TomAiello 26
Squeak 17
QuoteQuotefrom the other not suited thread
QuoteActually. You're proving my point with continuing to post about EMR in this thread, despite the fact that there's a WHOLE NEW THREAD about said topic. Patients often put stuff in the wrong area that if charting is done correctly then has to be cleaned up by someone that knows what he/she is doing.
Who has the responsibility to ENSURE that patients fill in the relevant documents correctly?
Maybe train THEM up to do the job they are paid for??
The job "they" are paid for is taking are of patients. "They" get exactly zero additional compensation for using the EMR, even though it takes a significant amount of time and effort.
Nope you are missing my point tom
When patients fill out patient info card (forms) they are generally check at reception and entered into the system.
Make sure you staff are doing their job appropriately.
Here at least, the medical receptionist is the one charged with ensuring patient information is filled out correctly and entered into the system, the consulting doctor annotates the patient records during the consult.
You are not now, nor will you ever be, good enough to not die in this sport (Sparky)
My Life ROCKS!
How's yours doing?
My Life ROCKS!
How's yours doing?
well I have not had to yet, but I have withheld some information regarding barotraumatic injuries. sometimes you just gotta take one for the team in my line of work or the fucking pencil pushers will burn your whole unit.
we are very close, and trust our lives to each other every day. there is no room for negligence or negligent people. we strive for perfection in a not so perfect world, and under less than optimum circumstances. but when shit goes south on us more than likely somebody is going to fold or get really fucked up. unfortunately we cannot defy the laws of physics in my business.
we are expendable until somebody gets fucking trashed, then all of a sudden everybody cares. they don't really give a flying fuck though they just want to point fingers so they can start cutting people loose.
if what I tell the hyperbaric doctor doesnt leave his office then i will come forth with every detail of how it went down.
if they make the doctor make me sign a release to the company, then fuck em..you spend a fortune trying to find out why and you may never know
i don't toss my boys in the fire. i will lie till i die first.
we are very close, and trust our lives to each other every day. there is no room for negligence or negligent people. we strive for perfection in a not so perfect world, and under less than optimum circumstances. but when shit goes south on us more than likely somebody is going to fold or get really fucked up. unfortunately we cannot defy the laws of physics in my business.
we are expendable until somebody gets fucking trashed, then all of a sudden everybody cares. they don't really give a flying fuck though they just want to point fingers so they can start cutting people loose.
if what I tell the hyperbaric doctor doesnt leave his office then i will come forth with every detail of how it went down.
if they make the doctor make me sign a release to the company, then fuck em..you spend a fortune trying to find out why and you may never know
i don't toss my boys in the fire. i will lie till i die first.
if you want a friend feed any animal
Perry Farrell
Perry Farrell
Drug use.
"How long have you smoked cigarettes?"
Immediate, "I don't smoke."
...looking at annual chest x-ray and pausing, "Do you smoke anything else?"
"No."
...hmmm, so what is it? Is somebody lying because it is illegal.
Sex.
"Have you engaged in risky sex practices?"
...ala unprotected sex with someone who apparently uses poor judgment also...
Stupid stuff -
Stuff that you already know is a variety of a bad idea.
You expect a judgmental look and a chat about, if you admit.
"Yes, I may be an addict. I do eat ice cream once a week.
The Twister with Reeses Cups ground up in it."
"How long have you smoked cigarettes?"
Immediate, "I don't smoke."
...looking at annual chest x-ray and pausing, "Do you smoke anything else?"
"No."
...hmmm, so what is it? Is somebody lying because it is illegal.
Sex.
"Have you engaged in risky sex practices?"
...ala unprotected sex with someone who apparently uses poor judgment also...
Stupid stuff -
Stuff that you already know is a variety of a bad idea.
You expect a judgmental look and a chat about, if you admit.
"Yes, I may be an addict. I do eat ice cream once a week.
The Twister with Reeses Cups ground up in it."
BIGUN 1,323
I'd also like to know your thoughts on the MIB and the Office of the National Coordinator for Health Information Technology.
Nobody has time to listen; because they're desperately chasing the need of being heard.
kbordson 8
Health Information Technology sells nicely... but a national database of health histories? Great for data collection and research... but not great for privacy or personal rights.
