As much as EHR systems are blamed for sins of commission, it is often the sins of omission that trip up users even more. She developed gangrene, which led to the amputation of her lower legs and forearm.
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Her husband, Richard, has become her primary caregiver and had to retire early from his job with the city of Kenner to care for his wife, according to the suit. Each party declined to comment. With EHRs now nearly universal, the face and feel of medicine has changed.
The doctor is now typing away, making more eye contact with the computer screen, perhaps, than with the patient.
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Beyond complicating the physician-patient relationship, EHRs have in some ways made practicing medicine harder, said Dr. Hal Baker, a physician and the chief information officer at WellSpan, a Pennsylvania hospital system. Even if docs may be at the keyboard during visits, they report having to spend hours more outside that time — at lunch, late at night — in order to finish notes and keep up with electronic paperwork sending referrals, corresponding with patients, resolving coding issues. For all that so-called pajama time — the average physician logs 1. In preliminary studies, Ratwani has found that doctors have a typical physiological reaction to using an EHR: stress.
Karla Dick, a family medicine physician in Arlington, Texas. Among the daily frustrations for one emergency room physician in Rhode Island is ordering ibuprofen, a seemingly simple task that now requires many rounds of mouse clicking. Every time she prescribes the basic painkiller for a female patient, whether that patient is 9 or 68 years old, the prescription is blocked by a pop-up alert warning her that it may be dangerous to give the drug to a pregnant woman. The physician, whose institution does not allow her to comment on the systems, must then override the warning with yet more clicks.
What worries the doctor most is the ease with which diligent, well-meaning physicians can make serious medical errors.
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She noted that the average ER doc will make 4, mouse clicks over the course of a shift, and that the odds of doing anything 4, times without an error is small. This is a poor tool issue. Sam Butler, a pulmonary critical care specialist who started working at Epic in , leads those efforts at the Wisconsin-based company.
He said Epic uses such insights to improve the client experience. This is something the government mandated. In early December of that year, Obama, barely four weeks after his election, pitched an ambitious economic recovery plan. The idea had already been a fashionable one in Washington.
In the depths of recession, the EHR conceit looked like a shovel-ready project that only the paper lobby could hate. The goal was not just to get hospitals and doctors to buy EHRs, but rather to get them using them in a way that would drive better care. Everyone had big ideas for the EHRs. The FDA wanted the systems to track unique device identifiers for medical implants, the Centers for Disease Control and Prevention wanted them to support disease surveillance, CMS wanted them to include quality metrics and so on.
Not everyone agreed, though, that they were the right ideas. Halamka, who was an enthusiastic backer of the initiative in both the Bush and Obama administrations, blames the pressure for a speedy launch as much as the excessive wish list.
Bob Kocher, a physician and star investor with venture capital firm Venrock, who served in the Obama administration from to as a health and economic policy adviser, not only defends the rollout then but also disputes the notion that the government initiative has been a failure at all. But Rusty Frantz heard a far different message about EHRs — and, more important, it was coming from his own customers. The executive team was inaccessible!
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The service experience was terrible! Frantz had bounced around the health care industry for much of his career, and from the nearby perch of a medical device company, he watched the EHR incentive bonanza with a mix of envy and slack-jawed awe. This company, we were complicit in it, too. Even that may be a generous description. The consultant also noted that similar problems appeared to be occurring at as many as a dozen other hospitals that had installed NextGen software. By , NextGen had more than 19, customers who had received federal subsidies.
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NextGen was subpoenaed by the Department of Justice in December , months after becoming the subject of a federal investigation led by the District of Vermont. Allscripts said in an email that it cannot comment on an ongoing investigation, but that the civil investigations by the Department of Justice relate to businesses it acquired after the investigations were opened. Much of the marketing mayhem occurred because federal officials imposed few controls over firms scrambling to cash in on the stimulus.
Following the same playbook used by pharmaceutical companies, EHR sellers courted doctors at fancy dinners in ritzy hotels. But as the federal government opened the stimulus tap, many raised doubts about the promised savings. Last month, Sen. In addition to the U. She visited doctors around the country, at big urban practices and tiny rural clinics, and from those front-line physicians she consistently heard one thing: They hated their electronic health records.
What she heard then became suddenly personal one summer day in , when her husband, himself a physician, collapsed in the airport on his way home to Indianapolis after a family vacation. For a frantic few hours, the CMS administrator fielded phone calls from first responders and physicians — Did she know his medical history? Did she have information that could save his life? Her husband survived the episode, but it laid bare the dysfunction and danger inherent in the existing health information ecosystem.
A free exchange of information means that patients can be treated anywhere. Blumenthal acknowledged that he failed to grasp these perverse business dynamics and foresee what a challenge getting the systems to talk to one another would be. In the absence of true incentives for systems to communicate, the industry limped along; some providers wired up directly to other select providers or through regional exchanges, but the efforts were spotty. She has promised to reduce the documentation burden on physicians and end the gag clauses that protect the EHR industry.
In one sign of progress last summer, the dueling sharing initiatives of Epic and Cerner, the two largest players in the industry, began to share with each other — though the effort is fledgling. When it comes to patients, though, the real sharing too often stops. Fewer than half would share records via email. The Bible offers a vision of a God who is big enough to handle such questions, and big enough to trust even when life seems to be falling apart. One of the deepest and most poignant treatments of suffering in the Bible is the story of Job.
Job was an innocent man who suffered terribly; he lost everything he had and, on top of that, was covered in boils. Their reasoning was this: Surely Job must have provoked God in some way! That is the only possible explanation for the suffering that has overcome him.
What did you do to deserve this?
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Job even prays for his friends because God is angry with them for how they treated Job. One use of the book of Job is to distinguish a biblical view of suffering from the concept of karma, which is the notion that there is a kind of unbreakable cause-and-effect law in the moral realm. In a universe governed by karma, people who do good will experience good, and people who do bad will experience bad. That means that if we see someone suffering, we can conclude that they did something wrong to bring it on themselves.
Many people assume—perhaps sometimes subconsciously—that this is exclusively how suffering works. The biblical view of suffering is more nuanced than the karmic view. In the biblical view, we cannot always understand why suffering happens in this life. Job never learned the true cause of his suffering, even after he had been restored by God. But Job encountered God. Some critics look at this response as a non-answer to the problem. When Job sees God, he no longer needs an answer. God himself is the answer. Job responds with joy and repentance. Like the character Orual in C.
We see here a hint of the hope that the Bible offers to sufferers.
Why is this? He gave us himself.
A Deeper Look at What the Bible Says about Pain and Suffering
He came. He entered space and time and suffering. At the center of the biblical story is a God who actually enters into suffering for us. He was born, lived, died, and rose again from the dead to defeat evil and reconcile to God those who trust in him. When Jesus hung on the cross, he suffered one of the worst deaths imaginable, because he took on all the sins of humanity. Despite his innocence, he died for our transgressions.
This is the main message of the Bible, and it is a message of incredibly good news. At its heart, the Bible is not a book of advice or moral principles to help us deal with suffering and have a better life. Fundamentally, it is the story of what God has accomplished for us, how he is repairing a broken world; it is a message of hope in light of his suffering for us. If Jesus was God among us, as the Bible claims, then we can no longer view suffering in the same way.
As Dorothy Sayers wrote:. Of course, the suffering of Christ does not immediately take away our own pain. In fact, Jesus assured his followers they would indeed have trouble in this life.
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