Checkboxes, Ebola, and Embedding the EHR

October 14, 2014

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Should the EHR be blamed? After a Texas hospital let Liberian Thomas Duncan go home (with Ebola), hospital officials blamed the electronic health record (EHR). A day later, they retracted their statement -- without explanation.

The retraction is only partially correct. EHRs don’t send sick adults home with fevers spiking to 103-degrees. People do. But sometimes that’s because the system makes good care difficult. In this case, the EHR is at least partially to blame.

EHRs are primarily for data collection. They were built for billing, not for patient care.  Ask doctors and nurses what a mess Obama’s EHR mandate has made of health care. Peter Pronovost, safety director at Johns Hopkins University in Baltimore, recently said their hospital was “more dangerous than a hospital that was built 30 years ago” because the EHR “is backed with scores of pieces of equipment that do not communicate,” reports Politico Pro (Oct. 4). John Halamka, chair of the Health IT Standards Committee reports, “I get emails saying...that 'EHR has ruined my life.'” (Politico Pro, Oct. 15)

Thomas Duncan is not the first to be harmed by the EHR. He won’t be the last as clinicians are forced to focus on EHR-imposed checklists and rely on EHR automation. The FDA says at least 6 patients have died because of an EHR.

Consider the mandatory checklists. EHR checklists for government reporting and health plan “quality” measurement divert critical attention from patients. Mr. Duncan said he’d been in Africa, but that didn’t seem to raise any flags during triage and the EHR didn’t make his answer easy to notice. Was the “Travel” checkbox just one of many boxes that needed to be checked off as the staff went though a mandatory list of standardized questions before they could actually start looking at the patient?

Checklists also intrude.  I regularly refuse to answer questions on activities like smoking, caffeine, drinking, drugs, and guns. Usually the clinic assistant clicking the checkboxes looks at me like I’m a problem. But the questions have nothing to do with why I came to the clinic. One doctor told me if too many patients refuse to answer the checkbox questions, she’d be in trouble with HealthPlan auditors. She could face 30 – 45% cuts in reimbursements.

This is wrong. Patients should not be forced to make sensitive disclosures as a prerequisite to patient care. And clinicians shouldn’t be wasting their valuable skills and our valuable time filling out checklists for outside busybodies.

Obama wants you to help impose EHRs. After I wrote “Don’t Drink the EHR Kool-Aid,” a hospital worker told me staff are instructed not to ask people if they want to sign up to access their EHR online, but to just sign patients up and give them an access code.  That’s because Obama’s EHR “Meaningful Use” (MU) criteria requires that hospitals and clinics convince 5% of their patients to access their own EHR (actually PHR) online – or risk financial penalties. By embedding the EHR in patient’s psyche, they hope to embed it in patient care permanently.

Just say no. You don’t have to help anyone build a system that can hurt you. I’ve refused the access code at several clinics.

The need for legal protection is clear. Ask your state legislators to enact a law that allows patients to refuse to answer any question they don’t want to answer, and allows doctors to refuse to ask any question they don’t need for their patient’s condition. It’s time to leave nosy checkbox lists behind – and let doctors and nurses focus on the patient who needs their full attention.

Working together with you to protect patient lives,

Twila Brase, RN, PHN
President and Co-founder