Doctor’s Tip: Better medical record system could save lives, money
September 11, 2017
This is the last of a series of columns based on the insights of Robert Pearl, M.D., CEO of the Permanente Group and author of "Mistreated, Why We Think We're Getting Good Health Care — And Why We're Usually Wrong."
According to "Mistreated," 50 percent of American physicians still lack electronic medical records (EMR). Of those who do have EMR, few are deriving all the benefits that this technology offers. Hospitals and health-care providers use so many different EMR systems that often the systems are not compatible. Dr. Pearl notes that "American doctors and hospitals invest millions in fancy medical equipment … but U.S. health care trails almost every other industry in the adoption of information technology." A few real patient stories will illustrate the problem.
Dr. Pearl's father, Jack, developed a blood disease in his 60s that required removing his spleen. This operation makes people susceptible to severe infections from the pneumococcal bacteria, and everyone who has a splenectomy should be given a pneumococcal vaccine (commonly called the "pneumonia shot" because it prevents pneumococcal pneumonia).
Although Jack was treated by many skilled physicians, none of them thought to give him the vaccine, and later Jack ended up dying from an overwhelming pneumococcal blood infection. It turns out that Jack split his time between New York and Florida, and doctors in each location assumed that doctors in the other location had given the vaccine. Jack's death would not have occurred with a comprehensive, nationwide EMR system.
A woman was washing dishes one night, a glass broke and she cut the tendons in her hand. The hand surgeon performed a nerve block with an anesthetic that included epinephrine (adrenaline) to make the nerve block last longer. Her heart rate was monitored and suddenly the rate accelerated and her heart stopped. The emergency team was unable to resuscitate her. The one question the surgeon had failed to ask her preoperatively was whether she had ever experienced heart palpitations. In her PCP's record, there was a notation that she had an abnormality in the electrical system of her heart. This is another death that would have been prevented with comprehensive, shared EMR.
Screening for colorectal cancer should begin at age 50. A neighbor of Dr. Pearl's in her mid-50s developed carpal tunnel syndrome, for which she underwent surgery. She had never had a screening colonoscopy, and two years later she was diagnosed with metastatic colon cancer and died. If the surgeon had comprehensive EMR and was concerned about more than her carpel tunnel syndrome, he would have advised her to get screened and this is another death that would have been prevented.
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Kaiser-Permanente is the largest medical group in the country. In 2006 it began installing a comprehensive EMR system in all of its medical centers and hospitals. The goal "was to provide all 17,000 of our physicians with immediate access to the medical records of our 10 million patients coast to coast." Medical assistants in every office at Kaiser are taught to review and update each patient's medical record each time they put a patient in an exam room.
Dr. Pearl was visiting the ophthalmology department in a Kaiser facility recently, and noticed a small ceremony taking place. Sarah was a glaucoma patient and came to the medical center every few months to have her eye pressure measured. Christy, an M.A., noted in the EMR that Sarah was due for a mammogram, and advised her to walk down to the radiology department to have this done after her eye appointment.
The next time Sarah returned, Christy noticed that the mammogram had not been done. Christy quelled Sarah's fears about having this screening test, and after the eye appointment walked her down to radiology and waited while Sarah had the mammogram, which turned out to be abnormal. Within 48 hours Sarah was on the operating table and cancer was confirmed. Because of the early diagnosis, thanks to Christy, she was cured. The celebration that Dr. Pearl witnessed was the head of the ophthalmology department giving Christy a medallion, on which was engraved "I Saved A Life."
The first three stories are about what happens all too often in our fragmented system with underutilized and outdated information technology. The fourth story is about how health care can and should be both "high tech and high touch," and about the system we in the medical field should strive for. Unfortunately, in all the recent discussions about tweaking or replacing "Obamacare" I have seen a lot about political ideology but nothing about the important issues that Dr. Pearl raises in his book, "Mistreated."
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at email@example.com.