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Digital Life: The Future of Medicine: Electronic Health Records

This session features Catherine DesRoches, instructor in medicine, Harvard Medical School.  As before, the majority of this is being put below the fold and will be built in part or whole from the tweets.

Catherine DesRoches, future of medicine: Electronic Health Records; background EHR & HIT Adoption Init. Get good definition imp.

if electronic system doesn't have clinical decisions support, not good according to quality people. Hmmm.

Problems with implementation, both tech and legal (conerns, phys. want some coverage); hospital status and barriers (cost big)

rates of adoption are very low for docs and hospitals; many do have key functions in place (good start); lot of ground to cover

is major goal of new admin as well, full adoption by 2014. Cost is major barrier, stimulus helping but not enough. next? HITECH init

incentive payments, penalties, regional exchanges, HIT extensive centers; certification process, meaningful use, privacy?, what about personal health record (PHR). Q&A How has expectations matched with reality on cost and effec? Million dollar question.

That answer was a bit sketchy. Well... hard to sort out. Discussion. Feds will define meaningful use, up to docs/hosp to meet

Cart before horse, many scared to go to doc/have info where can cost them insurance? Good question. Paper not secure either, dig just as secure, a bit of tap dance, discussion; question on billing and single payer

VA Q from me; seperate DoD from VA, VA does VA is good, very good overall, VA high quality for low price, very complicated mix, do very good for that. NOTE, care taken by speaker to say that DoD facilities were where majority of probs were, mold, shoddy care, etc. , slam of DoD made (strong) point that "data" says VA gives excellent care, sure there are some "variations" but data doesn't show

discussion of why for-profits are not wanting to go electronic, most due to cost (subtle push for single-payer???)

More discussion.  Large emphasis on government, what government is doing and why (and why then need to/need to do more).  (cynical reporter in me wondering about funding and other potential bias points:  no reporter and no speaker is free from bias, that's why it is crucial for reporters/bloggers to dig and make things transparent).

Emphasized again that this admin is wanting to focus on use, rather than just implementation like previous admin.  

Discussion of who owns the record, good point:  doctor, patient, who?  Good discussion on records, how hard to get, what to do, digital divide, and more.  Record and media question (good one) on need for paper, use of, short life of digital media.  Yes, there is concern about this, mostly academic focus.  Ag extension center model to assist effort(?)

Two hard questions, lack of answers, lack of data, based on 20-year-old obsolete model, speaker looking a bit defensive...  Medical records far more complex than anything pointed out, problem is that we have two conflicting values, for profit and medicine as a right.  We're conflicted, on that and on it, I'm no geek cant talk this part of it, still getting hammered on model and assumptions, very defensive now.  

Do you think it really is an assumption in the US healthcare is a right?  On average, yes, Americans do think that, but...  

Ownership again, yes, lots of debate lawyers involved, huge issue yet to be resolved.  (funny, could swear I hear the theme from Jaws playing in the room)

More discussion. 

LW

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