I also heard grumblings about implanting a chip with medical info while I was in the military. Not keen on that idea either.
I also heard grumblings about implanting a chip with medical info while I was in the military. Not keen on that idea either.
BIGUN 1,323
Agreed.
Imagine not only Identity Theft; but health theft. 
Nobody has time to listen; because they're desperately chasing the need of being heard.
LMAO. They can have my health and my credit too! Nobody wants to touch my shit. And I like it that way.QuoteAgreed.
Imagine not only Identity Theft; but health theft.
I hold it true, whate'er befall;
I feel it, when I sorrow most;
'Tis better to have loved and lost
Than never to have loved at all.
I feel it, when I sorrow most;
'Tis better to have loved and lost
Than never to have loved at all.
Skyrad 0
Hi Karen
As you know I'm a Clinician by background and I've been working as a Consultant in Healthcare Informatics for a large multinational for the past five years. This stuff is my bread and butter I currently Lecture on a Post Grad Healthcare Informatics Course and reguarly give addresses at Healthcare Informatic Confrences (three last month). I was responsible for designing the workflow and testing programme for the London LSP RIS/PACS Program 31 Hospital Trusts across London England to be linked to central dual mirrored Data Centres. I designed the Training program for London LSP and was the Test Manager for London LSP program, designing, writing and implemented test scripts for London LSP Program (part of the UK National Programme http://www.connectingforhealth.nhs.uk/)
Of course it depends on the set up of the system that you use. It is possible on the solutions that my company produce to set the security setting to only allow the named Physician and their team to be able to access the data. However, this is most often used in private institutions in the area of RIS (Radiology Information System) and PACS (Picture Archiving Communication System). I'm currently working on my second National Programme to deliver PACS and RIS as the first part to a full EMR.
Part of the issue is the fact that many companies involved in such projects only view security and privacy in terms of do our products comply with HIPAA http://www.hhs.gov/ocr/hipaa/
without appreciating the workflow of the Clinicians and designing appropriate checks into the workflow design. I have worked in many countries in this role including South Africa, Sweden, Denmark, UK & Gibralter, Ireland, Netherlands, USA. Of all these countries I have found that the worst for this approach is the USA who tend to be almot totally technology focused and assume the workflow to be generic.
There has to be a professional responsibility on behalf of the Clinicians also. Appart from time what is the diference from a Dr looking into a patients notes if they want to? (Obviously the checks and balances to preventing ths from happening will be different across various institutions) But if a Health Profesional wants to view a patients notes/records it is not often that difficult. Also with a paper trail there is no guarenteed audit trail unlike on a HIPAA compliant EMR. As you correctly said in your post maybe the information is valuable and maybe not to the case that you are looking after but without seeing the information you'll not know until afet the event when its to late.
Of course the aim is to securely deliver the clinical information to the point of delivery across the entire care cycle anytime, anyplace and anywhere.
As described by oter posters in this thread Patients already either lie or just tell us what they think we need to know without knowing what that might be anyway I think most patients are only concerned thatwe treat them and get them on their feet again.
P.S Good to have you back
When an author is too meticulous about his style, you may presume that his mind is frivolous and his content flimsy.
Lucius Annaeus Seneca
Lucius Annaeus Seneca
rhys 0
You shouldn't need to hide anything from your doctor, If you do and it is relevant to your health and wellbeing then you would be an idiot,
"When the power of love overcomes the love of power, then the world will see peace." - 'Jimi' Hendrix
pirana 0
Neither paper or electronic records are perfectly secure.
In one access is controlled by who has the keys to the cabinets, the other way access is controlled via roles and permissions stored electronically. IMO, if someone is really out to get a look at your records, it would be easier to get at the paper than the electronic version. And at least with electronic their is an audit trail.
People were pretty paranoid about online communications in general when that first started too. And cars too. Cars were seen as really scary and a lot of smart people said they would never become accepted.
New technology scares a lot of people at first.
In one access is controlled by who has the keys to the cabinets, the other way access is controlled via roles and permissions stored electronically. IMO, if someone is really out to get a look at your records, it would be easier to get at the paper than the electronic version. And at least with electronic their is an audit trail.
People were pretty paranoid about online communications in general when that first started too. And cars too. Cars were seen as really scary and a lot of smart people said they would never become accepted.
