healthy4u: Denise Koppit

Here is a story exemplifying the extremes to which faith-based informatics beliefs can drive healthcare facilities, to the benefit of IT companies and at the expense of patients.  This is occurring a bit north of the Chicago area: <blockquote class="tr_bq"><a href="http://newssun.suntimes.com/news/15001817-418/county-health-department-clinics-moving-to-electronic-records.html" target="_blank">County Health Department clinics moving to electronic records</a> By Judy Masterson Last Modified: Sep 11, 2012 02:43AM People who rely on Lake County Health Department clinics for their health care have found cuts in service during walk-in hours as the department began implementing a new electronic medical record.</blockquote>  That, as is explained further in the story, is an understatement. <blockquote class="tr_bq">The massive shift to electronic storage of medical data by the department has been underway for about two years, at a cost through April 2012 of $3.8 million, according to department spokeswoman Leslie Piotrowski. During the first phase, appointment-taking, laboratory, financial and demographic information and billing were transferred from paper records to electronic storage. Under the newest phase of the project, physicians and staff are being trained to use new computer software to electronically gather health histories and record information on tests, treatments and prescriptions.</blockquote> Are they using the software to record health histories, or to gather them?  There is a difference, and I believe this passage exemplifies that these "EHRs" are no longer innocuous filing systems, but are interfering in and regulating the information gathering process from patients itself (i.e., the physician-patient relationship) itself.  More on that issue below. <blockquote class="tr_bq">Denise Koppit, Health Department associate director of primary care services, acknowledged the training has temporarily cut by half the number of walk-in patients seen at the department’s clinics in Waukegan, Zion, North Chicago, Highland Park and Round Lake Beach.</blockquote> Cut by 50%?  That is remarkable.  That an electronic record system could be so hard to learn and use that patient count has to be halved is stunning - and outrageous. It suggests a fiasco in the making in terms of care quality when the clinicians are asked (and probably forced) to get back to more traditional volumes. Similar situations are noted here:   "Avatar fails - No, not the Cameron movie, but yet another lousy EMR system implemented by amateurs." <a href="http://hcrenewal.blogspot.com/2010/11/avatar-fails-no-not-cameron-movie-but.html">http://hcrenewal.blogspot.com/2010/11/avatar-fails-no-not-cameron-movie-but.html</a> and here: "Contra Costa's $45 million computer health care system endangering lives, nurses say." <a href="http://hcrenewal.blogspot.com/2012/08/contra-costas-45-million-computer.html">http://hcrenewal.blogspot.com/2012/08/contra-costas-45-million-computer.html</a> <blockquote class="tr_bq">“We’re learning new systems which totally change the way we gather information about patients,” Koppit said, noting “it was a little bumpy” the first day, Sept. 5, but Sept. 6 “it was a little better.”</blockquote> "Totally change the way we gather information about patients?"  (As opposed to "the way we record information?") This is concerning to me, as it suggests interference (ill-conceived and deleterious interference is probably more accurate) in medical processes by technology.  To my knowledge, there's been no revolution in clinician history taking and performance of physical exams.  The state government needs to examine exactly what is being referred to. Also - add "a little bumpy" to the list of banal excuses for toxic software such as - it's a rare event, it's just a 'glitch',  it's teething problems, it's a learning experience, we have to work the 'kinks' out, it's growing pains, etc. I'm actually surprised not to see the usual refrain in this article, that "patient care was not compromised." <blockquote class="tr_bq">... “We want to improve quality of care and increase efficiency so patients don’t go through multiple tests and so everyone can see medications,” Koppit said. “This will allow ready access to patient information. Patients will receive a printout of their diagnoses, medications and lab work.”</blockquote> As described in other posts (query link <a href="http://hcrenewal.blogspot.com/search/label/faith-based%20informatics%20beliefs" target="_blank">here</a>), these are "faith-based informatics beliefs" (i.e., enthusiasm and technology-deterministic statements of fait accompli not driven by robust evidence, especially considering the state of health IT in 2012). <blockquote class="tr_bq">Patients who transfer to different providers, will receive their medical history and information in a paper file or on a flash drive.</blockquote> Paper file? <blockquote class="tr_bq">The reductions in number of walk-in patients accepted hit the Zion clinic especially hard. One user, who contacted the Lake County News-Sun, said patients waiting outside the clinic “on any given day” look like “a Depression-era soup line” that snakes around the corner of 27th Street. Koppit said that the Zion clinic, which also serves patients from Winthrop Harbor, Beach Park and Wadsworth, relies on just two physicians who typically treat between 12 and 15 walk-ins per day.</blockquote> Health IT project managers whose plans caused “a Depression-era soup line” of sick patients should be sanctioned, in my opinion.  <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7BMxnqggy8uE_HoqysLU-USfqGKgEWNs2naCXaUx-aPxh9WRQvxS19R805UvDwmf20L2UOCnh1KhJ58tJniA8pk5GD5fC4xBNLXPYD6QOQb1OxFnzi6zjyEmpp2jgZJisGzjTTESz8jEJ/s1600/soupline-depression-550.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7BMxnqggy8uE_HoqysLU-USfqGKgEWNs2naCXaUx-aPxh9WRQvxS19R805UvDwmf20L2UOCnh1KhJ58tJniA8pk5GD5fC4xBNLXPYD6QOQb1OxFnzi6zjyEmpp2jgZJisGzjTTESz8jEJ/s400/soupline-depression-550.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">When an EMR implementation causes "Depression-era soup lines" at the clinic, one can reasonably conclude project mismanagement is occurring.</td></tr></tbody></table> This is entirely unnecessary, and endangers patients dependent on the care provided in these clinics.  This project as structured, in fact, violates patient's rights in my opinion. <blockquote class="tr_bq">She admitted that regular appointments can take two months to schedule. “If somebody comes in very sick, we’re trying to get them squeezed in,” she said.</blockquote> We're "trying to get them squeezed in"?  And, if they are harmed or die because they can't be "squeezed in", or because the clinicians are up to their necks in cybernetic frenzy, who's liable? I suggest the implementation leadership team should, in that case, find themselves as defendants. -- SS

Lake County Health Department: The extremes to which faith-based informatics beliefs can drive healthcare facilities - Depression era soup lines at the clinic?

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