[LINK] U.S. health data czar sees role for government hand

stephen at melbpc.org.au stephen at melbpc.org.au
Sat May 2 17:21:00 AEST 2009

Am wondering if an 'ideal EHR system' is possible. Imho, the user/patient
pays free-choice EHR suggestion surely won't reach our most disadvantaged 
(medically and socially) Australians, nor, necessarily suit all providers.

Bernard forwards,

> 'U.S. health data czar sees role for government hand' .. Reuters
> "It is clear that this field has not advanced (enough) ... when left 
> exclusively to the private sector so there is a public role," said Dr..
> Blumenthal's office must determine just how practitioners would qualify 
> for payments as well as potential standards for medical record software.

Here's one US doctor's viewpoint ..


Lyle Berkowitz is not an electronic health-record systems basher; far 
from it.

Nor is he opposed to the federal government subsidizing hospitals and 
physician offices, although he says the proposed maximum payments of 
$44,000 for most office-based physicians like himself won’t cover the 
true cost of installing an EHR. 

No, what gets Berkowitz going is the poor quality of the user interface 
of the current crop of EHR systems on the market. 

“The actual cost of buying and implementing these systems as well as 
factoring in the lost time and problems — it’s significantly more than 
$50,000,” Berkowitz said. 

“It’s probably more than $100,000. The systems alone are not the real 
cost, when you factor in the change management that has to take place.” 

One potential problem is the stimulus law, with its deadlines for 
purchasing an EHR system .. and .. "they all are inadequate; they’re not 
all evil, but certainly none of them are perfect.” 

So, Berkowitz has done a good deal of thinking in the past few years on 
the ideal physician/computer interface. 

“Any screen I see should essentially have two parts,” Berkowitz said. 

“It should have historical information or data I need to make a decision. 
And that data is going to be pulled in from all parts of the record, 
vitals, labs, meds history, evidence-based medicine guidelines. The other 
half should be today’s history, physical exam and plan. This is where I’m 
going to document what I see today and what I’m going to do today. There 
is no reason a computer can’t pull most of this information in and pre-
populate everything I’m going to do. It significantly cuts down my work 
and leads me in the right direction.” 

“To get this information now, I have to jump to every different screen to 
find all this, or if it’s on one screen, it’s not an articulate screen, 
it’s just mashed all together,” he said. 

“I don’t know if the EHR vendors should be doing this, or whether they 
should be giving us the tools to do it, because they haven’t done it too 
well thus far.” 

“I think we should create a single, iPhone-like platform on which 
everyone can create applications,” Berkowitz said. 

“Making it an open platform on which everyone can create applications and 
then you get the best of both worlds, a government platform for 
standardization and then you get everyone making the customized things 
that make your practice run.

“I am optimistic that we’re starting to see EMR vendors acknowledge they 
don’t have a one-size-fits-all “user interface” and they’re opening up 
APIs (application programming interface) so some people can create their 
own user interactions," Berkowitz said. 

"If we see more of that, I think it’s a good sign that we have a chance 
to bring innovation back into the EMRs and let doctors figure out 
creating the user interface that works for them and leave the underlying 
data schema to the vendor. 

“Right now, we have documentation as an end result as the focus of the 
EMR, and what we need is a workflow tool where documentation is an end 
result of those tools,” Berkowitz said..


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