Stop blaming faxes and malpractice fears, start embracing EMRs and CDS

If you saw our flagship health publication, FierceHealthcare, on Monday, you would know that the California Department of Public Health has been cracking down on hospitals responsible for breaching patient privacy.

Likewise, readers of FiercePracticeManagement already know that defensive medicine costs tens if not hundreds of billions of dollars every year and that, according to a survey of physicians across many specialties, duplicative and medically unnecessary testing as a safeguard against malpractice suits can severely strain the physician-patient relationship.

I'm pretty confident that you, the readers of FierceEMR, know where I'm going with this.

In one head-slappingly stupid California incident, Children's Hospital of Orange County reportedly faxed six documents containing various pieces of protected health information to an auto shop in 2009. 

Staff apparently didn't follow hospital policy of sending a test fax first, but that's really beside the point. Hospitals shouldn't have to rely on 1980s technology to transfer medical records in the first place. As long as there's good security and proper identity management, this sort of thing couldn't happen with EMRs and health information exchange, right?

Similarly, the survey about defensive medicine is emblematic of an industry that's living far in the past. "When you sit around at a dinner party with doctors, malpractice fears and a kind of hatred of the malpractice system really comes up as a common theme," New York internist Dr. Tara Bishop told the Associated Press. Tort reform is offered as a solution.

I'd argue that tort reform is only a short-term fix. What's really needed is information reform, workflow reform and a greater focus on quality. Have previous test results readily available via EMR and duplication goes away. Give physicians user-friendly clinical decision support and you should see a decline in unnecessary testing. Include diagnostic decision support in CDS systems and the old game of trial and error gets tossed into the dustbin of history. And above all, start incentivizing outcomes rather than volume. If diagnostic testing weren't so profitable, there wouldn't be so much unnecessary ordering. - Neil

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