electronic health records


What Your Shrink Thinks? Pilot Study Opens Psych Records To Patients

(Life Mental Health/Flickr via Compfight)

(Life Mental Health/Flickr via Compfight)

Here’s how far we’ve come beyond the old stereotype of the inscrutable psychiatrist who refuses to do anything more than nod and hum. If you’re a patient in a pilot program just now getting under way at Boston’s Beth Israel Deaconess Medical Center, you’ll soon have a whole new window into your psychiatrist’s thoughts: the mental health notes in your own medical record.

Patient access to personal medical records is a growing trend, but the pilot takes it a pioneering next step, into mental health records that are often kept closed to patients. The program’s rationale — the expectation that the tactic will lead to better care — is laid out in “Let’s Show Patients Their Mental Health Records,” an article in this week’s Journal of the American Medical Association.

I spoke with its first author, Dr. Michael Kahn, a psychiatrist at Beth Israel Deaconess. Our conversation, lightly edited:

CG: Here’s my colleague’s response to the idea of patients reading their psychiatrists’ notes: ‘Omigod, that’s terrifying! Do you really want to know what they think of you, especially if you already have issues?’ How would you respond?

MK: My main response would be that ‘what they think of you’ might actually be a great relief. Many patients are quite frightened that the doctor ‘will think I’m crazy,’ and the meaning of that varies from patient to patient. Mostly, those patients are not out of touch with reality; they’re just overwhelmed, and they’re often very reluctant to ask their doctor about it because they’re afraid their doctor will say, ‘Yes, you are crazy.’

So when they read in the note that “The patient is struggling with anxiety or depression, and should get better with this treatment,” that’s often a great relief to them, because they often see they’re not as impaired or deficient or defective as they feared.

I imagine the response from many psychiatrists would also be, ‘Omigod, that’s terrifying.’ You write in JAMA that this ‘feels like entering a minefield, triggering clinicians’ worst fears about sharing notes with patients.’ And you mention specific fears — how will a patient with a personality disorder react upon learning of that diagnosis? What if patients are outraged by the terms used? How do you respond to doctors’ fears?

The first thing is to recognize that it’s a totally natural, understandable and honest fear. I think we all learn in our professional development to use these terms — you might call them jargon — that are often but not always accurate, and often but not always have more pejorative connotations.

I think clinicians know this and are concerned that if patients read, for example, that they have Borderline Personality Disorder, then they will feel insulted, shocked, demeaned. I think this is a totally understandable and reasonable anxiety on the clinician’s part, but I think for many patients — and I’ve seen this many times — if it’s introduced to them in a tactful way, they can get the message that “The reason your life is in such turmoil is not because you’re a bad person but because you have this thing we call Borderline Personality Disorder that has these features.” And patients often say, ‘Oh my God, that’s me!’ and that’s actually a relief; they feel less alone and stigmatized.

So overall, the expectation is that patients being able to see these notes would far more often be helpful than harmful? Continue reading

Questioning The True Cost-Savings Of Digitized Health Care Records

(MC4 Army/flickr)

In an opinion piece today in The Wall Street Journal, Harvard professor Stephen Soumarai argues that the savings promised from electronic health records is little more than hype.

Soumerai, a professor of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, writing with Ross Koppel, a professor of sociology and medicine at the University of Pennsylvania, suggests that the IT guys selling this stuff are promising huge savings that “turn out to be chimerical:”

Since 2009, almost a third of health providers, a group that ranges from small private practices to huge hospitals—have installed at least some “health IT” technology. It wasn’t cheap. For a major hospital, a full suite of technology products can cost $150 million to $200 million. Implementation—linking and integrating systems, training, data entry and the like—can raise the total bill to $1 billion.

But the software—sold by hundreds of health IT firms—is generally clunky, frustrating, user-unfriendly and inefficient. For instance, a doctor looking for a patient’s current medications might have to click and scroll through many different screens to find that essential information. Depending on where and when information on a patient’s prescriptions were entered, the complete list of medications may only be found across five different screens.

Now, a comprehensive evaluation of the scientific literature has confirmed what many researchers suspected: The savings claimed by government agencies and vendors of health IT are little more than hype. Continue reading

Mass. Study: Electronic Health Records Bring 6-Fold Cut In Malpractice Claims

A sample electronic medical record (Wikimedia Commons)

There’s strong consensus that the American medical system must march decisively into the era of electronic health records and the shift is happening rapidly, particularly here in Massachusetts.

But understandably, some concerns remain that computer glitches could potentially cause errors. I don’t even like to imagine a doctor with my technological abilities — or lack thereof — getting used to a new prescription or diagnostic system. So here’s a bit of reassuring news from a paper just out online in the Archives of Internal Medicine:

“The rate of medical malpractice claims when electronic health records (EHRs) were used appeared to be about one-sixth the rate when EHRs were not used, according to a research letter that reported on a total of 51 unique closed malpractice claims and survey data from some Massachusetts physicians.”

From the paper, some interesting analysis on whether this really means better medicine is being practiced:

This study adds to the literature suggesting that EHRs have the potential to improve patient safety and supports the conclusions of our prior work, which showed a lower risk of paid claims among physicians using EHRs. By examining all closed claims, rather than only those for which a payment was made, our findings suggest that a reduction in errors is likely responsible for at least a component of this association, since the absolute rate of claims was lower post-EHR adoption. Continue reading

Uncle Don Wants You! (To Do Your Part On Electronic Health Records)


Is it me, or is this a somewhat plaintive plea from a man who controls a federal budget that runs northward of $700 billion?

Dr. Donald Berwick, current chief of Medicare and Medicaid and a longtime health-care quality expert hereabouts, asks hold-outs in this two-minute video to bite the bullet and make the transition from paper to electronic health records. “I’m well aware that this isn’t easy,” he says. And:

“So if electronic health records are so great, why aren’t we there yet? And the answer is that it is hard to do. It means new hardware, new software, new skills. It means a new culture. Your work on this is critical. Our nation needs your help. You have, and you will have, a profound influence on the direction that our country will take in the next few years. You are keys to success. We’re now at last on the threshhold of a major modernization of health care in our nation. Everyone can be a winner in the end. I know that. But it isn’t easy, and I know that, too…”

When I came upon this video this morning on YouTube, it had only been viewed about 50 times since it was posted on Mar. 31. Maybe it’s a message that the hold-outs don’t want to hear?

‘Event’ Registry For Electronic Health Record Errors

The Wall Street Journal’s health blog just reported:

Today a not-for-profit alliance of medical society and professional liability carrier executives is rolling out EHRevent.org, a new safety reporting system for EHRs. Doctors and other health-care workers can go online and report problems and mistakes they experience as they ramp up the use of digitized records

Here’s one reason this is a good idea. A certain school I’m familiar with recently sent out an electronic form for parents to use to update their information in the school’s online directory. The form asked the parents to check off which grade and which class their children were in. At least one parent misunderstood so badly that he or she checked off all the classes in all the grades. Continue reading