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Do We Need A Health Platform?

Posted on August 30, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I consider all of the different health platforms that are being built by mobile health companies, I can’t help but wonder if we need a health specific platform. Let me make the case for a minute that we don’t need one.

We already have plenty of platforms that we’re using already. Facebook and Twitter readily come to mind. LinkedIn is another interesting platform that most of us are on. Plus, while I’m sure that some don’t consider it a platform, I don’t know a single person online that doesn’t have an email address. In fact, I think I’d have to dig into some of my nursing home visits to think of someone I know who doesn’t have an email address they use regularly (although, many of those in nursing homes have emails as well).

Do we really need a separate health platform beyond those that are already free and publicly available today?

I’m sure that people’s first gut reaction will be around the security and privacy concerns associated with the platforms mentioned above. Certainly there’s a strong case to be made for this. I recently saw a report that said that your credit score could be effected based on how many of your Facebook friends have bad credit scores. It doesn’t take much imagination to see how health insurance companies could use your data on these public platforms to influence your premium.

Certainly there are some concerns there, but that doesn’t seem to be stopping a whole generation of people who share their health information just the same. It’s possible that this will catch up with them and they’ll want a more private place to discuss their health, but I don’t see this happening soon.

I’ve also been intrigued by chronic patients approach to the privacy of their health information. They’ll share anything and everything with anyone who could lead them to an improvement to their chronic condition. The concept of privacy doesn’t mean much when you’re dying.

This still leaves everyone in the middle. I know I’m careful about what health information I share online. More than once I’ve gone to my wife and asked her if she really wanted to share that information with the world. It’s hard to balance the benefits of sharing with the unknown.

Certainly I haven’t made a very strong case for the current platforms. They still have some major weaknesses. I have no doubt that we’ll have health built into current platforms and dedicated healthcare platforms. If you’re an entrepreneur I just think you have to be aware that whatever your building might get beaten by what’s already out there.

Adding Insult To Injury, Sutter’s Epic EMR Crashes For A Day

Posted on I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The Epic EMR at Northern California’s Sutter Health crashed earlier this week, leaving the system inaccessible for an entire day, reports Healthcare IT News. The system, which cost Sutter nearly $1 billion, went offline at approximately 8AM, locking out doctors, nurses and staff from accessing vital information such as medical lists and patient histories.

The crash followed a few days after planned downtime of eight hours which was scheduled to take place due to implement an upgrade.  During that period nurses could still read med orders and patient histories but had to record new data on paper and re-enter it later into the system, Healthcare IT News notes.

During the unplanned outage this week, the Epic system was offline at several Sutter locations, including Alta Bates Summit Medical Center, Eden Medical Center, Mills-Peninsula Hospital, Sutter Delta, Sutter Tracy, Sutter Modesto along with several affiliated clinics, the magazine said.

The outage drew the ire of the California Nurses Association, which called this incident “especially worrisome.” But the CNA notes that the crash is hardly the first time there’s been a concern over the Epic rollout. Nurses at Sutter have been complaining for months about alleged safety problems with the Epic system, notes the Sacramento Business Journal.

According to the CNA, more than 100 nurses had previously filed complaints at Alta Bates Summit, arguing that the Epic system was hard to use, and that computer-related delays had adversely affected the ability of nurses to monitor patients properly.

Sutter nurses’ complaints included the following:

• A patient who had to be transferred to the intensive care unit due to delays in care caused by the computer.
• A nurse who was not able to obtain needed blood for an emergent medical emergency.
• Insulin orders set erroneously by the software.
• Missed orders for lab tests for newborn babies and an inability for RNs to spend time teaching new mothers how to properly breast feed babies before patient discharge.
• Lab tests not done in a timely manner.
• Frequent short staffing caused by time RNs have to spend with the computers.
• Orders incorrectly entered by physicians requiring the RNs to track down the physician before tests can be done or medication ordered.
• Discrepancies between the Epic computers and the computers that dispense medications causing errors with medication labels and delays in administering medications.
• Patient information, including vital signs, missing in the computer software.
• An inability to accurately chart specific patient needs or conditions because of pre-determined responses by the computer software.
• Multiple problems with RN fatigue because of time required by the computers and an inability to take rest breaks as a result.
• Inadequate RN training and orientation.

