January 15, 2010


Luke: "I don't believe it" Yoda: "That is why you fail"


As the healthcare community is beginning to come around to the idea of embracing technology (with the push of federal regulations), there are naysayers who have begun to ring the warning bell. They are raising the red flag regarding increased physician accountability and liability due to access to potentially unlimited patient data through the use of technology.

As both a practicing physician and Chief Medical Officer of DrFirst, I do recognize that these concerns should be addressed when “using technology” actually becomes the standard-of-care (SOC). But today, technology has still not been embraced by the medical community; and rushing to these conclusions can seriously hamper the progress that needs to be made. In addition, it is unlikely that physicians will be held liable at this point-in-time for utilizing clinical decision support tools like e-prescribing or an EMR.

One of the major concerns is that by having access to prescription fill history, do physicians now have a responsibility to check to see if their patients filled their prescriptions, and if not, to follow up with the patient to ensure they are sticking to their treatment? This is a slippery slope of a blame game and physicians with whom I’ve discussed this are very concerned.

Before this becomes an issue, it is critical that we determine that patients have to be personally responsible for their own health. Providers can diagnose and prescribe medications, and can even utilize fill history to help patients understand the ramifications to their health for not taking the medications, but at the end of the day, the patient makes the final decision. Society cannot expect physicians to badger patients to comply and adhere to treatment.

Another concern is the level of accountability a physician holds when he/she receives a plethora of detailed patient information that is not necessarily relevant to their case. I agree that there is a dilemma with this. In the old days, the referring physician would summarize the patient history in a letter, and pass it on to the consulting physician.

Technology vendors need to devise a strategy to prevent a data dump of patient information from one physician to the next. We physicians need to insist on being presented with a filtered set of important data in order to increase the quality of care. We cannot possibly review every X-ray and lab test in the extensive record of a new patient.

Anecdotally, I recently asked for my mother’s records from her primary care physician, who has recently moved to a paperless system with a high-end EMR. Unfortunately, most of her notes are now in a scanned form, and I was sent a 300+ page PDF of her entire chart with every note, X-ray, lab report, etc., many in no particular order and almost all as scanned images (would I couldn’t search!). Physicians must push for systems that can filter data to improve patient care and also limit our liability.

The moral of the story is that e-prescribing and other health IT helps patients have the safest and most informed doctors possible. But we need to remain cognizant of the fact that using the information requires more than just a dump of ALL of the information. We shouldn’t just scoop up all of our paper records; and scan them into our new high tech systems without consideration of how this data will be used in the most efficient way.

My call to physicians is to believe in the future of healthcare technology and not fail before we try. Ask yourself where you stand and let me know, because I am more than open to comments on this issue.

About pkaufman

Schooled at MIT, Dr. Kaufman nurtured a strong interest in medical informatics while a Bowman Gray School of Medicine faculty member. After entering private practice he founded PiNK software in 1996 to produce EMR software, later becoming DrFirst’s chief medical officer upon its founding. He lectures nationally on various healthcare IT topics, and as a board certified gastroenterologist, he continues a limited clinical practice. Dr. Kaufman is a member of the Health IT Standards Committee, Privacy and Security Workgroup for ONC (Office of the National Coordinator for Healthcare Information Technology). Representing the American Gastroenterology Association’s (AGA), Dr. Kaufman is a delegate to the AMA and was the co-chair of the Physicians Electronic Health Record Consortium (PEHRC). He has participated on workgroups at CCHIT (stand-alone e-prescribing), HIMSS (e-prescribing), and NCPDP (e-prescribing).