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| Electronic Medical Records----Do We Need Them? |
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by Bob Blumm, MA, PA-C, DFAAPA - July 29, 2010
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The original quote by Edward George Bulwer Lytton (1802-1873) is, “The pen is mightier than the sword.” However, as health care professionals, we need to recognize that our pens can be deadly. Five years ago, I attended a meeting of my professional association where the president of the AMA was a scheduled speaker. This physician gave us some of the internal directives that were being incorporated into the AMA. There was to be an emphasis on handwriting errors and penalization for those whose writing was unintelligible. As the makers of Virginia Slims said, “We’ve come a long way, baby.”
The Hospitals, Urgent Care Centers and some of the Retail healthcare clinics are concentrating on systems that are extremely costly, but are preventing errors that will cause loss of life. We look at cost versus benefit and comprehend that adding these systems to our arsenal will enhance patient quality care, prevent life-threatening situations and lower the incidence of mortality and morbidity. The long range result will be the lowering of the number of claims across the country. There is no price tag that is too high to prevent injuries and death to patients who place their trust in our health care system.
Fifteen years ago I used an EMR (electronic medical record) in a Long Island emergency department. This was almost the genesis of these systems and basically we had templates with ideas and facts that we could insert. I found that this better prepared me in writing my own charts as these EMR’s were formatted to prevent malpractice and to simultaneously document aspects of the patient’s presentation that may have otherwise been overlooked. We have since learned from litigations that lack of pertinent information demonstrates a shoddy intake and can be the cause of a lost law suit. Documentation still remains a key aspect of what we do in our professional lives.
Recently I spoke with a close friend of mine who is a malpractice guru. As we examine litigation for PA’s we see that most of the suits that are generated come from emergency medicine, orthopedics and family practice. As we look at the NP profession, most litigation arises from Women’s health, family practice and emergency medicine. The difference and the similarities arise from the fact that PA’s are found in greater number in an orthopedic practice. Common areas such as emergency medicine and family practice are similar regardless of the clinician. Both of these areas are considered high risk because of the fast pace, overwhelming numbers and plethora of clinical exams that are necessary to reach the proper diagnosis and to formulate a treatment plan which may , in fact, include a physician referral. Having worked in a 85,000 visit ER I have seen very sketchy documentation on the written record because of the time involved in writing a progress note or because of the clinician’s lack of information concerning the proper tests to perform. Sometimes we just don’t know what we don’t know! How beneficial would an EMR be in a situation such as this where data could be instantly available and guidelines could be in place.
Similarly, Women’s Health is rapidly becoming a target for the legal beavers because of the possibility of poor histories or incomplete histories. Nothing in a patient past medical history is inconsequential and prompting from an EMR can satisfy the reservoir of knowledge needed to properly treat the patient. As in all specialties, it is important to be knowledgeable and capable of performing the necessary procedures competently and consistently. There are now more than a handful of companies that exist for the purpose of aiding clinicians in preparing medical records that are complete, consistent and unchangeable without addendum to satisfy the curiosity of those that doubt the veracity of the chart.
The new changes incorporate such concepts as bar codes to insure proper identification of drugs and patients as well as to add the dispensing nurse to the record. The systems are integrating multi discipline templates that are acceptable to pharmacists, nurses and physicians as well as to nurse practitioners and physician assistants. The merit of these systems will be the universal integration of knowledge- based support tools that will demonstrate potential drug interactions as well as allergies and potential complications that are adjusted to the patient’s medical diagnosis and medical history.
As we become aware of the possible integration of these systems, it becomes the responsibility of non-physician providers to actively support and unify in joint cooperation for the utilization of these systems in their medical practices and healthcare facilities. As professional organizations it becomes our sacred responsibility to put aside differences and to decide how and where we can work together to help our patients and our practitioners. As members of these organizations it is our responsibility to comment, to suggest or to implore our leadership to find common ground and to work interdependently. Ultimately, they have the ability to prevent the 100,000 medical errors that have caused the death of unsuspecting patients yearly in these United States.
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| TP PA-C/SA (Texas) |
on 03 Aug 2010 at 5:45 pm |
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Having developed and queried EMR's over the past 25 years, I agree that adequate medical documentation is important and that computers can help in this process, however, this venue has caveats which most clinicians who write these notes are unaware. There is as high as 7% data entry error rate on average. Whether interfaced data came across cleanly into your patients file as with duplication of the medical record number on different patients is a concern. Automatic insertion of old discontinued medications onto a discharge medication list was extremely problematic at a quaternary facility of previous employment. Copy/Paste functions which bring the previous note(s) ahead may contain errors which may not document interval changes. If an untoward event occurs which is totally unrelated to the documentation discrepancy, this can be used by lawyers, administrators and others for litigation or administrative purposes and beyond the providers control.
It is proposed that the EMR will reduce errors. This postulate must be tested and results replicated across all the different specialties before we can conclude "it will save lives". As with any database or EMR system, if garbage goes in, garbage comes out. There are just many more variables to consider with reference to where the garbage came from : the provider of note in the EMR, coding errors for data propagation and/or extraction, redundant data fields. A phone call or page will usually fix a problem with a legible order or dose question. |
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