Friday, August 13, 2010


hmmmm call me old fashioned, call me a heretic. But will this really improve care? If I was one of those slick high tech cool medical bloggers, I would tell you how wonderful it is and how the art and the science of medicine will be so greatly advanced and how much this is going to help patients. Lots of people would read and retweet, the news media loves it and it will help patients.
Now lets talk about the realities nobody wants to blog about except me it seems.
First of all, how will it help patients. LESS ERRORS. This is good. How so? Handwriting errors, handwriting errors HANDWRITING ERRORS. Fantastic. Hmm is that an N or an H? I can't read the handwriting. EXCELLENT. No more of that ever. IT will probably save a few lives every year.
Think about it there are only so many ways for a prescription to get from your doctor to the Walgreen's in your neighborhood. 3 ways actually. The doctor phones it in to the pharmacy, the doctor faxes it to the pharmacy, or the doctor hands you a handwritten prescription to take down and hand to Kristen or Eli your ever pleasant pharmacy technician at the drugstore.
That's it that's how it works. No More. Electronic prescribing will be the law in the great progressive State of Minnesota at the end of 2010.
It will cut down on other errors too. Maybe. Theoretically You can have a more thorough list off all the meds you have ever been on. This should help on missed drug-drug interactions. Right. Sounds good.
Hows it work?
Well first off all most people that work in medicine are not doctors, they could never see electronic prescribing as being anything but good. These non medical people actually write most of the templates for the software for electronic prescribing. Big money to be made for these non medical- medical consultant experts. Licking their chops so to speak.
So you doctors office or somebody spends a lot of money to get the templates and then they can electronically prescribe. It gets sent to the pharmacy electronically, sort of to a clearing house over the Internet, I guess you could call it sort of an intranet, and it is about as secure as secure can be with lots of firewalls and things. I mean think about how secure your stored information is when you purchase something over the Internet. nice and secure, nobody could ever get in with all those firewalls.  
The software really is great, lots of drop down menus invented by non-physicians telling you exactly when where how much how often you get to prescribe something. Since these templates are generally written by non-medical people the art of medicine really shines. You doctor can't really personalize the treatment to you.It is rigidly standardized. Sure there is a little place at the end where you can attempt to put in specific instructions, often hard for the [pharmacist to find and extremely user UNfriendly for the doctor, to actually individualize the treatment to the patient. I mean we all fit into nice pigeon holes, right?
Then there is the issue of the fact that many non-physicians are going to be entering the prescription into the computer and hitting "send". Boy I hope they are not having a bad day or pissed off or something or having a bad home life that week and  don't make an error on the drop down menus. Its ok though because it will still be the doctors fault in the end.
Then there is the beauty of the fact that depending on the software and the clearing house, something you took for a week will still be showing up years later, like you broke you toe and went to the ER and got three lortabbs. That just will keep coming up or or you took amoxicillan for a strep throat five years ago for am week. Right there in your face, the dates and quantity may be a little less harder to find. Sort of got to look. Hopefully someone will mark it as not active but expired stuff still follows you around, thank you rich thoughtful computer software companies medical non-doctor consultants.
But here's the best part. Formulary restrictions, all a patients data is out there including insurance, behind lots of firewall encrypted safety devices of course.
In other words when a doctor tries to prescribe something and a patients insurance won't cover the med-BAM the clearing house will reject it. Nice hunh? You are not allowed to have that med. It is like that now, but at least we still have the old prior authorization,- that's where you doctor spends all day usually several, fighting with some private sector company employee of a corporation contracted with the federal government, sitting in some cubical in Solon or somewhere telling the doctor they are not allowed to prescribe the appropriate med and to use something else.
It will be a lot easy to avoid this, with e-prescribing and to really really start limiting and putting the clamps down on what meds you are allowed to have based on your payer.
And this part is even better than best-now we can truly monitor physicians prescribing habits and make lots of inferences and punitive actions against physicians who prescribe too many expensive meds. Way to really reign em in. Bout time right? Unless its your husband or wife. then shouldn't they have the best medication even if it is expensive? Nope and NOPE.
Anyways I guess it will cut down on forgery and prescription drug abuse too right? Maybe. Luckily criminals are not smart with computers and all that stored information on you and dangerous drugs out there in the electronic password encrypted firewall protected cyber world.
Call me old fashioned, I will get used to it. I must be getting old and set in my ways, I just don't think human beings and their treatment fit into drop down boxes and templates. It will be OK though, in all fairness a majority of hospitals have been using electronic entry of orders and meds for inpatient units for years. Why look how often we don;t have errors in those hospitals anymore.
Pretty soon we can have a robot hold your hand or talk to you instead of a human, technology-nice and healing but a human will still have to program and turn on the robot, chances are it won;t be a physician.
In more all fairness the Government Medicine Programs the VA and the DOJ (Federal Prisons) have excellent electronic prescribing and electronic records, that are prototypes and lead the way. I'm sure we can find lots of data on how errors have been decreased and patients helped and the care improved over at those venues. Right?
I know I got to do it. It just feels sort of bad to have something imposed on you, when you had a pretty good system and checks and balances set up to avoid errors, and now you have to change, you had something that worked and maybe the system you had actually helped patients and not hurt them, and now that system will be illegal in a few months. Sad Sad Sad.
By the way do you know how often I hear- "the doctor (half the time it is a nurse practitioner) never looked at me they just kept staring at the computer screen"
and  here's a good one "the doctor could not do anything, the server was down, they were having trouble with the computer"
I hear those quotes a lot more and more every year, I pray those are not said about me someday.
A final thought, I think we should be more cognizant of the CEO' salaries of these medical software companies and start scanning the benevolence factor of these companies- kind of like we do the drug companies, God knows there first priority is helping the patient.

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Talking about the book with the Lake Superior wind....... a calm day