Often the pushback takes the form of the report "lacking peer review", which in a non-free market, vendor-dominated situation (as in pharma, with money flowing everywhere but up) is as likely to produce censorship or, at best, groupthink, as objective science.
Here is one that is candid, by the American Association of Physicians and Surgeons.
The Association of American Physicians and Surgeons , founded in 1943, regularly testifies before the U.S. Department of Health and Human Services regarding development and implementation of health information technology. It consists largely of physicians in private practice. I've been a member of the organization, but was not at the time this survey was performed and written up:
PHYSICIAN ATTITUDES & ADOPTION OF HEALTH INFORMATION TECHNOLOGY (PDF)
Results Compiled on 6/9/2008
Specialties Responding:
Family Practice 73
Psychology 38
Internal Medicine 33
OBG 27
Orthopedic Surgery 27
Ophthalmology 26
General Surgery 22
Dermatology 21
ENT/OTO 15
AN 14
Neurology 13
Pain Management 13
Urology 12
Pulmonary
Diseases 11
Neurosurgery 8
Vascular Surgery 6
Cardiology 5
Radiology 5
Gastro 5
Emergency Med 4
I am simply reproducing some of the comments received below without additional comment:
A patient's medical history is nobody's business but the doctor's and the patient's.
All EHRs examined are cumbersome and ineffiecient
As a 'computer programmer,' can see pushing buttons to make statements about a patient's health, really makes patient care more distant, takes the personal, hand-touched art out of practicing medicine, AND lends itself to inaccuracies and errors
As a primary care physician, I rarely see patients for one problem, yet most EHRs Ive tested are based on the 'problem/visit' models.Expanding the visit to include the 'oh, by the way, doc's' is cumbersome and even more time consuming.
Better--paper record (for patient, also, to keep)
Big Brother is watching you--1984
Can't view my study printouts and look for change--pages 'turn' too slow
Comment: I do write notes on my computer but it is not part of any 'system.' I do not send bills via computer.
Comment: as anesthesiologists, we use the hospital's EMR, but we haven't implemented our own. Possibility that it won't lead to improvements in quality of care
Comment: However, I work with a physician's group to promote EHRs and run into many obstacles
Comment: we have spent upwards of $200,000 on Nextgen software plus hardware for our clinic and have never been able to make it function over the past 5 years
Compatibility
Concern about presumed access to record by multiple non-insurance third parties.
continued cost of support, maintenance, and updates of hardware and software
cost benefit ratio too high
Cost of upgrades
degradation of personal dr/pt relationship. Instead of a conversation between two people there is the intrusion of a mechanical 'other.'
Distraction from personal patient care
diverts attention from patient to data processing
Doesn't work. Studies show no better. Push for EHR due to 'Big Brother's' appetite for info and control.
Don't need it or want it. Concern about accuracy. Many of the automated consult letters I receive contain glaring errors and omissions.
EHR generates false pre-programmed info that does not truly reflect the time actually spent with the patient allowing the MD to 'upcode' for the visit and bill higher. It is more honest for me t spend 20' with my patient and write wo words of actually pertinent info.
Ehr in use for nurses only at my second site and it slows down the care they give.
EHR is most impersonal. It does not give a fell for what is going on with patient.
EHR notes are poor, very poor. Full of useless verbiage and usually no place for physicians to add specific notes (or they are lost in the mass of irrelevant detail automatically supplied by the program. Also encourages physicians, who are often pressed for time, to make any specific notes.)
EMR are very time consuming, result in production of lengthy repetitive notes of questionable clinical value and reliability.
Comment: companies go out of business and new systems need to be installed.
Comment: Federal and state govt. will continually add requirements
EMR printouts contain extensive boiler plate data. The real data is hard to glean from the chaff.
Fills the chart with negative (non-used) information
Getting the computer 'right' will become more important than taking care of the patient.
Have started process
Have used EHR and find written records more reliable and practical
I am a fulltime ER doctor. I have no say but if they go electronic, I go.
I am blind
I am concerned with control that's being exercised here. There's no room for creativity, judgement and financial shortfalls. If the government or insurance companies would take the overhead including this financial then it might be palatable
I am not a good 'typer'--on a keyboard--I do not type at all. Don't want to type, never will. I am not trained as a secretary or clerk.
I do not want to have to turn on a computer everytime I speak to a patient or need a chart with consulting with another physician or a pharmacist.
I feel like I would be a secretary to enter data on my patients so that government can easily slide into socialized medicine.
I hate typing and anything that distracts me from writing and examining
I have not found a system that will speed up my patient encounter. All make it slower--with keyboard--not patient--time.
I see no benefits; would certainly disrupt my thinking process.
