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Electronic medical records draw frequent criticisms

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Last year, his department found that physicians spent nearly five of every 10 hours on a computer, he said. "I sit down and log on to a computer 60 times every shift. Physician productivity and satisfaction have fallen off a cliff."

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Other doctors spoke of cluttered screens, unresponsive vendors and illogical displays. "It's a huge safety issue," said Christine Sinsky, an internist in Dubuque, Iowa, whose practice implemented electronic records six years ago. "I can't tell from the medical display whether a patient is receiving 4mg or 8mg of a certain drug. It took us two years to get a back-button on our [Electronic Health Record] browser."

She emphasized that electronic records have improved her practice. "We wouldn't want to go back," she said. "But EHRs are still in need of significant improvement."

More than one in five hospital medication errors reported last year -- 27,969 out of 133,662 -- were caused at least partly by computers, according to data submitted by 379 hospitals to Quantros Inc., a health-care information company. Paper-based errors caused 10,954 errors, the data showed.

Tracking the mishaps

Legal experts say it is impossible to know how often health IT mishaps occur. Electronic medical records are not classified as medical devices, so hospitals are not required to report problems. Many health IT contracts do not allow hospitals to discuss computer flaws, say Koppel and Sharona Hoffman, a professor of law and bioethics at Case Western Reserve University in Cleveland.

"Doctors who report problems can lose their jobs," Hoffman said. "Hospitals don't have any incentive to do so and may be in breach of contract if they do."

For one senior internist at a major hospital, who requested anonymity because he said he would lose his job if he went public, a 2006 installation provoked mayhem. "The system crashed soon after it went online," he said. "I walked in to find no records on any patients. It was like being on the moon without oxygen."

While orange-shirted vendor employees "ran around with no idea how to work their own equipment," the internist said, doctors struggled to keep chronically ill patients alive. "I didn't go through all my training to have my ability to take care of patients destroyed by devices that are an impediment to medical care."


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