Sutter officials, for their part, are not having any of it. Hospital spokeswomen Carolyn Kemp called the allegations that Epic was causing problems “shameful,” and argued that the accusations are arising because the hospital system is involved in a labor dispute with the CNA.

Meanwhile, Sutter execs are turning up the heat on nurses whom they feel aren’t using the EMR properly. According to Healthcare IT News, leaders have been scolding nurses whom they believe have not been entering all billable services into the EMR, which resulted in a loss of $6,000 in a single week, according to a July memo obtained by HIN.

Sutter’s spokesperson, Bill Gleeson, offered this official response:

Sutter Health undertook a long-planned, routine upgrade of its electronic health record over the weekend. There’s a certain amount of scheduled downtime associated with these upgrades, and the process was successfully completed. On Monday morning, we experienced an issue with the software that manages user access to the EHR. This caused intermittent access challenges in some locations. Our team applied a software patch Monday night to resolve the issue and restore access. Our caregivers and office staff have established and comprehensive processes that they follow when the EHR is offline. They followed these procedures. Patient records were always secure and intact. Prior to Monday’s temporary access issue, our uptime percentage was an impressive 99.4 percent with these systems that operate 24/7. We appreciate the hard work of our caregivers and support staff to follow our routine back-up processes, and we regret any inconvenience this may have caused patients. California Nurse Union continues to oppose the use of information technology in health care but we and other health care provider organizations demonstrate daily that it can be used to improve patient care, convenience and access. While it’s unfortunate the union exploited and misrepresented this situation, it comes as no surprise given the fact that we are in a protracted labor dispute with CNA.

Without This EMR Step, You Might Never Get It Right

Posted on August 29, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

It’s not hard to find physicians and nurses who say that far from improving health care, the EMRs they use are something to work around.

Billing problems, lost productivity and even diminished quality of care are common complaints, sometimes long after the implementation kinks should have been worked out. In some cases, doctors who bought into EMRs as a way to operate more effectively and efficiently have found themselves disappointed enough to look for hospital employment, try new practice models or even close their doors, as HealthcareScene.com founder John Lynn has written.

Often the problem lies deeper than the technology, according to a recent white paper from TechSolve, a Cincinnati-based consulting group. After all, an electronic overlay does little good when it serves only to automate bad processes.

TechSolve is promoting a process-mapping approach to EMR for hospitals through its Lean Healthcare Solutions unit. It’s part of a trend toward applying the efficiency techniques of Japanese manufacturers to EMRs and other aspects of health care.

Like Toyota and other pioneers of lean, health care providers should rely on line workers to help root out waste, according to TechSolve.

“While you may be inclined to dismiss negative comments as resistance to change, staff may be aware of design issues that the design team, PI facilitator, and vendor were not,” TechSolve consultants Sue Kozlowski and Alex Jones wrote.

They offered seven steps to ensure maximum benefit from an EMR, a few of which I’ll share. I suggest downloading the full paper for a complete view.

TechSolve recommends thinking about process improvement before getting started with an EMR. Of course, if it’s too late for that, the firm and others in the space are happy to step in later, as well.

Here’s what TechSolve advises:

  • Map your current processes. This can be done with help from your process improvement team or an outside group. In some cases, it’s best to assign a team to each service line.
  • Compare current and future states. Color-coding is one way to do this, highlighting visually for staff members how their work will change.
  • Prioritize issues that affect patient care and payment timing. An “issues list” can be created and then reviewed after “go live” to make sure problems have been corrected. Also, examine how well staff members are adhering to the new processes, asking questions such as, “Where are they using work-arounds, and where have they found new capabilities in the system?”
  • Process map again. This new snapshot is the baseline going forward. It can serve as a reference for staff members when they’re in doubt and as a training tool for new hires.

