Electronic Medical Records: Who's On the Menu?

with caption 'EMR's are saving time, money and making people safer how???' by El Mnopo

I recently finished The Last Lecture, the book written after Randy Pausch's inspiring lecture that delved into more of his stories. One of them brought to mind both the error message from an electronic medical record (EMR) above and some frustrating databases I've encountered. Dr. Pausch used to bring in videocassette recorders (VCRs, remember those?) to his classes on one day, then a sledgehammer on the next day to destroy them in front of his startled students. Why?

When we make something hard to use, people get upset. They become so angry that they want to destroy it. We don't want to create things that people will want to destroy.

His hope for his students creating new technologies now is that

Once in a while I come into their minds, swinging that sledgehammer, reminding them of the frustrated masses, yearning for simplicity.

While I can't advocate taking a sledgehammer to EMRs (they cost a heck of a lot more than a VCR) I can certainly understand the temptation to do so from system demonstrations/screenshots I've seen in addition to watching when the nurses, my doctor & lab staff enter data into my own. Simplicity seems to be an impossible dream for current systems, even if they are considered really good ones.

Nonetheless, the push is on to mandate EMRs in the United States and Scotland's National Health System is on track to be the first paperless health service in the world.

If you aren't at the table, then you are on the menu.

This response from Dr. Val Jones to Dr. Rob's discussion about a healthcare reform article isn't new but it is relevant to the healthcare information technology (health IT or HIT) stakeholder discussion for EMRs and the amounts of future funding coming down the federal pipeline for them.

Who is at the table? According to Dr. Rob, "Politicians, hospital corporations, pharmaceutical and insurance companies, and lobbyists". There is no mention of physicians or patients, the core of health care, although in theory they are there.

A look at 'Making Health Information Technology Work' at HealthIT.hhs.gov, bold emphasis mine, includes

Health IT will help consumers gather all of their health information in one place so they can consider it in as a whole.

It's important to note this is not about having a patient's health information in one place for a clinician to 'consider it'. How does a complete collection of health information transfer into patients' knowledge and understanding in order for them to 'consider it'? There is no Google Translate button for clinical data in EMRs to convert to consumer health language, and even if there was I wouldn't want to make decisions about my health based on that output.

How do you get the public to care about and support EMRs/health IT? A good first step is the video below that is available here:




How do you get medical librarians to care about and step up to their roles in EMRs and health IT? Yes, there are roles to be had here. Check out Librarians and the EHR: Envisioning the Future, which is where I learned about Woods Hole & why I applied to go there in order to develop a health informatics class geared towards medical librarians' involvement in health IT and particularly EMRs.

It was during a presentation at Woods Hole I learned about medical librarians' front-and-center involvement in a patient information portal not from the presenter himself while he was demonstrating the system, but on Twitter from Rachel Walden with a link to this 2007 JMLA article that covers their experience.

If that doesn't emphasize the fact that nobody will invite medical librarians to the table unless we step right up and take our own seats there, I'm not sure what does.

Perhaps a stronger version of 'you're on the menu' line may help. We are in the 21st century, where medical libraries are being abruptly closed or the librarian retires and institutions decide not to fill the position. Like the video above, the Vital Pathways resources are a step in the right direction for medical library advocacy although rather vague on direct librarian EHR/EMR/HIT involvement and I'm hopeful for much more meat in the white paper.

Perhaps the majority of medical librarians don't care about involvement in health IT. I hope I'm wrong, as there was stiff competition to attend Woods Hole and I know of other bright stars kicking butt out there. One of them wants my tomatillo salsa recipe. Maybe 'Cannot quit' should be our motto!