On the path to EHRs, slower may be safer
By Jeff Rowe, Editor
One of the most widely cited justifications for pushing healthcare practitioners toward greater use of EHRs is that electronically accessible data will lead to better care for patients.
That rationale makes a lot of sense, but a closer look at the reality of making the switch to EHRs suggests that advocates need to be patient.
According to this observer, there “are two issues . . . that have been the confounding factors of EHR adoption in the past and will continue to be so in the foreseeable future.”
Specifically, “EHRs offer the promise of data aggregation which can be used to refine clinical treatments for both improved quality and, possibly, lower costs, but this aggregation is dependent upon standardized dictionaries and, importantly, standardized data entry.”
The doctors goes on to explain that the problem, in short, is that the current EHR templates are not flexible enough to record the full range of symptoms and “observed signs” that doctors generally rely on for their diagnoses.
“Patient care,” he points out, “especially when dealing with complex problems, requires the clinician to differentiate subtle distinctions among less than obvious alterations from normal physiology.”
As an example, he describes a patient who is complaining of shortness of breath. In reality, there are numerous possible causes of shortness of breath, but, too often, EHR templates, relying on standardized data entry choices, do not allow physicians enough flexibility when it comes to recording their observations.
“While there is a high statistical likelihood that shortness of breath will result from one of a relatively small number of potential pathologies,” the doctor writes, “assuming a diagnosis based on statistical likelihood will lead to poor or even dangerous patient care.”
When viewed in the light of this observer’s experience, it seems there are two sets of challenges.
As he points out, for IT designers the challenge is “to work out a way for experienced clinicians to be able to commit to the record the sometimes subtle thought processes and observations that lead to their diagnoses, while maintaining enough control and/or discipline over the input to allow the potential of data aggregation to be realized.”
Meanwhile, for policymakers the challenge is to keep pushing providers moving down the road toward new HIT without putting at risk the quality of care that patients deserve. |
发表于 2010-2-19 23:24:27
