Posted on 01/05/2017 10:57:44 PM PST by Zakeet
if docs had readable handwriting ...
my internal medicine guy couldn’t read the oncologist’s
notes.
re: getting up to speed in using the program and that took time away from their patients.
Doctors used to spend 90% of their time seeing patients; 10% on paperwork. Most paperwork was done by non-medical employees.
Now doctors, both in hospitals and in private practice, have to spend 60% of their time as data entry clerical workers. That leaves only 40% of their time to see patients.
Consider how that drives up healthcare costs.
There are several factors in EMR.
10. The software is atrociously designed and coded. There is no thought given to response time. So if a doctor is at the keyboard for a 10 minute session, 5 of those minutes are spent looking at a spinning disk, or at a green or blue bar creeping accross the screen.
9. The software tries to be all things to all doctors and all patients. But not all doctors are the same and not all patients are the same.
8. The software and hardware are not designed for each other. The intent is that any software should run on any hardware. Good luck with that. Try crawl..but not run.
......
#10. The Gummint gums things up. Government bureaucracy moves very slowly. The current CMS requirements of both EMR and non-EMR software are based on a 1990s paradigm of 7 layer fat-client-server architecture. IT has changed a lot since the 1990s and will change rapidly in the future. There is no way the government bureaucrats can keep up. The bureaucrats will always be living in the obsolete technology.
Now, I'm an old guy, some of the younger ones are more efficient, having trained on these systems and they can push their patient contact time up to five or even six minutes.
But the whole premise of the EHR (decision support, e.g., what to do) is that the DIAGNOSIS is already known. In fact, the first thing I have to do when I "open" a chart is to code (correctly) the diagnosis.
PAs and NPs are actually BETTER than doctors at following guidelines (a/k/a "practicing evidence based medicine"). But, once an incorrect diagnosis is in an EHR, it assumes a certain permanence, and we have built a machine to do all federally approved interventions for the diagnosis, RIGHT OR WRONG, and we are creating an army of "providers" to carry them out.
This family doctor sums up the problem.
Dear Congressman Brooks,
As a practicing family physician, I plead for help against what I can best characterize as Washington’s war against doctors.
The medical profession has never before remotely approached today’s stress, work hours, wasted costs, decreased efficiency, and declining ability to focus on patient care.
In our community alone, at least 6 doctors have left patient care for administrative positions, to start a concierge practice, or retire altogether.
Doctors are smothered by destructive regulations that add costs, raise our overhead and ‘gum up the works,’ making patient treatment slower and less efficient, thus forcing doctors to focus on things other than patient care and reduce the number of patients we can help each day.
I spend more time at work than at any time in my 27 years of practice and more of that time is spent on administrative tasks and entering useless data into a computer rather than helping sick patients.
Doctors have been forced by ill-informed bureaucrats to implement electronic medical records (“EMR”) that, in our four doctor practice, costs well over $100,000 plus continuing yearly operational costs . . . all of which does not help take care of one patient while driving up the cost of every patient’s health care.
Washington’s electronic medical records requirement makes our medical practice much slower and less efficient, forcing our doctors to treat fewer patients per day than we did before the EMR mandate.
To make matters worse, Washington forces doctors to demonstrate ‘meaningful use’ of EMR or risk not being fully paid for the help we give.
In addition to the electronic medical records burden, we face a mandate to use the ICD-10 coding system, a new set of reimbursement diagnosis codes.
The current ICD-9 coding system uses roughly 13,000 codes. The new ICD-10 coding system uses a staggering 70,000 new and completely different codes, thus dramatically slowing doctors down due to the unnecessary complexity and sheer numbers of codes that must be learned.
The cost of this new ICD-10 coding system for our small practice is roughly $80,000, again driving up health care costs without one iota of improvement in health care quality.
Finally, doctors face nonpayment by patients with ObamaCare. These patients may or may not be paying their premiums and we have no way of verifying this. No business can operate with that much uncertainty.
On behalf of the medical profession, I ask that Washington stop the implementation of the ICD-10 coding system, repeal the Affordable Care Act, and replace it with a better law written with the input of real doctors who will actually treat patients covered by it.
America has enjoyed the best health care the world has ever known. That health care is in jeopardy because physicians cannot survive Washington’s ‘war on doctors’ without relief.
Eventually the problems for doctors will become problems for patients, and we are all patients at some point.
Sincerely yours,
Dr. Marlin Gill of Decatur, Alabama
Scary. Sounds like a freaky movie from the ‘80’s :(
Thanks for your spot on answer and explanation, octex, to the direct 0CommieCare connection.
Incorrect. The only people exempt from this cutting are patient-facing staff--doctors, inpatient nurses, etc. All the rest of us are eligible.
Currently, there are around 20,000 employees. We're cutting 800-900 people, which , technically, is less than 5%. However, by exempting a whole section of employees, the 5% number rises quite a bit.
