Wednesday, July 22, 2009

Robust Medical Information Oxymoron!

Sometimes policy makers and elected officials are right on...and one of the truths to medicine is "there is too much diagnostic testing performed." There are many reason for this...medical liability...lack of research to guide physicians into best practices, comfort level of the physician, pressure from patients, the lack of an integrated records system, etc.

Today, I want to focus on the latter - the lack of integration of medical records. It amazes me that there is some "computer in the sky" or "big brother" who has all my financial reports, balances, the ability to go to a bank on the east coast and withdraw money from the west coast bank, etc. What we are lacking in health care is that same ability (at least as a nation) for health records. Most physicians are in private practices and these practices may be a solo practitioner or small groups (at least in the majority of the country). Most hospitals are nonprofit entities with small systems, again the majority in this country. Despite what you may think, the profit margin (as a provider) is not much and therefore people have limited funds to integrate an electronic record.

What this means, is that there is limited financial resources (and lack of motivation) to have a well organized record keeping system that is in an electronic format. The financial industry can transmit much information electronically and the systems have a unified way in which a combination of systems can operate (thus, the above bank analogy). But many hospitals and the majority of physicians do NOT have electronic records. In fact, it was only in the last few years that my hospital incorporated a partial electronic record. Not only is there a lack of systems, but many of the systems (within a hospital) don't have the capability to speak with one another. I know for those involved in business, it is hard to believe, but when a hospitals profit margin is only 1-2% per year, you can see there is little revenue or incentive to modernize!

Add to this the ablity to integrate with independent practitioners' records in the community is a disaster. Again, it wasn't until a few years ago could physicians in my area get outpatient lab results that were performed at the hospital.

Think about it, Mrs. A cannot have labs done at lab B because her insurance company doesn't participate so she has to go to lab C but lab C sends the results by mail and there is no lab interface directly with Doctor D, so he not only can't get the results (unless he calls - an added step) but no one else caring for Mrs. A has access to the records (especially when Doctor C's office is closed) and Mrs. A does to the ED at Hospital D...get the big picture! And do you think that most emergency medicine physicians like to practice this way...more to follow tomorrow...

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