should try to realize all the benefits of interoperability.<br />But just like cars and airplanes, there should be some sort of regulatory safety requirements in place to ensure that not too many people are harmed. It will never be zero and that's understandable.Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-74631775974473922162010-06-11T01:06:48.777-05:002010-06-11T01:06:48.777-05:00Margalit:
Do cars kill people? Do airplanes?
We...Margalit:<br /><br />Do cars kill people? Do airplanes? <br /><br />We all know there are tens of thousands of traffic fatalities each year in the US, but we still drive cars, because we know the risk of death (per mile driven) is tiny and the benefits of the technology outweigh the risks, by far. <br /><br />Plus, there are things we can do, like wearing seatbelts and not texting while driving, that mitigate the risks of a traffic fatality.<br /><br />It's the same thing with EHRs. They are a technology with risks and benefits. You should decide to use them if you believe the benefits outweigh the risks, and you should do whatever is possible to mitigate the risks.<br /><br />Glenn Laffel, MD, PhD<br />Sr. VP Clinical Affairs<br />Practice Fusion <a href="http://www.practicefusion.com" rel="nofollow">EMR</a>Glenn Laffel, MD, PhDhttps://www.blogger.com/profile/05860076245385623275noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-61565168342568227492010-06-10T15:05:38.594-05:002010-06-10T15:05:38.594-05:00I think Michelle that the culpability of the "...I think Michelle that the culpability of the "computer" depends on whether the computer is functioning as designed and if, a big if, the user is aware of the design principle.<br /><br />If the software design is faulty and if the user is for example not aware that he has to click on buttons to see addenda while viewing a progress note, than it may be a training issue. If the addendum button requires scrolling to get to, or it appears in different places on different screens, it's a design/usability issue. If the button fails to appear if there's only one addendum because the developer started counting the array from 1 instead of 0 (common stuff), it's a bug.<br />In all cases the responsibility lies with the computer, a.k.a. vendor (developers, UI designers, QA engineers, acceptance testers, trainers, technical writers and implementers).<br />If the computer has the ability to obscure information, which a paper chart cannot do, then the computer is responsible for what the doctor sees and as Jasmin said, that is mighty powerful stuff.<br />If the computer assumes to perform calculations, than it is the computer's responsibility to be correct. If the clinician has to check all calculations by hand just to be sure, then why have a computer?<br />If the computer loses data entered by a clinician, it should suffer the same consequences as the medical records clerk who misplaced records - she usually got fired.<br /><br />Of course, there could be user errors too. Garbage in garbage out. We need to differentiate though between what is under direct control of the user and what is not.Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-4040892582040809622010-06-10T11:24:00.894-05:002010-06-10T11:24:00.894-05:00Great article Margalit - I touched a little on thi...Great article Margalit - I touched a little on this during a presentation at HIMSS Virtual and one of the things that struck me in researching various errors is the idea that the system has now become the sole funnel and filter for patient information. <br /><br />The fact that HealthIT related adverse events are only voluntarily reported troubles me. The lines between device-system-interface are blurring and taking silo-based approach can only lead to confusion.Unknownhttps://www.blogger.com/profile/09987735107975015899noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-53340371421557887022010-06-10T10:52:21.966-05:002010-06-10T10:52:21.966-05:00Once again, a great assessment of a complex issue....Once again, a great assessment of a complex issue. I was about to bring up <em>Health Care Renewal</em> until you mentioned it yourself; certainly, while I agree in some measure with those authors that harm can occur and is probably not be self-reported, I'm also wary of anyone offering "projections" of numbers without a solid base to calculate from.<br /><br />The line here in what makes the computer a partner is blurry, to say the least. For example, does my use of blogging software constitute a partnership in presenting information? What about public works like power stations and water treatment plants, or transportation centers like airports or train stations? When a mistake is made, how far does the culpability of the computer reach in all those instances (not just medical)?<br /><br />I can see the reasoning behind your response to Faisal's comment, but I think a distinction should be made: a computer doesn't "decide" anything, it merely follow the course that it has been programmed to take. Yes, it seems to determine what is shown and what is not shown, but that is really a choice a person made at some point in development, or a user at some point in installation.Michelle Whttp://www.occampm.com/blognoreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-43173084661796207832010-06-10T10:00:10.690-05:002010-06-10T10:00:10.690-05:00I think, Faisal, that there is a distinction here....I think, Faisal, that there is a distinction here. The illegible note is fully within the doctor's control. It is up to him/her how he/she writes the note and up to the reader to decide if it is readable. The information in and within itself is all there.<br />On the other hand, if the computer is placed in between users, the computer may "decide" what is worthy to show and how it is shown. This makes the computer a provider of care, IMHO.Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-10329045594488348042010-06-10T09:31:15.696-05:002010-06-10T09:31:15.696-05:00'The EMR as a medical instrument', that...'The EMR as a medical instrument', that's an interesting connection. With anything, if there's a middle layer (EMR) between the patient and provider there is some level of interpretation. But what happens when an MD writes an illegible Rx on a paper notepad? Is the notepad an instrument?<br />HITECH was designed as a catalyst, allowing states and the free market to shape the EMR. It's up to MDs on advisory panels of software companies to take more responsibility and give better feedback as though they themselves were the 'medical instrument'.Faisal Qureshihttp://www.meaningfuluses.comnoreply@blogger.com