If mandated--no standard for format. Took 15 years to finally get standard for electronic billing.
If purchased would be faced with frequent expensive changes to format. They still can't get the new NPI number to work! Everyone I know who spent $50,000 to buy a system either junked it or are planning to!
In 2000, I lost my billing staff. Led to a computer-based billing system due to that. The transition was horrible! I could not use the system myself and training for staff was expensive; the IT guy was expensive; billing personnel who had experience with my system were few. In the end, 4 years later, I had an AR $136,000 and as aconsequence, I closed that practice
Inappropriate EMR causes defocus from reason for visit, etc. Problem with sketches.
Still would need 2 charts--one paper, photos, etc. and 1 EMR
Inefficient. They do not provide the clinical data that I need.
It is impossible to skim through an electronic record to find data. It is impossible to sketch the affected anatomy in electronic records. If the computer breaks down or the technology becomes obsolete, the patient record disappears. It takes too long to enter data into a computer.
You still need a paper chart to share reports and other patient paper records.
It will be of no value in my single practitioner spine surgery practice lack of any standard format/compatibility of various systems
Lack of personal patient interplay
Less time with patient, more time with computer. There are better ways to give ER docs access to patient's med records. Survey ER docs to learn what info they would need when pt. is unconscious. Put that into pt. ID card using 2D Barcodes or magnetic strips. Card readers in ERs can then access that info. If AAPS helped develop and sponsor this for its members, it could be a source of $$ for AAPS
loss of dr-patient relationship
Loss of patient control over privacy of records
Loss of quality of patient's personal records. Physical deterioration of data over many years
Inadequate accuracy of voice recognition technology Lack of evidence that EHRs
are any better or equal to paper records except in narrow applications
I purchased an EHR system and was unimpressed. Main reason: prefer personal notes. I believe dictated notes are more specific and detailed and are customized for each patient visit
May not be able to get to computer records in case of computer crash or power failure (eg. Katrina).
most software have major problems in functionality and changes how physicians practice in a potentially negative way
Must have voice recognition for input at 100% accuracy and reliability.
my patients are given copies of all reports (lab, x-ray, consults) as they are collected and told to keep in their medical file
No adequate voice recognition systems
No clinical evidence that this improves outcome. No clinical evidence that there is a return of investment.
No evidence that EHR will improve care or reduce costs to the patient/doctor/healthcare system.
No improvement in quality of care provided.
Once they force us into the more expensive, time-consuming system that does not work, they
own us! It is too easy for the courts, government, hackers and insurance companies to take 'all,' once it is in the system!
One of worst business decision we made.
open source software is available (but VA Vista split into Open Vista and World Vista groups and is written in a language that is not known to many programmers) but I haven't taken the time to find something that could work--I don't know if any of them can keep up with the government requirement
oppose all government interference
Paper charts are much more accurate and efficient for me.
Patient safety
perpetuation of errors
Preoccupation with the computer takes time from patient. Increased errors from EMR especially CPOE. We already have well established safety checks and reviews in our system for tracking tests and medicines. No system especially CPOE have been tested for safety and efficacy nor approved by any regulatory agency and thus the alteration of care from these (?) is nothing but an experiment and patients have not signed consent. Preoccupation with the computer takes time from patient. Increased errors from EMR. We already have well-established safety checks in our system for tracking tests and medicines. No systems have been tested for safety and efficicacy nor approved by any regulatory agency
Reduced time with patients. My patients complain about other doctors playing with EHR computer instead of looking at them during visit.
reliance on psychological pen and paper tests
Slower system than handwritten notes
slows review of chart at each office visit
some parties are paying $10,000 per month for technical support
Sorry, I cannot fill this out--I have visual problems
Still building the software
Studies are not showing conclusive evidence that EMRs improve patient care or safety, but do increase practice costs.
systems are difficult to implement; I've been trying for 2 years
The EHR in the hospital slows me down. A paper record is more efficient for me.
The systems seem to impede quality clinical care and passing along of relevant clinical information
There is not one advantage to me, at all!
There is one product I would use, PRAXIS. [www.informed.com] I would need $30,000 infrastructure and $30,000 adoption overhead grant in order to do so
They don't improve patient care--just adds to overload
time taken up up for data; focus on computer rather than on patient in the exam room
Too rigid. I like to draw pictures of what I see on ophthalmological exam.
Typed, dictated note can be read much more quickly. I use a print about 1/2 the size of your print on this page and there are perhaps 4 or 5 pages of regular print per page which I read without glasses. Computer and power problems do not hide my records.
Unfunded mandate with huge cost in a severely declining reimbursement arena.
without a personalized note, it is worthless.
Read the entire report as linked above. No additional comments are needed.
-- SS
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