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Dump badly designed government e-health records. Open up e-health systems to public ratings and reviews. And make technology firms compete for the right to do business with doctors and nurses

The reason that your favourite apps are so fluid and practical? They have to compete for your business. There are over 1 million apps on the Apple store. They all fight for the right to be bought and downloaded. There are all rated, reviewed and featured in endless uTube videos. Competition raises standards.

In contrast, there is no competition for e-health records system. Government departments blithely sign off on billion dollar contracts for software that they will never use. Hospital CEO’s buy million dollar computer systems that have never been tested, rated and reviewed by their ground floor staff.

The result is far lower standards in e-health software than any modern applications. Sluggish, clunky, poorly designed e-health records are the norm. No e-health records system had to compete for the user’s dollar.

Some recent examples. Nurses have complained to me that the latest electronic drug charts have built-in alerts, which force the nurse to go back to the patient 10 minutes after they have given out the medications and ask if the medication was “effective”.

Seriously? Would you ask yourself if your reflux medication made you feel better 10 minutes after you had taken it every morning? Or your beta blockers? Or panadol? Most people don’t feel anything after they have taken medication. It is mostly long term treatment, that stays in their system for 24 hours or more, and has an accumulative effect. Why tie up nursing staff with silly rules that are not practical?

Medications

Medications

Medication errors, like all hospital errors, are an epidemic. But they are part of the wider problem. Hospitals are filled with frail elderly people having unnecessary, invasive and often distressing treatments. The reason is a lack of funding for long-term planning and end of life management. Health care is only funded in brief, episodic events. 1 blood test = $20. 1 CT scan $250. One medical review of 10 minutes $85. No GP, nurse or hospital is funded to deliver coordinated, practical, long-term care. Making nurses go back 10 minutes after each medication has been signed off and ask the patient ‘how they feel’ will not fix this problem.

Other reasons for hospital errors are a health ‘data’ disaster. The inaccuracy of medical records is comparable to a 19th Century Russian novel. Wrong name, wrong date of birth, wrong diagnosis, wrong medications, wrong hospital admission, wrong body part operated on in surgery…

Jumbled bits of paper fall out of manila folders, that are held together with elastic bands and carted around in shopping trollies (no I’m not joking). The one hospital ward can have different computer systems that don’t interact or share data.

Nothing cross references in health care. Instead of accurate data we have information silos and secrecy obsessions. People talk in hushed tones about the need for privacy of medical records. And ignore outrageous errors that result from keeping information fragmented and out of date.

In the UK, nursing errors are apparently being graded on a scale of 1 to 5. Nurses are being tied up with silly regulations that overemphasise the importance of the most irrelevant issues like giving two panadol less than 6 hours apart while systemic and fundamental problems are ignored.

At the same time health care services are being flung into the hands of private contractors. In Australian one-third of all hospital beds are now private. The result? Permanent nursing staff are sacked (too expensive). Private hospitals run on a skeleton of agency nurses  (lowest grade possible). Doctors are visiting consultants only (bus stop medicine, drive in, drive out). Essential procedures like handover, discharge planning and preoperative checklists are reduced to a tick and flick procedure. More errors anyone?

I’m all for efficiency. But I’m also all for giving people the right tools to do their jobs properly. If people get to choose productivity apps like Evernote and Dropbox, why can’t they choose e-health records? The back end of any e-health system is just a database. The front end could be hundreds of options. Pick your favourite e-health system. May the best contractor win.

And as for silly bureaucratic regulations and electronic alerts on drug charts, they are nothing more than swapping deck chairs on the Titanic. A recent study showed that almost 20% of errors occur with medications. I’m surprised the figure is so low. Why are we overmedicating so many elderly people? What happened to keeping people warm, clean, well fed and comfortable? Old age in a normal stage of life, not a disease to be cured. Or a billion dollar financial opportunity for multinationals.

Let’s have an open rating on all e-health systems. Make software companies compete on the open market. uTube, blog and Podcast every electronic health system; invite comments, ratings and reviews. Transparency is how you fix problems. Not silly regulations, mountains of red tape and lucrative contracts to big business.

© Wikihospitals November 2015

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