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Big Bad Legacy EHR Products

IBM "cloud" computing - circa 1975 There is no self-respecting innovator in Health Information Technology (HIT) who has not spoken or written about the horrific state of Legacy EHR products, which are slowly but surely being deployed in more and more health care facilities as a result of Meaningful Use incentives and changing reimbursement models. A couple of months ago I saw an EMR in a small practice. They’ve been using it for 15 years and it was a DOS based system with the ubiquitous neon green text glaring on a black and sometimes blue background. Aha! That must be a Legacy EMR, and sure enough the doctor was looking to replace it with a more modern product, but which one should he get now? After all, the last thing you’d want is to have him buy yet another Legacy EMR. According to dictionary.com , a Legacy system is a “computer system or application program which continues to be used because of the cost of replacing or redesigning it and often despite its poor competitiv...

Rationing Our Finite Resources… with Our Eyes Open

Two articles published in the latest NEJM issue are devoted to “our finite resources” and the inevitability of rationing care. First Dr. Howard Brody is attempting to rephrase the issue as one of “waste avoidance” and is delving into the ethics of practicing waste avoidance which is defined as withholding non-beneficial care. Of course non beneficial is not a cut and dry label, so Dr. Brody is envisioning that “[a]n ethical system for eliminating waste will include a robust appeals process”, where “[p]hysicians, as loyal patient advocates, must invoke the process when (according to their best clinical judgment) a particular patient would benefit from an intervention even if the average patient won't”. While the sentiment is commendable, I am not clear who exactly should physicians appeal to “according to their best clinical judgment” and I am not certain where the newly empowered and engaged patient go. Or is all this empowerment and engagement talk just a cruel joke? The second a...

Electronic Parking Lot

I was headed to a meeting downtown yesterday, and finding a place to park in the city is always a challenge. Luckily, there is a little old lot right next to the office building, which is a bit more expensive and does not accept any ticket validation, but it’s very clean, well lit and convenient. Up until last year the lot was owned and operated by a “mom and pop” type of business. You pulled in, found a good spot and by the time you grabbed your stuff and stepped out of the car, an elderly gentleman was standing there writing your receipt. You gave him some cash, took the little pink receipt and went about your business. When you were done, you came back, got in your car and drove away. No automated barriers, no buttons, no credit cards and no hassles. Yesterday, my little parking lot was different. The first thing I noticed was that the parking spots were numbered, with big white digits imprinted on the freshly resurfaced asphalt. The second thing I noticed was that it was a bit hard...

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