Secure web messaging between patients and doctors: Not well received

Although e-mail may be an efficient clinician-patient communication tool, standard e-mail is not adequately secure to meet Health Insurance Portability and Accountability Act (HIPAA) guidelines. For this reason, firewall-secured electronic messaging systems have been developed for use in health care.

The Kryptiq messaging system was implemented at an academic center and messages were monitored continuously and tracked.

In the 8 months after implementation, only 5 messages were initiated by patients in contrast to 2,363 phone calls.

Patients/families expressed strong interest in e-mailing but secure Web messaging was:

- less convenient than using the phone

- too technically cumbersome

- lacked a personal touch

- only by a handful of patients

One pediatrician on Twitter wants a simpler solution:

@Doctor_V (Bryan Vartabedian): Gimme an integrated, secure Tw like tool for doc to doc/pt comm - part of record.

Comments from Twitter:

@davisliumd: No, Kaiser's data different: Use of Health Information Technology Leads to Improved Care Quality

@yejnes: My patients like it!

References:

Secure Web Messaging in a Pediatric Chronic Care Clinic: A Slow Takeoff of "Kids' Airmail". PEDIATRICS Vol. 127 No. 2 February 2011, pp. e406-e413 (doi:10.1542/peds.2010-1086)

Medical practices using email with patients see their voicemail volume drop - email replaces inefficient phone tag. "We in health care can no longer sit back and say, "I don't do email with patients" - a doctor in WSJ, 2012.

Image source: Wikipedia, public domain.

Electronic medical record (EMR) - review of pros and cons in Cleveland Clinic medical journal

Some negatives regarding the use of EMR:

- So far, electronic systems are not interconnectable
- Do electronic records improve or worsen the quality of care?
- Accuracy vs copying and pasting
- A third party in the examination room
- Devoid of real medical thought

A contrasting view:

- Connectivity will improve
- Staying focused on the patient, even with a computer in the room
- Doctor-doctor communication is enhanced

References:
The electronic medical record: Diving into a shallow pool? CCJM.
The electronic medical record: Learning to swim. CCJM.
"The iPatient is getting wonderful care across America. The real patient wonders, "Where is everybody?" NYTimes, 2011.

Electronic Prescribing Decreases Prescribing Errors Seven Fold

For e-prescribing adopters, error rates decreased nearly sevenfold, from 42.5 per 100 prescriptions at baseline to 6.6 per 100 prescriptions one year after adoption.

For non-adopters, error rates remained high at 37 per 100 prescriptions at baseline and 38 per 100 prescriptions at one year.

Illegibility errors were very high at baseline, and not surprisingly, were completely eliminated by e-prescribing (87.6 per 100 prescriptions at baseline for e-prescribing adopters, 0 at one year).

Prescribing errors may occur much more frequently in community-based practices than previously reported. This study findings suggest that stand-alone e-prescribing with clinical decision support may significantly improve ambulatory medication safety.

References:
Electronic Prescribing Improves Medication Safety in Community-Based Office Practices. Journal of General Internal Medicine, 2010.

EMR or "How Computers are Harming Doctor-Patient Relations" - Rick Payne

EMR or How Computers are Ruining the Doctor's Office and Harming Doctor-Patient Relations - a presentation by Rick Payne.

My experience with EMR has been mostly positive but it is certainly useful to be aware of other points of view.

Related:

Medical Malpractice Liability in the Age of Electronic Health Records - NEJM, 2010 http://goo.gl/cGZG9
"The iPatient is getting wonderful care across America. The real patient wonders, "Where is everybody?" NYTimes, 2011.

TED video: CIO of Cleveland Clinic talks about electronic medical records (EMR)

Video - TEDxCLE - Dr. C. Martin Harris, CIO of Cleveland Clinic talks about EMR. The Cleveland Clinic uses Epic Systems EMR and, although the system costs millions of dollars to purchase and maintain, it has been perceived as very useful by both physicians and patients.

Disclaimer: I was a Clinical Assistant Professor of Medicine at the Cleveland Clinic until 2008.

Related:

Medical Malpractice Liability in the Age of Electronic Health Records - NEJM, 2010 http://goo.gl/cGZG9

Turning medical residents away from copy-and-paste culture facilitated by EMR

From MedCityNews:

Cleveland VA is trying to cut out the burgeoning subculture of “copy-and-paste”: A phenomenon made possible by electronic medical records in which physicians copy old information about a patient and paste it into a new section of the chart.

The practice is seen by medical residents as a time-saver but the attendings consider it an “egregious problem” because the practice has the potential to perpetuate mistakes. For example, someone might copy and paste information from a patient’s medical history without verifying that the information is correct. Any errors that might exist will be repeated.

EMR can’t just disable the copy-and-paste function, since such a move would impact other programs.

References:

Turning medical residents away from copy-and-paste culture. MedCityNews.

Medical Malpractice Liability in the Age of Electronic Health Records - NEJM, 2010 http://goo.gl/cGZG9
"The iPatient is getting wonderful care across America. The real patient wonders, "Where is everybody?" NYTimes, 2011.

NYT interviews Dr. Blumenthal, the President's EMR "czar"

From the NYTimes:

We found that about 17 percent of physicians in 2008 had adopted an electronic health record, and about ten percent of hospitals.

The Danes have virtually 100 percent of physicians using electronic health records. In Britain, virtually 100 percent of primary care physicians use them. In Australia, Sweden, Norway, virtually 100 percent. In many, many other Western countries, the electronic record is virtually ubiquitous.

From 2011 to 2015, there is a bonus (for adopting EMR). After 2015, if you have not adopted, and you see Medicare or Medicaid patients, you may experience a penalty.

On average, the cost is between $40,000 and $50,000, of which about a third is the software and the hardware, about a third is the cost of getting it set up in the office, and about a third is maintaining it.

References:
Computerized Health Records. NYT, 2009.

Medical Malpractice Liability in the Age of Electronic Health Records - NEJM, 2010 http://goo.gl/cGZG9