Tuesday, December 30, 2008

EMR Rant #1: Stupid Data Tracking Kills!!1!

I was posting on a thread at Orac's site. I found myself going off on a tangent about electronic medical records or "EMRs." In the midst of rant #3, I realized I was, well, ranting, and decided to dump it all here.

BTW, anytime you'd like to hear me rant, just tell me that EMRs will save doctors bunches of time while also saving the US taxpayer billions. Ha! Lies! Lies! Lies!

Don't get me wrong. I'm not anti-EMR, merely anti-EMR hype. The hype hurts the EMR cause because it provokes disappointment.

The rant below concerns the data tracking requirements set by insurers, JCAHO, CARF, state licensing agencies, corporate boards of directors, etc. These people are too easily impressed by the appearance of usefulness.

When I imagine the brilliant minds behind Enron, the subprime mortgage crisis, the Wall Street bailout, the Madoff scandal, the invasion of Iraq, and so on, I see the smiling faces of helpful people not unlike the healthcare third party players I have come to know. The nice people in my mind's eye await the reassuring sound of a number which is to be written in a box on a form that will ultimately be incorporated into someone's quarterly report and/or Powerpoint slide.

Example: New Jersey wants nurses to track psychotropic side effects. Sounds good, right? Heh. Don't get your hopes up.

Here's what New Jersey requires: On the back of the monthly MAR for each day that meds are given, the nurse must record "NSE" meaning "no side effects." Otherwise she must list any side effects reported.

Stupid, stupid, stupid.

Firstly, among my patients, self-report is unreliable. Further, most side effects are not evident at the med pass. They're usually pattern alterations that manifest over time --e.g., irregular menses, constipation, sleep-wake cycle disruptions, appetite changes. Imagine how silly you'd feel asking a patient every morning, "any menstrual irregularity today?"

Better to record a few daily indicators such as:
- menses? yes/no
- poop? yes/no
- wet bed? yes/no

Plot these data on a monthly chart and patterns become obvious and can be checked against dates when meds were changed. As a bonus, this system controls for confirmation bias and selective recall.

Logic is on my side. I am the doctor. But can I win an argument with a state licensing agency? No, I cannot.

Although the facility may make a half-hearted attempt to track things my way, the effort will fizzle. No organization can afford two systems that serve the same purpose.

Moral of my story: tracking stupid stuff screws up the tracking of useful stuff. Beware!


  1. I so agree with that moral.

    best wishes for the new year Dr B.


  2. Clod ol' bean! Long time no chat. Hope that wetsuit's still in good shape.

    Happy New Year to you and your family.