We’re all looking for technology that makes our lives easier right away. But when it comes to EMRs, there’s no true turnkey solution. Making a system pay off requires investments, particularly of time, well beyond the sticker price.

Under traditional reimbursement models, though, planning is not what brings in the revenue. It’s easy enough to see why hospital employment, with guarantees of a salary and IT assistance, is becoming a more and more attractive option for physicians who want to limit expenses and risk.

Hospitals, though, have no plan B. They’ll have to marry their IT to efficient processes or else.

Which Type of Cell Phone Do You Use?

Posted on August 28, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today my sister was evaluating the various types of cell phones out there. I told her a couple of options that she couldn’t go wrong with, but it prompted me to wonder which types of cell phones readers of this site use. Sure, I could look at the stats for the website, but that would just be people who read the site on their cell phone. No doubt many read it from tablets, desktops, laptops, emails, and feed readers.

I look forward to seeing the results.


A Look at Email and HIPAA

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Disclaimer: I am not a lawyer and do not offer legal advice. The others quoted in this post are offering general information or interpretation and not specific legal advice or any statement of fact.

For more background on this topic, check out my previous post “Practice Fusion Violates Some Physicians’ Trust in Sending Millions of Emails to Their Patients

When I first started looking into the millions of emails that Practice Fusion was sending to patients, doctors were suggesting that these emails constituted a HIPAA violation. Practice Fusion has responded in my previous post that “The patient email reminder and feedback program is absolutely HIPAA compliant, under both the current and new Omnibus rules. We conduct thorough compliance research with every single new feature we launch.” I wanted to explore the HIPAA concerns regarding emails like these, so I talked to a number of HIPAA lawyers and experts. I believe the following look at HIPAA and emails will be informative for everyone in healthcare that’s considering sending emails.

Before I go into a detailed look at sending emails to patients, it is worth noting that under HIPAA emails can be sent to patients by doctors if the doctor has used “reasonable safeguards” and patients have agreed to email communication with their doctor. The following is a great HHS FAQ on use of email and HIPAA where this is outlined.

This leaves three HIPAA related questions:
1. Is Practice Fusion legally allowed to use the information in their EHR to send these emails?
2. Does the email contain Protected Health Information (PHI) that is being sent in an unsecured and not encrypted email?
3. Can Practice Fusion publish the provider reviews on their website?

Is Practice Fusion legally allowed to use the information in their EHR to send these emails?
The core of this question is whether the Practice Fusion user agreement (the version publicly available on the Practice Fusion website) allows the use of patient data contained in the Practice Fusion EHR for sending out these emails. Following are comments from William O’Toole, founder of the O’Toole Law Group regarding the user agreement:

I am not providing specific legal advice or opinion here, and I have no strong feelings about Practice Fusion one way or the other. That said, I find this issue extremely interesting and hope I can provide some direction and some interpretation of the law. Capitalized terms are defined under HIPAA and by now are familiar to all, so I will not define or elaborate.

The Practice Fusion Healthcare Provider User Agreement includes a section that, as between Practice Fusion and its customers, grants Practice Fusion the right to use a provider’s PHI (though I argue it is not the provider’s, it is the provider’s patients’ PHI, but I digress) to contact patients on the provider’s behalf, for various purposes, including “case management and care coordination” which is legally permitted. The conclusion can be easily drawn that Practice Fusion (or any other vendor doing the same) relies on this connection in claiming that its patient email is permitted under this section of the law, even if it contains PHI. Note – the topic of secure email is left out of this discussion.

