Most patients are unaware of the mechanisms called for by the Federal Government for physicians to qualify for reimbursement for investing in electronic health records. For a system to qualify it must meet all of the standards set forth by the US Department of Human Services, Office of the Coordinator for Health Information Technology. One of the technical qualifications is the use of embedded computer programs in the electronic record which remind physicians and their staff of best practices that represent current thought in modern medicine. For example: Prescription drugs come with many side effects and potential for adverse reactions. Imagine the hassle for physicians to read each and every circular on medications they prescribe and attempt to remember the various body systems affected by each drug you are on and whether or not there is concern about whether you can correctly metabolize the medication and whether it could have its affects compounded by the other medications you are taking.

The new Electronic Records come with features that allow the physician to prescribe the medication across the web and not only reduce your hassle of taking the script to the pharmacy but decrease the paper work. These systems include various eligibility rules (your co-pay) allowing you to make a sound financial decision and best of all alerts which help you and your doctor to remember any risks that might be associated with the drugs. One great example is the trend to over-prescribe a class of medications called benzodiazepines (like valium or Xanax) to the elderly. These have been associated with increased incidents of loosing ones balance and falling. Some of you probably know that one of the major reasons for admission to a nursing home is a fractured hip. Since Drs. Have started deploying decision support criteria with seniors and subsequently using less valium like medications, the fall incidence has decreased saving numerous patients the misery of a painful stay in the hospital and subsequent nursing home experience. – By the way, once admitted to a nursing home your risk of developing an ‘iatrogenic’ or medical treatment caused problem increases significantly. Some of the more common problems are pneumonia and malnourishment with physical de-conditioning. So the rule of thumb is STAY OUT OF HOSPITALS AND NURSING HOMES.

For a blast from the past with an extremely sad outcome yet a great deal of hope for the future I offer you my first experience with computer assisted decision support from my youth.

Almost three decades ago: As a Cardiovascular Technologist and Respiratory Therapist I was working in a small rural hospital that had just purchased a new kind of EKG (electrocardiogram) device for the emergency room. This device was wonderful; it actually examined the EKG wave form and diagnosed abnormalities. The year was 1982 and we were just then beginning to attach (interface) various types of electrodes and transducers to our patients that were connected to computers which presented data in a format combining graphical and tabulated results.

So a very nice 52 year old man walks into our emergency room and said; “I have horrible shortness of breath”. The nurse and I placed him on a gurney, hooked him up to our new machines and gave him a drink of water. The EKG machine’s report indicated that he had an arrhythmia (irregular heart beat) and that it was fast and each contraction of the heart was prolonged when compared to normal. Our doctor at the time was this man’s primary care physician ‘who was around fifty years of age. He quickly looked at the EKG monitor but did not read the machine interpretation since he had not been trained to do so. Since we had a new cardiologist at the hospital he ran out into the hall as the cardiologist walked by and said; “Dr Jones (different names used here); what is the latest treatment for SVT (supra-ventricular tachycardia) just a fancy name for a rather benign fast heart rate. The cardiologist informed him that the latest and greatest drug (used in Europe for the previous ten years) was something called Verapramil a drug which blocks the transport of calcium into the heart muscle fibers and slows the pulse rate. This was, in fact, the correct decision support criteria for the SVT diagnosis; however the patient did not have SVT and the attending physician would have recognized this had he read the printout from the EKG computer. Instead the EKG computer had called the problem “broad beat tachycardia” in which case the drug verapramil would have been contraindicated.

Instead of reading and responding to the machine’s output, the patients’ physician administered a large dose of verapramil through his IV. I will never forget the look on the man’s face as he looked up at us, grabbed his chest, fought for a breath and his heart stopped beating. He had an EKG showing signs of electrical activity but the heart muscle itself would not contract as the drug had induced a condition called electromechanical disassociation; when the electrical system works but the muscle does not. After thirty minutes of CPR the man’s Dr. declared him dead and went out to the waiting area to give the news to his wife. No further action was taken until the hospital reviewed its ‘negative outcomes’ in what we call our morbidity and mortality rounds the following month.

So here was a preventable death that could have been averted through the careful attention and reliance on computer technology. I can tell you today that we are much more adept at using these technologies but still unaccustomed as to how we can achieve the maximum benefit from their deployment.

Between 1997 and 2011 I have worked with many talented engineers, policy wonks, physicians and support staff to create a variety of computer tools that will allow us to take much better care of our patients, engage them and their support groups in self management and reporting, and securely communicate with us when they have questions and might need our help. In fact, it appears that –as long as we don’t alter the path chosen in 2008 we will even have mechanisms to reward clinical teams who demonstrate greater success and publish these data to you –the consumer- so you can fully participate in your own care decisions.

The epiphany that I have reached is that we have been a bit premature in deploying technologies that are still not fully standardized, rewarding a highly stressed out physician population for adopting the technologies and –in my humble opinion, not included you –dear consumer- in the actual process of design and training. Well perhaps a few focus groups but really, when you think about it we are talking about something that will become as common as the TV set in your family room. So, here is some excellent news:

1) The Office of the National Coordinator is always seeking comments from consumers so feel free to visit, participate and work toward a co-created solution

2) Now that we finally have all the stakeholders at the table: Government, Private Insurance, Patients, and Doctors etc. Many community forums are showing up that are requesting your input. Don’ take these lightly as actual business leaders and policy makers are looking at your feedback “finally some collaboration”. Of specific interest is the effort of Blue Cross of North Carolina to convene – what I consider to be the entire collective: Hospitals, Physicians, Pharmacy, Insurance Corporations, Employers, Biomedical Device Leaders, Attorneys and FINALLY us Patients whom they coin as ‘individuals’ which makes sense since we are all temporarily able bodies anyway! They call this community Let’s talk cost and have adopted a brilliant mascot; a Nubian Goat- implying that we need to retreat from our past behaviors of creating scapegoats, of one-another as the reason for the unbridled escalation in US healthcare costs. What a GREAT IDEA since we have now spent decades blaming each other, creating failed measures at cost control and generally reduced all stakeholders ‘especially individuals’ to a state of rambling diffuse psychobabble.  Take a peek you will be pleasantly surprised!