New technology scares a lot of people at first.
" . . . the lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging them and kicking them into obedience." -- Aldous Huxley
BIGUN 1,323
QuoteNew technology scares a lot of people at first.
It's about the technology, the process of privacy and who has the keys to the kingdom.
Please don't tell me that you believe PM's really are.
Nobody has time to listen; because they're desperately chasing the need of being heard.
I have to disagree about EMR taking more time an invading privacy. I've been using it for 5 or so years. The office I am at now has been totally paperless for over a year. I don't even have a pen in the exam room any more. My typing is much faster than my writing, not to mention more legible, and every exam room has a lap top. So the time I spent writing during the exam is now spent typing, which takes me less time. Letters to other docs take less time as the program automatically writes them for me, I just go in and delete the extraneous information (cardiologists, for example, don't give a damn what the glasses script is, so I get rid of that info) and hit print. If a patient needs their chart transferred, it's just a matter of hitting 'print' instead of copying illegible paper records. I can get an opinion from a surgeon by emailing a photo. Prescriptions are printed out so legible and pharmacists love that, plus there's no chance of someone stealing my Rx pad and writing scripts for narcotics on it (this happened to a friend of mine!). Things that change with time... blood sugars, intraocular pressures, cup/disk ratios are automatically put on graphs with the EMR, so very easy for me to pull up and show patients how things are changing with time.
From a patient privacy standpoint... there is no difference between me picking up the patient's paper chart and me looking up the EMR chart on the computer... either way two docs from the same office can still access the data easily, and that is what's in the patient's best interests from a continuity of care stance, and privacy is no different than it was before... it's just easier for different docs to pull up the information.
Do patients lie? Of course they do, but I doubt that this will change from EMR vs. paper charts. I see no difference in privacy from EMR vs. paper charts. It's not like random Joe can pull up an EMR. Everything is encrypted, password protected, not easy to get to (paper charts were actually much less secure than the EMR version).
Jen
Do or do not, there is no try -Yoda
From a patient privacy standpoint... there is no difference between me picking up the patient's paper chart and me looking up the EMR chart on the computer... either way two docs from the same office can still access the data easily, and that is what's in the patient's best interests from a continuity of care stance, and privacy is no different than it was before... it's just easier for different docs to pull up the information.
Do patients lie? Of course they do, but I doubt that this will change from EMR vs. paper charts. I see no difference in privacy from EMR vs. paper charts. It's not like random Joe can pull up an EMR. Everything is encrypted, password protected, not easy to get to (paper charts were actually much less secure than the EMR version).
Jen
Do or do not, there is no try -Yoda
Skyrad 0
Quote
I don't even have a pen in the exam room any more. My typing is much faster than my writing, not to mention more legible
A very valuable point when it comes to mis dispensing prescriptions and misunderstanding the patients history and clinical information in hand written notes and 'scripts.
When an author is too meticulous about his style, you may presume that his mind is frivolous and his content flimsy.
Lucius Annaeus Seneca
Lucius Annaeus Seneca
kbordson 8
My EMR - (Digichart) - has several faults and while they are making adjustments and improvements. It is a challenge. It is not very intuitive. When patients enter their personal information, they tend to mis-enter it. I don't know if that is a fault of the the EMR or the patients, but it is quite frustrating to then have to edit. Sometimes they don't understand or don't see where to enter, other times they CHOSE not enter it at all. And I am speaking from personal experience here. They don't like to enter number of sexual partners or number of pregnancies (especially if there might have been terminations) Which from a Gyn perspective - IS typically pertinent.
I honestly don't know about other EMR's... but if it would work smoother, would be willing to try. But... even then... would it be "better" than traditional. (and any one that uses bad handwriting as a reason to do EMR is just providing the doctors/providers excuses for irresponsible charting)
Also... Jen, would your opinion change on a gynecologist just clicking on a laptop while asking you about your cycles or sexlife? Is there a level of .... disconnectedness... with using the EMR in the exam room?
Not trying to do a "change is bad"... cuz some change is good. But the EMR systems that I have be subjected to have not been good change for the physicians or the patients.