Based on the user agreement, it seems like Practice Fusion is allowed to send out these rating and review emails to patients. William O’Toole does offer a reminder for providers:

For those of you that are familiar with my writings, you know what comes next. The Practice Fusion agreement clearly puts provider customers on notice that Practice Fusion has the right and option to contact patients directly on the provider’s behalf. The providers agreed when they accepted the terms of use. The most important piece of advice that I can offer to all providers is to read and understand the agreements to which you will be bound, or more appropriately, give the agreements to a healthcare technology attorney for review and opinion.

This is an important message for all providers to read and understand the user agreements they sign.

Does the email contain PHI that is being sent in an unsecured and not encrypted email?
You can see the contents of the ratings emails here (Note: The masked area is the name of the physician). Here’s Mac McMillan’s, CEO of CynergisTek and Chair of the HIMSS Privacy and Security Task Force, analysis of the emails:

The issue here is whether or not by the information included you can discern any protected information about the individual(s) involved. On the surface the email appears benign and does not include any specific Protected Health Information (PHI) and if coming from a general practitioner it would be near impossible to guess let alone determine for sure the purpose of my visit or my medical condition. Meaning I could have gone there for something as simple as a checkup, to refill a prescription, or I could have gone there for treatment of some ailment, but you don’t know and can’t tell by this simple email. Some would argue that this is no different than when Physicians communicate with their patients now via regular mail or email. The problem though is that not everyone may agree with this, and the consumer who may not be thinking rationally may take issue under certain circumstances. For instance, what if the email came from Planned Parenthood to a seventeen year old, or an AIDS clinic, or a specialty center handling a certain form of cancer, or a psychiatrists office? In these cases just the name and the identity of the covered entity potentially provides insight into the individual’s medical condition and therefore their personal health information. A patient might, whether legitimate or not, attempt to make the case that their privacy has been violated if others were to see this email who were not intended to like other family members, neighbors, employers, etc. I think this is really stretching it, but who knows how a Privacy attorney might see it?

Can Practice Fusion publish the provider reviews on the Patient Fusion website?
Assuming that Practice Fusion is authorized to contact its users’ patients, the next question is whether it is authorized to publish their responses online. When patients are posting a review, they have to agree to the terms of the “Patient Authorization.” Within that authorization it seems that Practice Fusion has done a good job making sure that they are getting authorization from the patient to publish the reviews they’ve submitted. David Harlow, a health care attorney and consultant at The Harlow Group LLC who blogs at HealthBlawg. notes that in addition to the Patient Authorization, “The Terms of Use on the PatientFusion.com review website make clear that posts on the site may be made public, and should not contain information that a patient would not want to be made public, or that a patient does not have the right to post.”

Summary
Hopefully this discussion around emails in healthcare will help more companies understand the intricate HIPAA requirements for email communication with patients. I see email communication increasing over the next couple years as more doctors realize the benefit of it. Plus, a whole new generation of patients wants that type of communication with their provider. We just have to make sure that we continue to respect patient’s privacy in the process. Making sure your emails are HIPAA compliant is not a simple task.

Practice Fusion sent me the following comment:

Practice Fusion’s goal is to create transparency in healthcare without compromise. It is critical that patients seeing any doctor on our platform understand the quality of their doctor. And, therefore, doctors using our free online scheduling application are required to make their reviews available to the public. Practice Fusion offers the only service on the market that validates a patient review was based on an actual visit. No PHI is ever shared in these communications.

Interesting EMR Interface Prototype

Posted on August 27, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I love when doctors and medical students talk about their first encounter with EHR software. In this case, I came across a medical student who ran into Epic in the hospital and writes about it in this post. Here’s his initial response to it:

I took the training module for it and the moment it loaded, I was bewildered. My monitor had turned into a wormhole and was suddenly displaying software built in the 1990s. I stared for 30 minutes at what was basically a wall of text, trying to find my way around small buttons and clogged sub-screens. I hadn’t even learned how to use Epic yet and I was already frustrated. Perhaps it’s because Epic was a platform built upon billing practices that made it so confusing. Either way, I was done before I had even begun.

