Electronic Medical Records

A friend just returned from a family reunion in Ireland. A lot of his relatives are doctors. The Irish ones make less money, but they love their jobs, not least because they all have portable digital devices with all their patients' information (including, for example, x-rays) available at the touch of a button. My friend's American doctor relatives make more money, but none of them seem to have access to anything like the Irish doctors' portable electronic medical records: all of them are still doing some, if not all, of their record-keeping on paper.

This is silly, and the government is working to change it. The stimulus plan includes billions of dollars to support computerization of medical records. But in a great new cover story for the Washington Monthly, Philip Longman explains that the Obama administration may be doing it all wrong. Longman compares two hospitals that adopted electronic medical records around the same time: Midland Memorial in South Texas, and the Children's Hospital of Pittsburgh. Things went great in Texas, but terribly in Pennsylvania. "The devil, as usual, is in the details," writes Longman:

While many factors were no doubt at work, among the most crucial was a difference in the software installed by the two institutions. The system that Midland adopted is based on software originally written by doctors for doctors at the Veterans Health Administration, and it is what’s called "open source," meaning the code can be read and modified by anyone and is freely available in the public domain rather than copyrighted by a corporation. For nearly thirty years, the VA software’s code has been continuously improved by a large and ever-growing community of collaborating, computer-minded health care professionals, at first within the VA and later at medical institutions around the world. Because the program is open source, many minds over the years have had the chance to spot bugs and make improvements. By the time Midland installed it, the core software had been road-tested at hundred of different hospitals, clinics, and nursing homes by hundreds of thousands of health care professionals.

The software Children’s Hospital installed, by contrast, was the product of a private company called Cerner Corporation. It was designed by software engineers using locked, proprietary code that medical professionals were barred from seeing, let alone modifying. Unless they could persuade the vendor to do the work, they could no more adjust it than a Microsoft Office user can fine-tune Microsoft Word. While a few large institutions have managed to make meaningful use of proprietary programs, these systems have just as often led to gigantic cost overruns and sometimes life-threatening failures. Among the most notorious examples is Cedars-Sinai Medical Center, in Los Angeles, which in 2003 tore out a "state-of-the-art" $34 million proprietary system after doctors rebelled and refused to use it. And because proprietary systems aren’t necessarily able to work with similar systems designed by other companies, the software has also slowed what should be one of the great benefits of digitized medicine: the development of a truly integrated digital infrastructure allowing doctors to coordinate patient care across institutions and supply researchers with vast pools of data, which they could use to study outcomes and develop better protocols.

Read the whole piece.

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