Dr. Jenny Devitt:

Maura Larkins informed Assistant Area
Medical Director Devitt on Nov. 16,
2011 that Kaiser had canceled its own
quality review
regarding missing
digitized X-rays.  

Dr. Devitt ignored the letter.  This
attitude could explain Kaiser's failure to
diagnose cancer patients who later die
unnecessarily.
“Once you get a diagnosis in there or a
medication or something that's incorrect,
that's an error, it gets repeated and
repeated and repeated,” Dr. Benson said.

Electronic Medical Records
'Not Ready For Primetime'?
Christin Ayers
7NEWS Reporter
April 29, 2009

DENVER -- Critics say some Denver area hospitals
are moving too quickly to implement electronic
medical records (EMRs), failing to work out some
major flaws in software systems that contain
patients’ sensitive medical information.

At a number of major hospitals in the metro area
and at some small clinics, when you go in for a
check-up, your medical information goes, not onto a
paper chart, but into a computer.

The Obama administration is offering $20 billion in
incentives for doctors and who start using electronic
medical records. But some critics say Colorado
hospitals have gone digital without taking care of
some kinks in their systems.

Dr. Louise Benson, an internist, has used electronic
medical records. She said there are documented
cases of EMR systems miscalculating medication
dosages and drug interactions, which could
endanger patients.

“If you are relying on a program to tell you what the
interactions are and you prescribe something and it
pops up OK and it turns out not to be OK because
there's an error in the program, that could be deadly
for the patient,” said Benson.

An article in the March Journal of the American
Medical Association points out that companies that
sell electronic medical records take no
responsibility if a software malfunction causes a
medical error.

“Vendors are not responsible for errors their
systems introduce in patient treatment because
physicians, nurses, pharmacists and health care
technicians should be able to identify--and correct--
any errors generated by software faults,” the article
says.

Doctors at Children’s Hospital, University of
Colorado Hospitals, Colorado Kaiser Permanente
and Denver Health all use electronic medical
records and have touted the benefits of the systems.

In December, the four hospitals launched a system
that allows them to digitally share the medical
information of emergency room patients, with their
permission.

“Colorado has been I think on the forefront in terms
of trying to share information among various
institutions that have the capability of an electronic
medical record,” said Dr. David Kaplan, chief
medical information officer at Children’s Hospital.
“Having electronic medical record has really been a
major breakthrough at our institution. For the first
time ever, we have everything right in front of us.”

Dr. Ann Martin, director of the Longmont-based
Colorado Women’s Care and Medical Spa, also
uses electronic medical records. She said they cut
down on errors.

“I think the benefits are everyone can read the
notes,” said Martin. “That's number one. Some
doctors are notorious for not being able to read their
writing.”

But Benson worries Colorado hospitals and small
practitioners are moving too fast with the
technology. Dr. Benson said another major concern
she has about EMRs, is that once erroneous
information is entered into a patient’s record, it is
nearly impossible to get erase.

“Once you get a diagnosis in there or a medication
or something that's incorrect, that's an error, it gets
repeated and repeated and repeated,” Dr. Benson
said.

Benson said she believes electronic medical
records can improve patient care, but that major
improvements need to happen before they go
mainstream.

“They are not ready for primetime from many
standpoints,” she said.
NO:
They can be deadly
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YES:
Digital Conversion
Holds Promise of
Lifesaving Payoffs for
Kaiser

Pervasive Paperless System
Provides Efficient Access to Data

Dr. Jenny Devitt, an
oncologist at Kaiser
Permanente’s San Diego
Medical Center, saw firsthand
this year how electronic
medical records can save a
life.
By Kelly Quigley
San Diego Business Journal
May 30, 2011
Two views of electronic medical records
Obviously, electronic medical records can easily be misused and abused
See missing or concealed medical records
Digital Records May
Not Cut Health Costs,
Study Cautions
By STEVE LOHR
New York Times
March 5, 2012

Computerized patient records
are unlikely to cut health care
costs and may actually
encourage doctors to order
expensive tests more often, a
study published on Monday
concludes.

