Computer Medicine

Computer medicine is certainly the destruction of quality care. It is most unfortunate that we have become entirely dependent on the computer to function. I need to create some reports today, but the computer won't let me access my flash card due to computer PMS. I need to access my medications database which I use multiple times per day to look up things (usually drug-drug interactions since everyone who comes here is on ten or more medications) but I can't. The web site doesn't like some of my cookies. The tech support there wants me to delete all of my cookies, which I obviously don't want to do. I do have a "tech man". He is quite good at what he does, but he can't seem to fix my computer, it is in a state of permanent breaking. He patches up one hole and another one pops up right away. Things are getting worse. There is a powerful move for us to all get "EMR". That is short hand for electronic medical records. It is an undisputed fact among the powerful (the "payors") that EMRs improve quality of care. The research that has been done shows that this is not true at all. There is no evidence to support that claim. What it does do, is it allows more access to medical activity that can be more quickly and easily assessed. It will help insurance companies to gain data on economic activity, but little else. There are computerized models that can assess "quality" based on guidelines. More and more power is being conceded to computerized methodology of assessing compliance with guidelines. But there is a very serious problem with this. Research on guidelines shows that they are not appropriate for MANY or even most patients. They have not been evaluated in the setting of multiple medical issues. We know that we should use beta blockers in heart failure since they decrease death. So that is a guideline. However, beta blockers can be very dangerous for diabetics with neuropathy since they cause fainting and broken hips and head trauma. So when I take them off their beta blockers in an attempt to balance risks and benefits, the computers find out that I am performing "poor quality" medicine. Research on this topic does not in any way support that idea, because no one has done research on how we should treat diabetic neuropathy patients who also have heart failure and present with dizziness that is due to "orthostasis". Since hip fractures have a 30% death rate, it is very possible that these people will actually have an INCREASE in their death rate if we treat them with a beta blocker. We just have no idea. So if we have no idea, and what we do know is that the patient is complaining of dizziness with risk of falling and passing out with the medication he or she is in certain danger from a medication with an unknown benefit. There is really no way to dispute this. However, the computer knows that this is bad quality. Meanwhile, I can't open the documents on my flash card. We can cosider putting the computer outside and driving over it with the Suburban (I'm not anti-environment. I have to have a Suburban due to a very large family). However, there is the blogging benefit. I can blog which seems to help with patient care. It lets me think about how taking care of the patients fits in to the universe. Also, I can get the patient notes at home. This is invaluable. If the terrorists or the hurricanes destroy my office, I have almost all of the patient chart information in the laptop. So you have to love them. But it's an awful state of affairs. It's love-hate.