Monday, September 8, 2014

Imagine if your mechanic couldn’t fix your car before consulting an “electronic car record”

In my guest blog post for today’s Philadelphia Inquirer, I imagine what it would be like if auto mechanics were required to go through the same kinds of hassles that physicians experience in using electronic health records.  I encourage readers of this blog to read the entire post; here are excerpts:

“Imagine you are a car mechanic, and the government offers to help you buy a new computerized tool to make it easier to fix cars.  The tool improves automobile safety, it says, by giving you the latest evidence on the most effective repairs and immediate access to all prior work that has been done on the car. If you buy a tool that meets government standards, you will get a government subsidy to help pay for it, but if you don’t, you’ll be fined.

"Imagine you buy the tool, and discover it that makes it harder for you to do your job. The tool requires that you review a digitalized record of everything that was done on the car in the past, relevant or not, before you are allowed to pop open the hood to take a look at it.  Before you can, say, replace a failing fuel pump, you have to document that you reviewed the last time the car’s tires were replaced . . .  The tool then takes you through a series of “decision support” questions before you are allowed to order the replacement pump.  Do you know that you are replacing the current pump sooner than the accepted standard of car repair? Have you considered less expensive repairs? Only after you say yes again and again, does it allow you to order the part. . . 

". . . Now, imagine that you have become so fed up with using the tool that you decide to quit.  Many other mechanics in your town are doing the same, resulting in consumers having to wait weeks to get their cars repaired by the diminishing pool of mechanics who remain in business.”

My conversations with physicians suggest that this scenario describes how most feel about today’s electronic health records, with two big differences:

For doctors, this isn’t imaginary; it’s what they experience every day in trying to use today’s EHR systems. And because doctors aren’t mechanics, and people aren’t cars, the stakes are much, much higher.

Researchers at the Rand Corporation say EHRs are the biggest contributor to physician burn-out,observing that “no other industry [to their knowledge] has been under a universal mandate to adopt a new technology before its effects are fully understood, and before the technology has reached a level of usability that is acceptable to its core users.”

Yet it is clear that the United States is not going back to paper records.  What we need now is a commitment by everyone involved in the current EHR debacle—government, EHR designers/vendors, standard-setters, certifiers, and the medical profession itself—to get behind an effort to reinvent EHRs so they actually do what they are supposed to do: make it easier for doctors to provide good care to their patients.  Is that too much to ask?

Today’s questions: What do you feel about your EHRs? What needs to be done to make them better?


Jay Larson MD said...

Great analogy. Things would slow down mechanics more if they are required to fill out prior authorization forms for brand name parts or further diagnostics.

So far I am pleased with our EMR as it does not provide too many pop ups to distract during the visit. The main issue with all EMRs is lack of communication between systems. We still have trapped silos of information, be it electronic rather than paper, but trapped none the less.

Harrison said...

Analogies with other industries are way too full of holes to be meaningful.
Mechanics already have paperwork that customers expect.
They have to shop the competition and are expected to beat even the lowest internet price.
They are often arguing about apples to oranges comparisons.
They do have to plug cars in to diagnositic tools and cars have onboard computers that present challenges for mechanics all the time.

Paperwork and documentation is a big problem in the car industry and governmental oversight is something they have to work with.

I don't think we can find much solace there.

I'm reminded of the analogies to the airline industry when it comes to medical errors.
But it just isn't the same.
The risks are not the same.
They never were.
The airline industry error protocols and investigations cannot really be models for medicine.

We have to do better than we do.
But it doesn't really help us a lot to look at other industries as models.