Modern electronic health
records are meant to give
doctors an integrated view of a
patient’s care, including
medical history, treatments,
medications and past tests.
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Industry experts have said that
electronic health records could
generate huge savings — as
much as $80 billion a year,
according to a RAND
Corporation estimate. The
promise of cost savings has
been a major justification for
billions of dollars in federal
spending to encourage
doctors to embrace digital
health records.

But research published
Monday in the journal Health
Affairs found that doctors
using computers to track tests,
like X-rays and magnetic
resonance imaging, ordered
far more tests than doctors
relying on paper records.

The use of costly image-taking
tests has increased sharply in
recent years. Many experts
contend that electronic health
records will help reduce
unnecessary and duplicative
tests by giving doctors more
comprehensive and up-to-date
information when making
diagnoses.

The study showed, however,
that doctors with computerized
access to a patient’s previous
image results ordered tests on
18 percent of the visits, while
those without the tracking
technology ordered tests on
12.9 percent of visits. That is a
40 percent higher rate of
image testing by doctors using
electronic technology instead
of paper records.

The gap, according to the
study, was even greater — a
70 percent higher rate — for
more advanced and expensive
image tests, including M.R.I.
tests and CT, or computerized
tomography, scans.

“Our research raises real
concerns about whether health
information technology is going
to be the answer to reducing
costs,” said Dr. Danny
McCormick, the lead author of
the study, who is an assistant
professor at the Harvard
Medical School and a member
of the department of medicine
at the Cambridge Health
Alliance, a health system north
of Boston.

Dr. McCormick had three co-
authors: Dr. David H. Bor, chief
of medicine at the Cambridge
Health Alliance; and Dr.
Stephanie Woolhandler and
Dr. David U. Himmelstein, both
professors at the City
University of New York School
of Public Health at Hunter
College.

The research was based on a
survey conducted by the
National Center for Health
Statistics, which collected data
from more than 28,000 patient
visits to more than 1,100
doctors in 2008.

Health policy experts who have
championed the adoption of
electronic health records were
critical of the study. They
noted that the data came from
the National Ambulatory
Medical Care Survey, which is
intended mainly for another
purpose — to assess how
medical care is practiced.

The study, they noted,
included any kind of computer
access to tracking images, no
matter how old or isolated the
function.

By contrast, modern electronic
health records are meant to
give doctors an integrated view
of a patient’s care, including
medical history, treatments,
medications and past tests.
The 2008 data predates
federal incentive payments for
doctors and standards for the
“meaningful use” of electronic
health records that began last
year.

The new study, they said, was
also at odds with previous
research. It is “one of a small
minority of studies” that have
doubted the value of health
information technology, said
Dr. David Blumenthal, a
professor at the Harvard
Medical School.

Dr. Blumenthal, the former
national coordinator for health
information technology in the
Obama administration, was co-
author of a study, published
last year in Health Affairs, that
surveyed articles in
professional journals in recent
years on electronic health
records.

It found that 92 percent of
those articles were “positive
over all” about the prospect
that technology would improve
the efficiency and quality of
care.

But Dr. McCormick said the
previous research had been
primarily statistical models of
expected savings, like the
RAND study, or research that
looked at the use of electronic
health records at a relatively
small number of flagship health
systems.

“We looked at not just a few
cutting-edge institutions, but a
nationally representative
sample,” Dr. McCormick said.

Dr. David J. Brailer, who was
the national coordinator for
health information technology
in the administration of George
W. Bush, said he was
unconvinced by the study’s
conclusions because they
were based on a correlation in
the data and were not the
result of a controlled test.

The study did not explore why
physicians in computerized
offices ordered more tests. Dr.
McCormick speculated that
digital technology might simply
make ordering tests easier.

Dr. McCormick said he hoped
the study would damp any
inflated expectations about
electronic records. But he
added that the technology can
improve the actual practice of
medicine.

The Cambridge Health
Alliance, where he practices,
made the switch to electronic
records in 2005.

“I’m a primary care doctor,” Dr.
McCormick said, “and I would
never go back.”
      YES                             NO