The Electronic Medical-Records Email(s) of the Day, #3

"There is a cultural element at work here; a particularly American ethos which sees technology as the solution to any challenge. Couple that with finance which dictates what happens in our health care system. You could call that ethos the real 'software' that has shaped and will, sadly in my view, continue to direct American health care delivery."

For background on the EMR saga, see this original article and previous installments one, two, three, four, five, six, seven, and eight. Our series went on hiatus while I was on the road in Mississippi. Now let's dig into the pros and cons once more.

1) If libraries can do it, why can't doctors too? A reader in the tech industry writes:

When libraries began to transition from 3 x 5 catalog cards to online catalogs the Library of Congress and leading libraries developed MARC (Machine Readable Cataloging) records.  See information about these standards at the Library of Congress website.

Now library automation vendors have to provide ways to import and export MARC-format records to and from their versions of a library’s online catalog.  In addition, library vendors can make it easy for users of their software to query the databases of other libraries based on using the MARC standards. is working in the area of electronic medical records.  It would seem that standards for medical records can be developed so that health records could more easily be shared.  It would be easier to change to a better software vendor without having to re-enter all the data. Vendors who develop a better interface would find it easier to attract customers to their product.  It would be easier for primary care physicians to exchange patient information with specialists, even if they use different software packages

2) The market mentality "is the real software of American health care." From a reader in New York state:

As a communications consultant to two local health networks, I see first hand different perspectives not only on EMR implementation but other changes driven by or attributed (rightly or not) to the ACA. 

For example, corporate administrators  harping on provider "productivity" (see more patients, get more $) tout EMR as an efficiency tool. Providers (physicians, NPs, RNs) vary in their responses but the majority would side with your "Commodore 64" doc's comments. They welcome tools that work and improve communication, especially shared, useful clinical info vs.billing codes and data that they deem irrelevant to quality medical care.

To me, the EMR hoohah reflects more than the predictable "software elephant" designed by engineers without serious input from actual end users and sold by hook and crook to administrators who then impose that particular system on their network practitioners and providers. 

There is a cultural element at work here; a particularly American ethos which sees technology as the solution to any challenge. Couple that with finance which dictates what happens in our health care system, seen and operated as a "market."  

You could call that ethos the real "software" that has shaped and will, sadly in my view, continue to direct American health care delivery driven by non-providers: insurance, bio-tech, pharmaceutical and yes, IT companies aided and abetted by politicians and Wall Street. This element is no doubt a major reason why American health care is the most expensive with lower quality outcomes than France, Sweden and other developed nations.

And as a bonus #(3), how out of touch Americans are. A reader begins with a quote from this previous exchange, and then replies:

[Quote] "I've long thought what we need is a card that is programmable, the size of a credit or insurance card, that you swipe through a reader, punch in a security code, and it downloads the info to the new doctor's system. Why no one has implemented this I have no idea."

This comment, from a reasonably informed reader, is illustrative of just how out of the loop people are in the United States.    Many countries have already implemented medical ID cards.   In France, the cards contain one's complete medical history.  The last I heard, the German cards were limited to the users insurance information and they were looking at going further. 

More in the queue, thanks to all. I went to my doctor today, for a routine checkup. Everything's fine! I've been grateful to him ever since he figured out the only serious health problem I've ever had, nearly six years ago, which led to surgery effecting its cure.

On the Hmmm! side about today's visit, I had to sit for a while filling out paper forms on a clipboard when I first arrived. (Me: "All this info is already on file. Why do I have to fill it out again?" Person at desk: "For insurance purposes," today's irrebuttable claim.) On the positive side, the doctor had all my past records available in a little laptop as we talked -- but looked right at me through the visit.  

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James Fallows is a national correspondent for The Atlantic and has written for the magazine since the late 1970s. He has reported extensively from outside the United States and once worked as President Carter's chief speechwriter. His latest book is China Airborne. More

James Fallows is based in Washington as a national correspondent for The Atlantic. He has worked for the magazine for nearly 30 years and in that time has also lived in Seattle, Berkeley, Austin, Tokyo, Kuala Lumpur, Shanghai, and Beijing. He was raised in Redlands, California, received his undergraduate degree in American history and literature from Harvard, and received a graduate degree in economics from Oxford as a Rhodes scholar. In addition to working for The Atlantic, he has spent two years as chief White House speechwriter for Jimmy Carter, two years as the editor of US News & World Report, and six months as a program designer at Microsoft. He is an instrument-rated private pilot. He is also now the chair in U.S. media at the U.S. Studies Centre at the University of Sydney, in Australia.

Fallows has been a finalist for the National Magazine Award five times and has won once; he has also won the American Book Award for nonfiction and a N.Y. Emmy award for the documentary series Doing Business in China. He was the founding chairman of the New America Foundation. His recent books Blind Into Baghdad (2006) and Postcards From Tomorrow Square (2009) are based on his writings for The Atlantic. His latest book is China Airborne. He is married to Deborah Fallows, author of the recent book Dreaming in Chinese. They have two married sons.

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