http://disqus.com/by/doctorkj/enTue, 01 Sep 2009 19:34:04 -0000http://thehappyhospitalist.blogspot.com/2009/09/what-are-some-funny-clerk-entered.html#comment-15739669<p>Congestive Fart Failure</p>doctorkjTue, 01 Sep 2009 19:34:04 -0000http://andrewmcafee.org/blog/?p=693#comment-7424294<p> The problem with EHR and CPOE is that the basis of the design for most of the currently available systems is not grounded in what is safe or best practices for patient care. EHR systems were designed not to improve or make care safer, but to satisfy collection of needed data to code a diagnosis of a certain complexity to be able to bill for a higher level of care in order to make more money from the insurance company. Any other "functionality" that current systems provide are secondary . The amount of additional work required by physicians to encode data in a meaningfully granular way to make the data useful for patient care decisions far exceeds any potential benefit of the current systems and methods of data input. CPOE systems suffer from essentially the same problem, they were designed to more tightly document the services ordered, manage inventory(both HR and physical) and care rendered so that hospital systems can bill more to the insurance company. The exceptions to this generalization in this country exist in the Armed Services and VA systems, which are probably the closest thing available to systems designed for safety and quality of care. <br> It all comes down to who is the purchasing entity and what is the motivation for their financial outlay. Until other factors such as quality of care and documentation of safety of care environment are the financial drivers of health IT decisions(and for that matter health care in general), Dr Armstrong-Coben's argument well continue to remain valid, and critical redesign of the systems we need to truly make care better will continue to elude our well meaning but woefully misguided attempts to bring healthcare into alignment with other industries and modernize health IT.</p>doctorkjSun, 22 Mar 2009 21:34:14 -0000