[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 EST 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.
> '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
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 wont 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 its significantly more than
$50,000, Berkowitz said.
Its 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; theyre 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 todays history, physical exam and plan. This is where Im
going to document what I see today and what Im going to do today. There
is no reason a computer cant pull most of this information in and pre-
populate everything Im 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 its on one screen, its not an articulate screen,
its just mashed all together, he said.
I dont know if the EHR vendors should be doing this, or whether they
should be giving us the tools to do it, because they havent 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 were starting to see EMR vendors acknowledge they
dont have a one-size-fits-all user interface and theyre 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 its 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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