The great part is that he wasn’t just complaining about the experience. He decided to create a prototype of what he thought an EMR interface could look like. Here’s his video prototype:

Obviously, it’s lacking a lot of detail, but I love his fresh take on how you could navigate the information in the EHR. We need more people who aren’t clouded with current EHR design to offer design suggestions like this.

The Categories of mHealth

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

mHealth (or mobile health if you prefer) is such a broad area. Not only can it include every aspect of healthcare, but it also has no geographic, economic, or cultural barriers. You might remember that I wrote previously about various categories of mobile health apps. I think there are also 3 categories of mHealth communities. While there is some overlap, I think it’s interesting to look at each communities unique assets.

Smart Phone User, Developed Country – This category of mHealth user has a smart phone and almost always has internet access. If they don’t have their smart phone, they’re in front of a laptop or computer, they’re holding a tablet, they’re always on and always connected. Internet access and electricity are generally not a problem.

Non-Smart Phone User, Developed Country – This group is quickly becoming smaller and smaller as smart phone’s become cheaper. Plus, it’s amazing how many people who can barely put food on the table have an iPhone in the pocket. However, this group also contains many of the older generation who don’t have a smart phone (my mom’s in this group). Both of these groups are really important parts of the healthcare system. However, for some reason many of the mHealth applications that are made don’t consider them.

Cell Phone User, Underdeveloped Country – We’ve all seen the statistic that shows that there are more people in the world with cell phones than there are people who have clean drinking water. These users have a cell phone, but these are generally feature phones and not smart phones. In some cases they might not have a place to charge the phone regularly and the service they get might be spotty. There are a lot of amazing mHealth applications being built for these communities. I’m always amazed at the power of a text message.

I’m sure we could divide these categories in a lot of different ways. Certainly there are plenty of exceptions to these categories as well, but I think it’s valuable to consider which type of user an mHealth application is trying to help. It makes all the difference when developing your mobile health application.

Addictive mHealth Apps

Posted on August 26, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I first fell in love with the Center for Connected Health when I attended their Connected Health Sympoisum a few years back. The organization is run by Joseph Kvedar who is one of my favorite thought leaders when it comes to mobile health. He’s optimistic, but pragmatic in his approach to mobile health. Plus, he’s not afraid to be transparent in his thoughts and approach to using technology to improve health. A great example of this was his recent blog post titled “Could Mobile Health Become Addictive?

The answer to his question is yes, but there’s so much more to the article. I particularly love his changing view of the value of mobile health applications versus something like a simple text message. No doubt there has been some “irrational exuberance” around mobile health applications. While the energy has no doubt outpaced the results, that shouldn’t discount the potential of mobile health applications.

Joseph Kvedar points out in his article that “those of us who own smart phones check them obsessively (by some counts 150 times/day).” No doubt many cell phone users are addicted to their cell phones. I’m not sure all the neuro chemical responses that we get from cell phone usage, but I’ve felt the endorphins kick in when you have a new message on your cell phone. This addiction probably also explains phantom vibration or phantom ringing.

The real question is how can we apply this type of addictive response to healthcare apps? Plus, how can we make sure that it becomes a healthy addiction. We’ve all heard of the person who’s too addicted to fitness or too addicted to self monitoring that it becomes unhealthy. There’s definitely a balance, but I’m sure that the day will come that mobile health apps are as addictive as a text message. I’ve started to see glimpses of it in the current mobile health offerings, but we’re not there on a widespread scale yet.

What mobile health applications or types of applications do you see that are headed down this path?

One Government EHR for All of Healthcare

Posted on I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Over and over I hear some doctor or EHR industry person say, “Why doesn’t the government just provide one EHR for all of healthcare?” Usually this is followed by some suggestion that the government has invested millions (or is it billions?) of dollars in the Vista EHR software and they should just make that the required national EHR.

