Mistakes That Last Longer Than You - Your Coming Electronic Health Record
It never happened - but it says so in the chart.
Posted Mar 10, 2011
If in the future you inexplicably don't get a job or insurance you thought you had, consider this story:
"Mrs. Smith. This is the health department. You have gonorrhea. You need to come in and see us quickly."
The shocked Mrs. Smith is the 67 year old wife of a prominent local physician. Ill and weak, she had just returned home from a major orthopedic procedure at a large regional hospital. Gonorrhea grew in a routine urine culture, and the hospital lab called the Health Department.
It wasn't her test.
Her husband quickly made sure that the report was in error. He called a medic who worked in Infectious Disease. The Health Department went off the case.
He then asked that the hospital to wipe the incorrect test report off the medical record.
Their answer - impossible.
Not Shakespeare's Comedy of Errors
My colleague was incensed - and fearful. He knows what medical records, correct and incorrect, can do to one's health insurance, disability insurance, future medical and economic health.
Yet the nightmare that played in his mind was different. His wife is highly allergic to the main drug for gonorrhea.
What if in a few years he wasn't around. The scene he kept seeing was a doctor checking his wife's chart and giving her the standard antibiotic. She would go into anaphylactic shock, perhaps die.
So he asked the hospital again - please expunge the record. He was told they could add an "addendum."
They were not sure. Somewhere in the chart.
"Can't you put an overlay at the beginning of the chart pointing out the mistake?
"We don't know how to do that."
When he pressed the matter, the "Risk Management" team was brought in.
Lawyers consider it a matter of faith (as in theological) that hospital records "cannot be tampered with."
The physician pointed out the tampering had come from the hospital - his wife did not have gonorrhea - the hospital made that error. They were tampering with the truth. Legal records get expunged - why not medical ones?
Things went around and around. Since the hospital medical director was out of town, another physician employed by the hospital told our doc he was in violation of hospital procedures and Federal law - he had looked at his wife's medical reports even though he was not a physician of record on her case.
This was his first infraction. He would be given a warning. If he looked again, he would be brought to the attention of the authorities.
Trying to calm down he quickly got his wife to sign an authorization so he could look at her chart. He needs to know what's happening - he takes care of her at home.
The Impossible is Not Impossible
He also checked out the hospital computerized electronic health records. They originated as a program devised by the CIA - which always left back doors. Later, a large corporation bought the software and morphed it into a hospital medical record program.
From the beginning the program was designed to allow fixes.
No one in the hospital ID department had a clue how to make that fix.
It turned out programmers could do it - for a fee. The total cost of taking out the error might be $25-40 thousand - if the hospital lawyers would allow it. However, a copy of the record was already uploaded to a server somewhere in the mountain states.
The costly fix would not fix that version of the record. Gonorrhea is fated to appear on Mrs. Smith's chart for as long as the record stays on a server.
It will go wherever it goes.
The Future of Electronic Health Records
Electronic health records can be effective. They save lives in countries with national health programs.
The US story is and will be different.
As of 2014, EHRs will be required by Medicare. Physicians will be expected to pay to set them up in their practices at a general cost of $60,000 each. Wiring up American health care will cost tens of billions of dollars per year - for many years.
Regulations are being written as we speak. But standardization? Portability? Privacy?
The record so far is mixed. Though electronic prescribing helps, American EHRs have yet to be shown to effectively save costs or lives.
Physicians and nurses alternately like and hate them. Many a nurse will tell you his day is filled with clicking a mouse rather than taking care of patients. Documentation uber alles!
And much of the required documentation is regimented. Many types of records do not allow for direct dictation. If what happened is not on the checklist, you can't put it in.
Privacy? As the Sopranos would say, "fuggetaboutit." With thousands of conflicting systems, expect at least 600,000 "providers," particularly health insurance and other insurance companies to have access to your private files.
Lots of people will have the chance to know the secrets of your life.
Fixing the Mistakes
Like the waves of the sea, Electronic health records will come. National standards that are fair, private and efficient can be copied from countries that already operate national health systems (please notice that's health, not health care systems - there's a major difference.) A few vetted national programs, carefully tried out and capable of networking with each other, might do the job. They should be studied not just for cost but efficacy - which includes studying what happens to medical care when doctors and nurses spend more time charting than examining and talking to patients.
But this is America. We do things our own way.
Our national rank in lifespan, according to the CIA, is 49th among nations.
This deplorable rank is achieved by spending about twice as much money per person as other "developed" countries.
Remember the airplane watch lists? The senators and small children kept off flights as terrorism risks?
That was small potatoes compared to this potential mess. If nationally we install hundreds or thousands of unstudied, competing IT systems expect your medical record errors to last a lifetime - the lifetime of electronic information systems, that is.