I honestly don't know about other EMR's... but if it would work smoother, would be willing to try. But... even then... would it be "better" than traditional. (and any one that uses bad handwriting as a reason to do EMR is just providing the doctors/providers excuses for irresponsible charting)
Also... Jen, would your opinion change on a gynecologist just clicking on a laptop while asking you about your cycles or sexlife? Is there a level of .... disconnectedness... with using the EMR in the exam room?
Not trying to do a "change is bad"... cuz some change is good. But the EMR systems that I have be subjected to have not been good change for the physicians or the patients.
QuoteHealth Information Technology sells nicely... but a national database of health histories? Great for data collection and research... but not great for privacy or personal rights.
I also heard grumblings about implanting a chip with medical info while I was in the military. Not keen on that idea either.
Has anyone thought of what the implications might be if the insurance companies get ahold of these records? maybe you'll have general health insurance because of socialized health care, but what about dissability, life, and other insurances? you could probably count those out if 5 years ago you did this or that and your new life insurance agent found out. Then your 250k policy will cost $500 a month instead of $50 a month because you told the doctor you smoked pot a couple times 8 years ago.
QuoteMaybe I'm wrong, but I figure that, at my age, my privacy takes a back seat to my health. I tell my Doc what he wants to know.
The two are interconnected because the health and life insurance companies all subscribe to the MIB database and have laundry lists of conditions which will keep them from issuing a policy to you.
If you stop working for companies which offer group plans (as you might when you retire), telling the truth may mean not having health insurance because you can't get a private plan and not all states have high-risk pools. That's not going to be good for your health.
At our office, the patients fill out paper history forms which are then scanned into the computer, just to avoid problems like you are having... every year they just look over it and initial/date with any changes. I can pull it up in the exam room and see it with no problem.
Funny you asked about ob/gyn and EMR... I was at mine last week and they had just switched to EMR. She carried in a lap top, had it on a stand in the exam room, so she was facing me the whole time, making eye contact, not typing. She asked all her questions, then during the small talk component, she entered it in the computer. At a GI specialist I went to a few weeks ago, he had a tech in the room, so he was talking with me the entire time, stated his findings out loud, and the tech entered it during the exam. I actually liked that system too, as his hands were free the whole time, and I got to hear all of his findings as he was finding them. Both systems worked pretty well at least from a patient perspective. However I was at an ER a while ago, and they were having problems with one of the work stations letting them log in. It was entertaining to watch, but probably very frustrating for them.
I'm lucky that from an eye care stand point, EMRs have been around for probably 7 or 8 years, so a lot of bugs have gotten worked out. The program we used was designed by an optometrist, so very conducive to the exam room. Our entire exam room is computerized, so things like retinal photos, refractions, visual fields, etc., are automatically transferred from the equipment to the EMR. Buttons are fun
Do or do not, there is no try -Yoda
TomAiello 26
What do you use while rounding on inpatients?
My wife has a huge number of complaints about having to print stuff out of their "paperless" system to take with her when they round (her entire practice is inpatient at the moment).
The only solution she's come up with is to install a wireless network (at her own expense and against hospital regulations) in the unit, then buy a tablet PC to round with.
Any advice you can give on how to deal with that hurdle would really be appreciated by both of us.
Thanks!
My wife has a huge number of complaints about having to print stuff out of their "paperless" system to take with her when they round (her entire practice is inpatient at the moment).
The only solution she's come up with is to install a wireless network (at her own expense and against hospital regulations) in the unit, then buy a tablet PC to round with.
Any advice you can give on how to deal with that hurdle would really be appreciated by both of us.
Thanks!
-- Tom Aiello
Tom@SnakeRiverBASE.com
SnakeRiverBASE.com
Tom@SnakeRiverBASE.com
SnakeRiverBASE.com
caress 0
House is wrong, I am 100% truthful. Dude cant help you unless you are truthful. Do I give 2 rat doos in a flea circus if people know my med history-nope read up and learn from my mistakes-Being dishonest with your dr kinda defeats the purpose dont ya think?-Caress
I've learned.... That being kind is more important than being
right.
right.
The job "they" are paid for is taking are of patients. "They" get exactly zero additional compensation for using the EMR, even though it takes a significant amount of time and effort.
Tom@SnakeRiverBASE.com
SnakeRiverBASE.com