Did you know that people are fixing to cut funding to Graduate Medical Education? Yeah, you know, the thing that actually allows us to make new doctors, while we’re in a PHYSICIAN SHORTAGE?!
Yeah, I know.
Everyone’s trying to cut costs.
But cutting primary education, infrastructure, and the funding that allows us to pump out the people who make sure you don’t die when you are in a car accident seems like a stupid, stupid move.
Here’s a better alternative.
You know what would take a significant chunk out of health care costs? In one fell swoop?
Standardize electronic medical records.
That’s right. All you private companies with your New! Improved! EMR Systems! need to take a bow and just disappear…instead of the doctors who use them. Cerner, Quadrumed, Sunrise, and all of you other overcomplicated, hypofunctional EMR systems…I’m sorry, but we just need to end this relationship. It’s not me, it’s you.
Do you have any idea how much time, money, and resources are spent repeating workups? A lot. A. LOT. This problem is exacerbated by the fact that patients now have a tendency to bounce from hospital to hospital, shopping for who knows what. At every hospital, basically the same workup is done. And it’s practically impossible to get records from previous hospitalizations, even if a patient signs himself out of one hospital and goes straight to another one. (This happens all. the. time.) So what does hospital number two do? Exactly the same thing that was JUST done at hospital number one.
But Dr. Grasshopper, I hear you saying. Why can’t the patients just fill you in on their medical history when they come to the hospital?
I’m sorry. I barely heard you through the millions-of-voices-strong chorus of that cringe-inducing statement: “It’s in the computer.”
What medications are you taking? I dunno. It’s in the computer.
What illnesses have you had in the past? I dunno. It’s in the computer.
Have you ever had any organs removed? I dunno. It’s in the computer.
This happens even at hospitals that DON’T USE ELECTRONIC MEDICAL RECORDS.
Okay, okay. I’d be a fool to expect Americans to take responsibility for their own health history. It’s absurd to ask someone to write down their medication regimens on a piece of paper when they go for a doctor’s appointment or present to the emergency department. It’s pure idiocy to expect people to remember whether or not they ever gave another human being permission to slice their bodies open and fiddle around with their insides.
But if we’re going to allow patients to abdicate their responsibility toward knowledge of their own bodies and make the healthcare providers solely responsible for the information required to treat people correctly, effectively, and inexpensively, then THERE HAS TO BE A RELIABLE WAY OF COMMUNICATING INFORMATION BETWEEN PROVIDERS.
And there just isn’t.
Except in one sector: The Veterans’ Affairs hospitals.
Why, you ask? (Don’t pretend you didn’t ask. I heard you through the computer chorus.)
It’s because of a program called CPRS.
Let me be the first to acknowledge that CPRS is an imperfect EMR program. But it is far LESS imperfect than any other system I’ve worked with. The biggest advantage of CPRS is that the medical history, imaging, and previous test results of any VA patient who presents to any VA hospital in the country is immediately accessible, no matter which VA hospital they had been to previously. I could go into details about the time, energy, and healthcare errors that are saved by such a simple thing, but I just don’t have the time or the energy to try and convey that kind of ENORMOUS MAGNITUDE.
Here’s my proposal: extend CPRS to all hospitals that use electronic medical records. All of them. We’ve already paid for the development of this system; CPRS was taxpayer-funded. So make the investment that would be needed to dump all of the other overpriced systems-of-marginal-utility and transfer them over to one, centralized repository of patient information whose design and development we have already paid for. And then just do it.
It has to happen. Electronic medical records are awesome, but like everything else in medicine, you can’t get a benefit without a side effect. And the biggest side effect I’ve noticed from EMR systems is that everyone outsources their knowledge of their own medical situations to some amorphous, all-knowing Computer. And from what I’ve seen, that’s not likely to change any time soon.
So why not just make it a reality? It would make life easier for everyone, doctors and patients alike.
Some immediate effects:
-Shorter wait times in emergency rooms, as doctors won’t have to sit and painstakingly try to reformulate by trial and error the magical sequence of questions that will drag useful information from forgetful, uncommunicative, or unengaged patients and family members. Doctor/patient time can then be spent with far more meaningful and fruitful interactions.
-Drastic decrease in healthcare spending; you’d be horrified at how often the same tests and imaging are repeated, just because the results of previous tests cannot be found in time to contribute to medical decision-making. Well, you might not be horrified, but I am. On a multiple-times-daily basis.
-Fewer medical errors, since medical providers will be able to make decisions based on the most complete set of information possible, instead of the slapdash patchwork of patient recall, previous records (if you can ever find them), and possibly-misleading-test-results-that-wouldn’t-actually-terrify-you-and-lead-you-to-do-a-full-panicked-workup-if-only-you-knew-that-the-patient’s-result-has-been-at-that-same-bizarre-level-for-the-past-fifty-years-and-it-has-never-made-any-trouble.
Everyone currently employed by the useless-and-now-defunct-if-this-proposal-takes-hold EMR companies can devote their energies to the security and functionality of the centralized repository.
What other single piece of policy change would have such a drastic positive effect on this broken, broken system?
I dunno. It’s in the computer.