10 Things Medical Records Won't Tell You!

The Wall Street Journal published an article last week on the 10 things medical records won't tell you.  I have condensed the list, so you get the idea...

1. COST: The price tag is HUGE!
2. SHARING IMPORTANT CLINICAL INFORMATION between providers is a myth.  Even high-price tag enterprise level systems do not do this well, or cannot, especially between different hospitals and doctors.
3. DOCTORS HATE IT in general and pretty consistently, especially if forced to use it by their hospital, the government, or partners.
4. DOCTORS HAVE LESS TIME to spend with patients...because they have to fiddle with machines.
5. PRIVACY physicians may employ strangers such as scribes to manage there cumbersome EHR into the previously sacred and secure doctor-patient relationship.
6. ERRORS MAGNIFIED mistakes are easier to make; just hit the wrong key, or have a voice recognition system hear "no chest pain" instead of "known chest pain".
7. INFORMATION OVERLOAD TMI- too much information...sometimes, in fact most of the time, we just don't need or want to read "War & Peace" on every patient, and only a section of the total is needed in any clinical situation.  But the EHR commonly gives it all. No one, especially not clinicians, have the time to read it.
8. IDENTITY THEFT EHR's contain much of your demographic information--social security, payment, address, phone, work schedule, etc.  They are therefore a fertile ground for the thieves that prey on such things.
9. YOU BECOME A MARKETING STATISTIC your information will be marketed and sold e.g. to pharmaceutical companies, insurance companies, etc.
10. BIG BROTHER IS WATCHING the government can and will track the events that occur in medical interactions through EHRs.  The requirements and criteria for this sort of tracking are already in place.

Choose an Electronic Health Record that has thoroughly considered these complaints and actively deals with them.  Complaint #10- government policies and incentives is the biggest driver in turning to EHR.

What to Do About PAIN in the ED?

The treatment of chronic pain has become a very complex and hot topic for providers. Little or no controversy exists about the treatment of acute pain; one just treats as necessary.  Acute exacerbation of chronic pain is also less clear.   

The goal is to treat patients humanely and appropriately without facilitating drug dependence and drug trafficking.

The pressures are complex and complicated. On the one hand, are those forces that make a physician more reluctant to prescribe pain medication, including:

1. States have created databases that keep, and make available online, records of all controlled medications prescribed, including the DEA number of the prescribing provider

2. Certain states, such as Florida, now require special licensure to treat non-cancer pain chronic pain.

3.Peer pressure from colleagues and support teams who feel everybody is a potential abuser. This puts certain patients with severe, painful conditions in the assumed category of “potential drug abuser”.

On the other hand, the real-time daily forces of clinical practice lead one to be less restrictive in administering pain medication. These include:

1.     CMS has made pain a de facto “vital sign” that must be addressed and documented.

2.     Patients request pain relief for a variety of complaints that are often very reasonable.

3.     Patient satisfaction scores like PRC and Press-Gainey emphasize pain relief. These scores affect contracts, RVU’s and levels of complaint to administrators. The #1 complaint in our ED is that the doctor was insensitive to pain relief and refused treatment.

What should one do? It is indeed a challenge to find a balanced, thoughtful approach trying to blend the various demands into a reasonable outcome. Our ED actually considered hiring its own pain specialist to deal with these endless problems.