Friday, December 18, 2015

Health Information Technologies - On One Hand and the Other

Give me a one-handed economist. All my economists say the one hand and the other.

President Harry S. Truman (1884-1972)

Like most doctors, I remain deeply ambiguous about use and abuse of Health Information Technologies (HIT) in general and Electronic Health Records (EHRs) in particular.

On the one hand, 80% of clinicians use EHRs in day-to- day practices.
On the other hand, only 20% plan to adopt the standards set forth in stage 2 and 3 stages of “Meaningful Use” (MU), of EHRs, and 111 physician organizations have asked for these standards to be delayed until MU standards are redesigned to make them clinically useful and their practices more productive.

Clinicians’ chief complaint is the sheer inoperability, user-unfriendly features, squandered time spent away from patients, distractions from doctor-patient interactions, lack of any discernible effect on quality, and waste of time and effort spent entering data that may be used against them. Why , some doctors ask, should they be data entry clerks and serfs for benefit of the government bureaucracy?

On the other hand, there’s the other side – the promising prospects of HIT – standardizing care, unraveling thegenetic code in order to predict disease and effective treatments, ushering in the era of precision medicine, allowing every patient to have their own EHR capable of being plugged into any doctor’s EHR, engaging and educating patients through online forums, and giving doctors access to information to help with quicker and more precise diagnoses and effective treatments.

Then there are two other questions.

One, how to integrate the computer seamlessly into the patient encounter?
Richard Frankel MD of the University of Indiana has suggested these guidelines, nicknamed POISED, to help clinicians transition to a new bedside manner.

P, Prepare: Review the EHR before seeing the patient.

O, Orient: Briefly explain who the computer will be used during the appointment.

I, Information Gathering: Entr data to show patient concerns are being taken seriously.

S, Share: Show the computer screen so the patient can see the information.

E, Educate: Display a graphic representation of , say, the patient’s weight or blood pressure over time.

D, Debrief: Make sure the patient understand what you said.

Two, how to make the patient-doctor visit so transparent that the patient cannot fail to understand what took place? Enter the OpenNotes movement, in which the patient has open online access to their doctors’ visit notes, such as the summary of their conversation and the doctors’ findings. In an experiment among 100 primary care doctors using the OpenNotes approach, 90% of participating patients endorsed the idea, and so did two-thirds of doctors. Patients are enthusiastic, doctor a little less so. Dr. Tom DelBanco, OpenNotes Founder, primary care physician, and Professor of Medicine at Harvard, says, “Patients generally love the program straight off, but with doctors, it’s an acquired taste like oystemrs, an acquired taste.”
Proponents say EHRs and OpenNotes are the wave of the future and should be adopted and mandated as the national standard of care. I predict such universal mandates will be successfully resisted. In America one should not be forced to do what one does not choose to do.


1. Sumathi Reddy, “Screen Time for Doctors, “ Wall Street Journal, December 15, 2015

2. Michelle Andrews, “Push On to Make Transparent Medical Records the National Standard, “ Kaiser Health News, December 17, 2015.

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