The IT department went through this in October, and we're facing it again already. Morale is not high.
“Enterprise wide electronic records, billing, and pharmacy are extraordinarily expensive and drain dollars from direct patient care. But that’s hardly news. M.D.Anderson should have been able to anticipate for that and adjust accordingly.”
I hate to take this on but you may not have more than an outsider view. The EMR is completely intertwined in the entire provision of health care along with the various insurance options. I am familiar with this situation at another large medical center. Between the time spent on designing, programming, inputting and conversion plus the amount of staff time, current and hired, to implement the systems while running current systems in parallel, the drain on financial resources is monumental.
I do not disagree with the theory of having a virtual medical record as care can be administered with knowledge of a person’s complete history but all this comes at a tremendous cost. I do not make those decisions but to suggest there could have been better planning for EMR is myopic: the medical providers were given a time frame to accomplish this for medicare along with a subsidy to do so.
Next time anyone goes to their provider, notice they have additional personnel working around the office and consider these are non medical providers inputting coding and results into data bases. At medical centers, I you may not see them, but they are present in large data centers within the facility. BTW, the costs are not just the input personnel, the centers must buy/lease new hardware, adapt new software, and network them.
We are now too far down the path to bringing this to fruition, so it is not possible to say let’s stop now. So, while we may quarterback which system is being employed, yes there are at least 3 main EMR system software providers, I don’t think we should criticize costs incurred as they had no choice but to do so. It would be right to criticize which system a facility chose to implement though as they are not all “user friendly”.
Don’t you love it when you have to go to doctor 1 to get a referral to doctor 2 to get a referral to doctor 3 to get a referral to doctor 4 who you wanted to go straight to from the beginning. Guaranteed somewhere in the mix, they’ll send a man with shoulder problems to a womens/baby doctor.
Good friend who is doc says EMR requirements have reduced his productivity by 30%.
My personal doc figured out a way to minimize his productivity losses from having to use EMR - he started a new company (his son) that acts as “scribes”, who, with the patient’s permission, record each patient exam and then they enter the data into the EMR.
Yes - costs him money - but a whole lot less than his losses would be otherwise.
PS: I was an exec with an Eli Lilly subsidiary that was involved with EMR in ‘96 & ‘97......in its infancy/embryonic stage. The problem with today’s EMR requirements is they meet the requirements of bureaucrats and IT guys - with little consideration of what a doc needs or wants. I was also involved with a neuro-surgeon who with his PhD former NASA engineer wife was developing an EMR from a doc’s perspective. Gov. killed it.
The only reason the Feds wanted the electronic system is so that 1) Obama could reward one of his cronies with a $5B contract for an electronic medical record storehouse, and 2) so the Feds can spy on us, remove guns from anyone with a wide variety of temporary conditions, discriminate in hiring due to medical conditions, etc.
Obama’s legacy of hate continues to manifest his droppings in ways most of us knew would happen and the enemedia ignored.
A lot of the major facilities in Texas that the University of Texas took over in the last decade have had bad upheavals.
“hundreds of new codes”
I think the proper term is “thousands of new codes”. The old ones could no longer be used & if the government decided you assigned the wrong ones you would be fined.
That said, while there is always a reduction in physician productivity with implementation, it's not as though resources were not available for M.D.Anderson since there are tons of organizations out there that they might have (and should have, if they didn't) learn from.
Furthermore, the article suggested that this was a replacement EMR. So they certainly had experience implementing one previously.
There are specialties in which physician productivity is only marginally impacted and there are some where it is a disaster. The longer the problem list, the more time consuming the data entry.
Your point about driving up costs is well taken however. You are probably aware of a number of specialties who now hire "scribes" to perform documentation for the physician. The whole thing is a morass.
Just curious. What training do these “scribes” have? Is is a good field for our youth to investigate?
My brother is a doc and says this last year he has two people who follow him everywhere to keep up with the medical records requirements.
It is a massive surveillance activity that accomplishes little or nothing so far as I can see.
My doc sold his practice because of the records keeping that he could not afford to do.
And the NY Slimes wonders if the Republicans are “waiting” for it to fail? It is a disaster already.
Again from a doc I know. He gets calls from the business office telling him to recode his diagnosis so they can BILL MORE!
The hospital network is Sisters of Mercy out of St. Louis. My sis calls them the merciless sisters.
“I’m not sure what this has to do with the ACA.”
Sorry, you are wrong. The push was there before barky care but barky care MANDATED it in full application.
It has just about everything to do with barky care.
Barky care is a full up indefensible disaster that none of us who work and pay the bills can afford. Nothing but another give away program.
I’m at the point where I don’t care about my credit rating. Especially on things that I am correct on. Threat of collection agency in disputes has become more like blackmail.
I have three of them chasing me right now for bills I’ve been sent that I DON’T OWE! I’ve tried to explain but to no avail. I’ll pay for service received I agreed to pay but nothing else.
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