More potholes on the road to digital medical records

Brandon Glenn at Modern Medicine talks about a problem inherent in Google’s PHR (Personal Health Record):

Google’s PHR problems apparently stem from their reliance on coding data to describe patients’ medical conditions in the PHRs. Health IT leaders from Google and Beth Israel Deaconess Hospital (where deBronkart, the patient, receives treatment) say PHRs are a new technology and “will improve as more precise coding language is adopted in the coming years.”

This reminds me of a “kicked back” claim I once received on a urinalysis I’d obtained on a patient.  I’d used code 788.1 (Dysuria).  Somehow, what the third party-payor got was 798.1 (Instantaneous Death).  Of course, even when this sort of data entry error doesn’t occur, there’s still a lot of coding nonsense out there.  Glenn concludes that this “doesn’t bode too well for the federal government’s stated goal that all American citizens have an electronic health record by 2014.”  No, it doesn’t.  Worse still, unrealistic government-mandated electronic record compliance mandates will incentivize many physicians to opt out of Medicare.

And Dr. Wes discusses another problem related to the lack of electronic record interoperability: The Health Information Legacy Problem:

“While every one’s talking about developing a fully-integrated nationwide electronic medical record, no one give a damn about the old systems that exist out there. They’re not worth supporting. No one cares about the data they contain, even though for the doctor, they contain critical documentation about patient’s prior health care and are vital documentation to prevent litigation.

“So I ask you, when the government decides on a single electronic medical record system that suits their needs and is all-encompassing, what’s going to happen to all the data on the other systems?”

Physicians’ notoriously illegible handwriting notwithstanding, paper and ink does have the virtue of being “interoperable.”  But these technical problems with medical health information technology (HIT) are no problem at all to HIT vendors who simply want to sell their products whether they are practical or not.  Nor is it a problem for politicians who have never had careers as practicing physicians, hospital administrators, or information technologists.  It’s easy to be boundlessly optimistic about the solution when you are utterly clueless about the problem.

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One Response to “More potholes on the road to digital medical records”

  1. I wish human data entry errors were all we needed to worry about. What worries me more is “inter-operability.”
    When you have different systems trying to talk to each other, there is the potential for problems.
    I will give you a very concrete example from an employer sponsored plan perspective. A couple of years ago, we adopted coverage for domestic partners. We use the HIPAA 834 ANSI X12 EDI transaction to communicate enrollment to all of our carriers. The file specs describe the code to use for a “life partner”. I think it is a 51. this is supposed to be a national standard.
    Yet for some reason, one of our carriers translated the 51 as a child. For several months, without fail, one of our members would call up to complain that they had just gone to the doctor’s office and were told by the doctor’s office that the insurance company had no adult on that plan with that ID #. (Why the doctor didn’t catch on after one or two months is another issue).
    The problem was that the system that accepted our file was different from the system that the doctor’s queried for eligibility status. It took the carrier almost eight months to fix this glitch.

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