You can see where this thinking comes from. The government has invested millions of dollars in the Vista EHR software. It’s widely used across the country. It’s used by most (and possibly all) of the various medical specialties. Lots of VA users love the benefit of having one EHR system where their records are always available no matter where in the VA system you go for health care. I’m sure there are many more reasons as well.

While the idea of a single EHR for all of healthcare is beautiful in theory, the reality of our healthcare system is that it’s impossible.

I’ve always known that the idea of a single government EHR was impossible, but I didn’t have a good explanation for why I thought it was impossible. Today, I saw a blog post called “Health IT Down the Drain” on Bobby Gladd’s blog. The blog post refers to the $1.3 billion over the last 4 years (their number) that has been spent trying to develop a single EHR system between the Department of Defence (DoD) and Veterans Affairs (VA). Congress and the President have demanded an “integrated” and “interoperable” solution between the two departments and we yet to see results. From Bobby’s post comes this sad quote:

“The only thing interoperable we get are the litany of excuses flying across both departments every year as to why it has taken so long to get this done,” said Miller, the chairman of the Veterans Affairs Committee…

The government can’t even bring together two of its very own departments around a single EHR solution. Imagine how it would be if the government tried to roll out one EHR system across the entire US healthcare system.

I hope those people who suggest one government EHR can put that to bed. This might work in a much smaller country with a simpler healthcare system. It’s just never going to happen in the US.

Is Your EMR Charting Accurately?

Posted on August 23, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

For all the hope — not to mention time and money — being invested in EMRs as a way to improve health care, they’re still exquisitely prone to the age-old problem in IT: garbage in, garbage out.

Several writers have commented recently on whether you can believe what you read in an EMR. They raise serious questions as meaningful use Stage 2 draws near and providers’ care patterns become further enmeshed with their record systems.

One problem, wrote Dr. Rebecca Bechhold, a medical oncologist, is the information overload that an EMR can generate: “page after page of predetermined queries and stock answers that are repetitive and irrelevant after the first visit.” The truth, as in what’s really going on with the patient, might be in there somewhere, but she finds it hard to dig out.

Worse still, doctors sometimes just check “normal” for everything under the physical exam section because they’re in a hurry and entering the information is tedious, Bechhold wrote. Some pretty important history, such as an enlarged liver or an amputation, can be left out.

It might sound bad, but it’s human nature whenever there are too many boxes to check. However, for Bechhold, the key disadvantage isn’t a lack of facts, but of feelings.

“You cannot express the emotion and anxiety that is part of oncology care in a prepackaged document,” she wrote.

Software selection consultant Sheldon Needle, meanwhile, wrote about the pitfalls of taking an EMR prescription list at face value.

Take the patient who comes to the emergency room because of a car accident. If the patient’s regular doctor is linked with the hospital’s e-prescription system, a medication list might soon be forthcoming. But who’s to say there aren’t other medications in the picture, prescriptions written by a doctor who’s not tied in?

Needle’s advice: Ask a human, such as the patient or a relative.

“If something looks off on the electronic medical record,” he wrote, “question it.”

HealthcareScene.com’s own John Lynn, too, addressed the issue of trusting health care data, noting that doctors are receiving information from more sources than ever, including health information exchanges, patients and patient devices. It’s hard for physicians to know what’s reliable.

The obvious solution to trust issues seems to lie in user interface design. If the EMR is a good fit for the doctor’s workflow, the right data should end up in there.

Unfortunately, it’s not quite that simple. Bechhold noted that charts she receives from other doctors are sometimes configured to include every piece of data available for the patient, including all medications and test results.

The physicians, she wrote, want to be able to show that they reviewed all information if they’re ever sued.

Doctors and health IT companies have a way to go in understanding each other. Only then can there be full trust in EMRs.