tag:blogger.com,1999:blog-3503957686158274288.post3342347822462395287..comments2024-03-12T12:32:15.598-05:00Comments on On Health Care Tech & Policy: Patient-Centered EHRMargalit Gur-Ariehttp://www.blogger.com/profile/08777722834145614546noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-3503957686158274288.post-76044474041315017022012-03-28T06:30:20.098-05:002012-03-28T06:30:20.098-05:00Hey, nice site you have here! Keep up the excellen...Hey, nice site you have here! Keep up the excellent work!<br /><br /><br /><a href="http://www.mdcovered.com/transcription/why-us" rel="nofollow"> Patient Appointment Scheduling</a>Nallihttps://www.blogger.com/profile/14584196074976791777noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-70545680603622182412011-07-12T15:00:03.706-05:002011-07-12T15:00:03.706-05:00"Finally, remembering that “every patient is ..."Finally, remembering that “every patient is the only patient”, we need to consider what EHRs should not be allowed to become. EHRs should resist the temptation of surrounding physicians with layers and layers of electronic data and communications, until each patient becomes nothing more than another blip of bits and bytes in an endless stream of the same. EHRs should not be constructed with a primary mission of collecting research and evaluation data points, either about patients or their doctors. Those who build EHR software, and those who regulate what is being built, should remember that if a treating physician is a guest in a patient’s life, researchers, population managers and governments are very much uninvited guests, and as such should humbly wait by the door, hat in hand, and respectfully accept whatever patient-centered care can spare for their secondary uses of data."<br /><br />Fat chance!tooearlyhttps://www.blogger.com/profile/06513358663917044513noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-78964768990667622822011-04-21T00:27:20.377-05:002011-04-21T00:27:20.377-05:00Well, let me start by correcting a slight misconce...Well, let me start by correcting a slight misconception. I do not work for an EHR company. I actually work at a company which is well positioned to benefit financially from as much change and rip-and-replace as possible.<br /><br />I don't see how a data-element centric approach is more patient-centric than an approach which maintains the context in which data elements were captured. You may consider this document centric, but I would like to remind you that HL7 v3, which is XML based, can and does accommodate both documents and tagged elements (see my comments to the PCAST report - http://onhealthtech.blogspot.com/2011/01/comment-on-pcast-report.html).<br />The data-element approach is best suited to research of all types, which should be considered secondary to patient care. The main driver in choosing a strategy should be the primary usage and the way it benefits patient care for the one patient at one moment in time. I don't know what can be more patient-centric than this goal.<br /><br />I am aware of the incessant cries of "give me my damn data", but honestly, dumping a bunch of data elements into your lap, and holding you responsible and accountable for managing those data, does not strike me as equal to putting your wishes and preferences at the center of all decisions regarding your medical care.<br /><br />On the other hand, getting all your data out (out of where?) in a computable format, will do wonders for all those non-HIPAA covered entities, just waiting to monetize your illnesses. Be careful what you wish for, because at this point, I have no doubt it will become true, and it won't get fixed until people get seriously hurt and lawsuits are filed.<br /><br />I do agree with you regarding what patients want and I think this fits very well with what Dr. Berwick said and what I believe to be true.<br /><br />The above post intended to offer some suggestions to those creating new, or upgrading existing, software. Easy small things that can make a big difference for patients and can be added with almost no effort on the part of vendors and no objections from physicians. <br />And, BTW, this has very little to do with whether HIE is performed via existing standards, or "new and improved", search-engine optimized, and ad-ready atomic data-element constructs.Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-7918298058769185382011-04-20T23:00:10.255-05:002011-04-20T23:00:10.255-05:00I offer all of these comments as a mere patient. ...I offer all of these comments as a mere patient. With that being said lets call a spade a spade. You work at an EHR company and therefore have a vested interest in the "status quo" of Electronic health records. While I agree that EHRs cannot shift healthcare to a patient-centered model, what they can do is provide a catalyst and support for patient-centric care. The document-centric approach that you advocate inhibits patient-centric care more than a individual element approach.<br /><br />You have fallen into the same trap as the proposal you oppose in wrongfully defining patient-centrality. Dr. Berswick didn't summarize patient-centeredness, he attempted to define it. Wholly missing the point in patient-centrality, which should be letting patient's define what they want. At least one group has studied this and determined that patients actually want whole person care, coordination and communication, support and empowerment, and ready access. <br /><br />Clearly after studying these components of patient care the individual data element approach is the best way to catalyze a patient-centric model compared to an almost static document-centric approach, which even if improved fails miserably to actually become as patient-centric as individual data elements.<br /><br />Both you and the government have fallen into the trap of daddy knows best. All of which is disguised as saying we are more patient-centric. The argument really comes down to data, who owns it, who gets to use it, and how it gets to be used. Your last paragraph addresses the issue in complete disregard to actual patient centricity. <br /><br />Patients should get to decide who is let in and who is left out. Yes the data is more easily aggregated and yes the government wants that information. However, those with an already vested interest in EHRs want the system to stay the same because of cost. Both of which completely miss patient-centrality. The patient should be in control of whether the physician gets to be a "guest" or if the government or researchers get to be a "guest." Regardless of the costs to companies such as yours or the government's potential benefits (which could actually be seen by patients as their benefits through evidence based medicine - cue gasp now) the individual data element is the best way to put patients in control of their care and data.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-8125881617144559982011-04-16T15:04:49.983-05:002011-04-16T15:04:49.983-05:00Thanks for these nice and healthy advices; I am go...Thanks for these nice and healthy advices; I am going to tell all these tips to my grandfather and my whole family also. Everyone should take good care about their health. Health is everything to human's life. :)botiquin de armariohttp://www.botiquin-de-primeros-auxilios.es/noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-50816505032253553302011-04-11T12:56:45.957-05:002011-04-11T12:56:45.957-05:00I think I must have sat around the same tables.......I think I must have sat around the same tables....<br /><br />As to the mindset, I do believe it still exists in places, but considering the direction we are taking, I am not sure about it's future.Margalit Gur-Ariehttps://www.blogger.com/profile/08777722834145614546noreply@blogger.comtag:blogger.com,1999:blog-3503957686158274288.post-2731309197833461422011-04-11T10:47:02.654-05:002011-04-11T10:47:02.654-05:00"these computerized aggregation and managemen..."these computerized aggregation and management tools have almost nothing to do with the concept of patient-centeredness as expressed by Dr. Berwick."<br />At some point we need to think through how such an EHR could be built. I agree that in the past, we used computatiional power in the wrong direction. I can raise my hand and say I've sat around tables where patients weren't part of the equation.<br /><br />"patient-centeredness becomes more of a mindset directive for those who provide medical care and those who design health care delivery systems. "<br /><br />Let's first make sure that mindset has changed.faisal_qhttp://twitter.com/faisal_qnoreply@blogger.com