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CIO Unplugged

Now It’s Personal -- The EMR Imperative

Published December 8, 2008 11:09 AM by Edward Marx
The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries.

Given my affinity for pushing myself physically (some would say punishing), I am proactive with prevention. For instance, 6 months prior to the Ironman, I underwent a battery of cardiovascular and VO2 tests to ensure I was healthy enough to compete at an elite level. Like most people, I am diligent about annual physicals and eager to compare my year-over-year results in order to make necessary lifestyle adjustments.

During my most recent physical, the nurse kept rechecking my pulse until I explained why it was only 40 beats per minute. The subsequent EKG put everything in perspective. The physician then put a smile on my face when he declared that the digital exam was no longer necessary given the advances in prevention and prediction. They drew blood, collected fluid, and I was out the door in less then one hour. Sweet.

A week passed and still no test results. I thought, I could look them up myself if we had a personal health record deployed. I comforted myself with the hope that in a year or so we probably would. My assistant called the physician's office on my behalf to check into the results status. After a few days of phone tag, the nurse urged her to have me set a follow-up visit to get the disturbing results in person. I immediately called the office and found that my lab results indicated serious issues from cancer to high cholesterol. I made the follow-up appointment.

Sitting on the exam table, nervously awaiting the news, I contemplated my uncertain future. My wife and I were nearing the empty nest stage, and we had grand plans to exploit our impending freedom. I then thought about walking my daughter down the aisle some day. Will I still be around? I wanted to do an Ironman with my son and attend his college graduation. Trying not to let anxiety rule, I prayed.

The physician came in and reviewed all the results in the paper chart. He paced back and forth, scratching his head. And then he said it. "I am really sorry Mr. Marx, but another patient's lab results were inadvertently placed into your chart. You're fine. In fact, your results are rather remarkable for someone your age, yet understandable considering your lifestyle choices."

I left that appointment on an emotional rollercoaster. Relieved but angry, bummed yet hopeful -- and highly sympathetic for the person with the terrible lab results. Then I contemplated the pushback, locally and nationally, on EMRs. The opposition cites the potential for automation errors. Excuse me? What about manual, paper-based errors? My experience only boosted my ardent sense of support for an EMR. I will push for automation because no patient should experience what I did when an antidote exists.

My physician is now in the queue to implement an EMR. Demand the same of your physicians. Fight for patient needs. You are in the position to influence.

7 comments

Ed, again, sorry for the confusion.  I had to smile, however, when I think about what happens in my PCP if I don't make it within my one year anniversary for a physical.  If I go beyond that date, my arrival is accompanied by an empty manilla folder/chart, because their paper volume is such that they archive anything over 1 year...so in addition to not having anything in my record, I have to try and recall all the history or complaints, from a year ago or more.  

Yes, an EMR is in their future, but not soon enough.

Best

Jim Jones, Healthcare - Biz Mngr February 3, 2009 11:35 AM
MA

Edward:

I too am a personal and professional proponent of an EMR, however, an EMR is not a panacea.  It is not an antidote to the unfortunate situation you experienced.  Duplicate, overlap and overlay records are prevalent within every form of electronic health information system.  So much so that we have built our business around resolving these data integrity issues and more importantly, their causes.  The effectiveness of any electronic system is dependent on the quality of the data within the system.  It is imperative that we move forward with electronic health records and with efforts to accurately link patient information within these systems and eliminate the bad data therein.

Beth Just

CEO

Just Associates, Inc.

Beth Just, Just Associates - CEO January 27, 2009 2:53 PM
Centennial CO

Ed,

Sorry to hear about your experience but I am glad to hear the final outcome knowing you are okay. We've experienced similar issue with someone in my family. He was told that he was HIV positive from his blood test. This was not good news to a guy who has been a faithful husband for over 35 years. We all believed that this was a mistake but this might not have been the case for some other people depending on their family connection. We just thought this might have happened from a blood transfusion he received on his surgery 2 years ago. Thank God that we got a call next day from the doctor stating that this was a mistake and it was someone else's blood results. It was a painful road to travel but we were grateful for the final outcome.

Josy, eDevelopment - eDevelopment Coordinator, Arlington December 15, 2008 6:00 PM
Arlington TX

Sorry you had to have that experience.  I agree with the other comments that an electronic system doesn't necessarily prevent these types of errors.  I've also seen records electronically misplaced.  

The electronic records can be even more dangerous because of the tendancy to believe the computer can't be wrong.  At least with a paper lab report, there is a name at the top.  Also, while CPOE can decrease some errors, it can increase others.  It's like always having a whole stack of charts on your desk.  It is very easy to write an order or note on the wrong one.

Greg, ED - Physician, HEB December 13, 2008 6:37 PM
Bedford TX

This is all so very true, Ed.  I forsee a day when we will be able to access our own health care records in an independent manner so that we can verify the veracity of the record as well as to ascertain our own progress toward personal health goals.  However, as a member of the team, I'm also disturbed by the strange reactions of the system that threatens us with termination should we access our very own records!  Could this be an overprotective "big brother" who wants to protect us from ourselves, or (much worse) who would protect themselves from possible litigation by denying us the very information that our own bodies have incurred?

Unless and until the health care industry is willing to release information to individuals (of course with proper constraints to protect PHI), our shared dream is nothing more than that.  I fear this is not in the immediate future and the struggle to obtain openness is going to be very difficult.

Thanks for your comments on this very convoluted process and your willingness to listen to all opinions.  Your leadership in our corporation is a beacon for us all.

Mark Johnson, Nova Clinical Centerpiece - CareConnect support, Texas Health Resources December 11, 2008 1:07 PM
Fort Worth TX

EMR's can include the same workflow mistakes at a faster speed but as a former GHC (like Kaiser) patient I expect to have real time access to my chart and email access to my providers. Last spring, after fainting at a project meeting and bonking my head on the table hard enough to need stitches I went to the local urgent care and was told to go to the ER instead to evaluate why I passed out.

After the quick visit I received the electronic discharge instructions that had the wrong diagnosis, indicated I had been given treatments for pnuemonia and narcotics which were all wrong. I pointed out the errors and the nurse cross them out with a pencil. When i got the bill it was clearly also wrong so I got the EMR records (which I had to drive over to get). My EMR had been merged with a 65 yo male and it took me 5 months to get them to make a note on the bottom that it was all wrong. From the H & P, treatments, labs and diagnosis. My insurance of course just paid the bill.

Btw.. the meeting I fainted at? It was to help design the implementation plan for another hospitals EMR! Remember that a PHR is worthless unless the Hospital has an EMR to populate it with. (think bank account versus quicken)

SR

Jennifer, Consumer Advocacy - Executive Director December 10, 2008 1:27 PM
Seattle WA

This is an incredibly story, real irony that it happened to you given your day job. You're right about how it resets your perspective on all the arguments against an EMR because 'bad things might happen'. Bad things happen every day because we aren't doing this electronically.

Andrej Kyselica December 8, 2008 10:38 PM

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