In the better one worlds, the computer systems of electronic medical records would serve less to improve the care offer, the quality of the diagnosis and the coordination of the personnel of health watch the scrupulous respect of the regulation, to protect the caring one for personnel of the risks of process, and to spend time and money in benefits of computer service.
It is nevertheless overwhelming that committee of the computer sciences and telecommunications of the national Counsel of the American research for Effective Health agreed for immediate steps and strategic directions (A computer technology for a system of health performance: immediate measures and strategic directions), and based on an examination of the systems set up in 8 of the American establishments the more in not at all regarding EMR software practices.
“The shutter technological and data processing of the observed professionals of the health committee rarely was well integrated in the practice clinic, rarely used to furnish them likely data to help them in their choice, the evaluation and the improvement of their practices, not more than to secure their care practices with the medical research.
The data processing of EMR furnishes rarely an overall view of the data relating to the patients, while the professionals of health spend a time considerable to inform the cares that they lavished them, in order to respect the regulation, and to caution itself risks of process, rather than to improve the quality of the lavished cares. Moreover, these systems put often decades to correctly to be adopted, and the major party of them were only little, or incompletely, integrated in the daily practice of the general practitioners.
The American president of a mutual insurance company raises as well as the success should not be measured according to the number of hospitals endow with computer systems of health or of the number of patients endow with electronic medical files. The success measures itself according to the improvement of the results clinics. While medicine bases on a complex report, and human, mixing observations clinics, medical knowledge and discussions with the patients, the doctors must pass of more in more time to integrate and to treat computer data brutes, abstracted and varied in systems and done often few interfaces case of what they can bring as service to their users. The all to the detriment of the patient, nerves of the doctor and quality of the cares.
To The final one, the comprehension of the position of the patient risks being lost to the beautiful environment of an amassing of data, of tests and of tools of monitoring. A time and a precious energy are passed to manage data rather than try understand the patient.
OF THE “POTENTIAL PATIENT” TO HELP THE DOCTORS TO UNDERSTAND THEIR WELL REAL PATIENTS
Without surprise, the report recommends the reorientation of these systems for that they (re)mettent the patient to the heart of the process, and focus themselves on what they can improve in terms of care quality, and not on the adoption itself of these systems, to the motive that the technology is secondary. Its suggestions aim some not less to go again further in the computerization of relation doctors patient, through the intervention of devices allowing automating the data anthology. The objective is to be able to model potential patients, alter egos numerical on which these the general practitioners could rest to decide treatments to apply to their well real patients.
The current systems would propose in fact not enough cognitive support to the general practitioners, while they should furnish helps and assistance in terms of decision take, and of resolution of the problems. This potential patient, underlines David C. Kibbe, expert of the medical technologies of information with the academy of the doctors of family, would be a conceptual model reflecting the comprehension, by the general practitioners, interactions physiologiques, psychological, sociétales, and other dimensions (sic) patient.
THE MEDICAL DATA ALSO MUST BE LEGIBLE FOR THE PATIENTS
The report recommends equally the development of technologies to even to clarify the context of the data, but also to identify and to eliminate (sic) the inefficient process of work, otherwise says, tools software loaded to do the housework in the other software of the factory to gas of medical data processing. In the same order of idea, it would suit also to avoid, in the future, the focused programs on the adoption of such or such applications or software, and to encourage, has contrario, the interoperability of the data, so that they can pass from one system to another, and to be used so by the different general practitioners that by the patients themselves.
Evoquant their vision of a cognitive support putting the patient to the center of the device, the authors of the report qualify thus ultimate and significant profit does, for the patients themselves, to be able to use these tools (that have therefore, they specify, to be conceived with this objective in head) so that they are able them also more better to apprehend, and understand, their own states of health. If the report recommends not clearly the adoption of standard ones, it insists for that the data can equally be réinterprétées, in the future, according to the advances and computer discoveries, and medical. It would be necessary therefore also to accelerate the research interdisciplinaires between biomedical data processing, social sciences and engineering of the systems of health.
A QUESTION OF BUSINESS
The issue has the ability, and the well chosen moment: the Boston Globe recalled thus recently that Barack Obama was involved itself to spend 50 billion dollars, in the 5 years to come, in technologies of medical information, in the framework of a plan of 700 billion dollars aiming to support the industry high-tech. The objective is to improve the care system, but also to save money, while reducing the administrative expenses, the medical errors, and the useless or redundant examinations. the estimated gain is not harmless, and could attain… the 80 billion dollars per year.
The computer systems of health in fact often are presented as an allowing means to fight against the medical errors (the report evokes thus the avoidable figure of 98 000 deaths each year to the WORE, while one talks about 10 000 deaths in France) and the treatment error, or medicinal counterindication, that would be responsible of 10 000 deaths).
If the Personal Medical File (DMP) French has all of fiasco (it suffices to read the summary of the report that was consecrated him in 2007 for some to be done an idea), the Pharmaceutical File (DP, that has for object to allow the pharmacists to divide the by name data relating to the medicine deliveries, in order to warn medicinal interactions), well more discreet, and well less debated than his predecessor, Is on the way to to generalize itself, with more than 2 million created files to the date back to January 5 last, a year and half only after launching.
Officially, it is a matter to spot the redundancies or undesirable interactions enters treatments, to improve the counsel of the pharmacist, to propose to the patient a therapeutic followed pharmacist and, at last, to supply the shutter medicine of the Personal Medical File (DMP) patient. But the objective is so economical: in his White Book, the Counsel on the order of the pharmacists posts thus clearly that the deployment of his DP is a major element of the debate on the maintenance, in any undisputable point, monopoly of the officine facing the announced competition of the hypermarkets and other parapharmacies. The similar creation of a system to the United States, that George Bush had promised to the horizon 2014, is thus she also on the rug. But it does not exist, to this day, of reassured system at the national level, and the legislation differences, regarding protection private life, differ often between States, returning the even more difficult task.
The interoperability problems are them also a brake, and not least: according to Melissa Goldstein, professor of public health to the university George Washington, the position would be similar to the years 80, when” Apple could not read the files WordPerfect and Microsoft Word”. Other problem, and not of the least ones: the cost of this computerization, borne in good party, indeed in entirety, by the general practitioners themselves. It would cost some to them between 25 and 45 000 dollars by office, more some other thousands for maintenance, each year. To this day, less than 25% of the American doctors would enter, in their computer systems, data relating to their patients.
As the underlines a professional of the systems of information of health, today, this is not the one that pays that wins to computerize itself. Now, if medical data processing respects the objectives that one assigns him, there will be less than medical or medicinal errors less than redundant examinations, and therefore less than consultations. Now, raise ironically the Boston Globe, the doctors are paid when they are
consulted, by to maintain their patients in good health…