AK Voices: Brian Sweeney Jr.

Brian Sweeney Jr. is an opinionated gastroenterologist in Anchorage.

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New Tricks, Ready Or Not

During the health care debate I went to a meeting where Senator Mark Begich came to discuss health care issues with physicians. Imagine asking the industry about the problem? Who does he think he is, Governor Parnell trying to find out concerns of the oil industry?

Marky Mark never ceases me to amaze me with how little he knows. At one point he talked about how the Veteran's Administration (VA) was a perfect example of how pharmaceutical expenses could be managed. Colleagues around me groaned.

In my field there are issues with the VA when it comes to proton pump inhibitors, inflammatory bowel disease drugs, and bowel preparations. There is no problem when equivalent less expensive therapies will work but the VA will stand on the deck as the ship sinks in many cases demanding use of something that does not.

The gastroenterologists in town know the VA's preferred bowel prep is inferior. It ends up with us having to recommend shorter colonoscopy intervals when a preparation is less than ideal. This in turn increases the overall cost of care despite saving pharmacy money. A classic problem in government not assessing how one piece affects the rest of the pie.

Another Begich saving grace for health care was Electronic Medical Records (EMRs). His example was records he had in Alaska not being transferred directly to a physician in Washington, DC.

Begich was just regurgitating a point Obama has made in the past. Could it have anything to do with Obama's cozy relationship with General Electric?

Marky Mark seemed to think if an Alaska physician and a Washington DC physician had an EMR there would be instant transfer. It is a naive statement in that even if the two doctors had the same system there would not be communication. Even large entities like the VA cannot transfer the information effectively from place to place seamlessly.

On top of that there are issues related to the Health Insurance Portability and Accountability Act (HIPAA). An office cannot release any information without the patient's consent.

EMRs are the future. I have been waiting for months to finally have mine installed in the next few weeks.

There are growing pains with any technology. It takes time for individuals using a system to become proficient. It takes longer to have people master it and some may never get there.

Old dogs do not like new tricks. Many older physicians resist EMRs. The advent of EPIC at PAMC played a role in Dr. Sweeney, Sr. retiring. I have even heard EMRs called dangerous by some physicians. It is an argument with some merit in the short term.

It can be extremely difficult to enter complicated orders or histories into an EMR. This is lost on many people outside medicine. It tends to be where the systems get snagged.

There is a false sense of security among patients. It is not unusual for a patient to say their medications are listed on a printout from an EMR. Sometimes the lists are not accurate. More importantly it is concerning that a patient is not using medications as prescribed if they do not have a list themselves. This is a common problem with VA patients.

There are many advantages to EMRs. There is less transcribing of orders. This means poor penmanship and spelling go away as problems. Dosing tends to be more accurate as well.

If data is inputted properly it puts information immediately at the fingertips of the user. This is especially helpful if patients have poor memories. The data can go back further as well as there is no reason to shred records after 7 years.

The lonely search for the chart is gone. The computer is turned on and the chart is there. The time this saves is often forgotten by many physicians.

The challenge to any EMR is getting by the growing pains. I went with a system I am now familiar with to some degree. I went with a system I felt would minimize communication problems with other entities in town. And I went with a system I felt would not be a threat to patient care and be cost effective.

There will be years and years of growing pains as EMRs die. Many will die from not meeting the long lists of regulations aimed at EMRs. Others will die because the small companies that make them will go bankrupt. All of it will drive health care entities across the country crazy as they struggle to comply with the clouded vision of bureaucrats.

A dentist with stars on his shoulders came to talk to us when I was at Elmendorf. He told we needed to view our patients as F-15s and follow the model set in the hangers.

I understood the point but the analogy has many problems. Medicine is not jet maintenance or banking or any other industry. Adapting computers to medical use is a complicated and unique process. It gets more complicated with a broken coding system and many players involved.

On balance, with time, EMRs benefit the health care system. It would be nice if politicians would at least demonstrate some knowledge of the ins and outs of the process before declaring it a savior. That would prevent them from passing laws that make the implementation worse rather than better.

The politicians do need to talk to the CEOs and the people in the trenches. There is a fine line between expert and special interest and it is one that our leaders must learn to navigate.

It has to be more than appearance. And statements that ignore simple realities do not inspire confidence. The country will remain on the wrong track until our leaders begin to worry about actually learning about an issue and getting it right.

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