Posted on 12/14/2012 3:59:39 AM PST by Kaslin
Here's more evidence that government "cures" are inevitably worse than the "diseases" they seek to wipe out. Buried in the trillion-dollar stimulus law of 2009 was an electronic medical records "incentive" program. Like most of President Obama's health care rules, this top-down electronic record-sharing scheme is a big fat bust.
Oversight is lax. Cronyism is rife. The job-killing and privacy-undermining consequences have only just begun.
The program was originally sold as a cost-saving measure. In theory, modernizing record-collection is a good idea, and many private health care providers have already made the change. But as with many government "incentive" programs, the EMR bribe is a tax-subsidized, one-size-fits-all mandate. This one pressures health care professionals and hospitals across the country into radically federalizing their patient data and opening up medical information to untold abuse. Penalties kick in for any provider that hasn't switched over by 2014.
So, what's it to you? Well, $4 billion has already gone out to 82,535 professionals and 1,474 hospitals, and a total of $6 billion will be doled out by 2016. But the feds' reckless profligacy, neglect and favoritism have done more harm than good.
Don't take my word for it. A recent report released by the Department of Health and Human Services Inspector General acknowledged that the incentive system is "vulnerable to paying incentives to professionals and hospitals that do not fully meet" the program's quality assurance requirements. The federal health bureaucracy "has not implemented strong prepayment safeguards, and its ability to safeguard incentive payments postpayment is also limited," the IG concluded.
Translation: No one is actually verifying whether the transition from paper to electronic is improving patient outcomes and health services. No one is actually guarding against GIGO (garbage in, garbage out). No one is checking whether recipients of the EMR incentives are receiving money redundantly (e.g., raking in payments when they've already converted to electronic records). No one is actually protecting private data from fraud, abuse or exploitation.
Little is being done to recoup ill-gotten payments. In any case, such "pay and chase" policing after the fact is a crummy way to run government in lean times -- or in fat times, for that matter.
As for the claim that the EMR conversion will reduce paperwork, many doctors say the reality is just the opposite. In Greensboro, N.C., Dr. Richard Aronson told local TV station FOX 8 that the mandate doubled the amount of paperwork in his private practice. Everyone from optometrists to general practitioners to chiropractors to podiatrists must divert precious time and resources to conforming with Washington health bureaucrats' imposed vision. Some medical professionals are now warning that the dangerous phenomenon of "distracted doctoring" is on the rise as a result of data-driven imperatives that direct health care providers' attention away from their patients and onto their screens and hand-held devices.
You know who is benefiting from the initiative? Put on your shocked faces: Obama donors and cronies.
Billionaire Judith Faulkner, Obama's medical information czar and a major Democratic contributor, just happens to be the founder and CEO of Epic Systems -- a medical software company that stores nearly 40 percent of the U.S. population's health data. Another billion-dollar patient-record database grant program has doled out money to the University of Chicago Medical Center (where first lady Michelle Obama and senior adviser Valerie Jarrett both served in high-paid positions). As I've previously reported, these administration grants circumvent any and all congressional deliberation as part of Team Obama's election-year "We Can't Wait" initiatives.
Even as the White House touted the move toward gee-whiz 21st-century electronic databases, health care professionals in the know have debunked that claim, too. Companies like Faulkner's, which lobbied loudest for the mandates and "incentives," represent traditional hard drive-dependent software firms that are already dated. As Athenahealth Chairman and CEO Jonathan Bush, who advocates cloud-computing alternatives, put it: The Obama electronic records mandate is "healthcare information technology's version of cash-for-clunkers."
Then there's the still-growing and untold number of doctors nationwide who are closing up shop or limiting their practices and converting to "concierge care" to escape this and myriad other Obamacare intrusions. My own primary care physician in Colorado Springs quit her regular practice and converted to "concierge care" because of the EMR imposition. Creve Coeur, Mo., doctor Shari Cohen made the same move.
"The demands of caring for my patients while navigating through the current health care delivery systems dictated that I take more and more time away from patient care and spend an increasing part of my day on the system itself," she told the Creve Couer Patch. "Electronic Medical Records was the final shove for me. It added another whole layer in interference in the doctor-patient relationship and one I was not sure I wanted to take on."
More paperwork. More waste. Less accountability. Less care. Government malpractice at work.
That is a fantastic post and delineates better than I could ever have a well functioning electronic medical records system.
The problem is for individuals or small groups unwilling or unable to participate. The fact is, their day is over. The scope of modern medicine is so broad, going alone in a practice simply can’t be tolerated by the evolving systemic change.
I would argue that what you experienced was not understood. You placed the blame in the wrong place. The reason for the ever increasing record keeping burden is not the use of digital records.
The reason for increase in written reports is to have evidence to produce in court when the lawsuit comes to trial.
Lawyers, blood sucking plaintiff lawyers, were to blame for your problems
Fast forward ten years. Unionized government doctors and healthcare.
What you describe is great if it was kept out of the evil hands of government who will use that information “for our own good”.
“I would argue that what you experienced was not understood. You placed the blame in the wrong place. The reason for the ever increasing record keeping burden is not the use of digital records.
The reason for increase in written reports is to have evidence to produce in court when the lawsuit comes to trial.
Lawyers, blood sucking plaintiff lawyers, were to blame for your problems”
Incorrect.
The increase is due to the need to establish “meaningful use”.
Nobody says docs shouldn’t consider automating their records and do so it if it makes sense. What is ridiculous is for the government to pay them to do it in order to control the data.
The problem is for individuals or small groups unwilling or unable to participate. The fact is, their day is over. The scope of modern medicine is so broad, going alone in a practice simply can’t be tolerated by the evolving systemic change.
Thanks. : )
As I said, I currently work in HR, my focus being in payroll processing and regulatory and tax compliance and in managing the Human Resources Information System (HRIS) so admittedly I’m a bit of a tech-y myself but I have seen a big change in recent years of moving from paper record keeping and manual processes in payroll and HR to e-processing, biometric hand scan time clocks, cloud computing, direct deposit and what many employees want and what many now demand.
Employees, especially younger workers want things like being able to access their pay stubs and W-2’s, view time off balances and request time off, make changes in their W-4 withholding or their direct deposit accounts in an on line in a secure environment 24-7 from their personal computers, tablets or smart phones.
For several years now we have held our annual open enrollment on line and new hire enrollment on line – all employees log in to the secure site and make their new hire or open enrollment insurance elections rather than filling out paper forms and those elections are electronically transmitted to the insurance companies, greatly reducing the error rate of illegible hand written paper forms being keyed into our HR benefit system and then again into a separate insurance system by humans who may not always key the information correctly or the problem of the paper forms getting lost in inter office mail or USPS mail or sitting on someone’s desk.
Employees can also see their current enrollments and see what their per-pay deductions would be if they were to make changes before they submit those changes. They can print out their own benefit statements and print their own insurance cards, they can even find providers and even make appointments on line.
Employees are also given secure access to the insurance company’s web sites so they can track their own insurance claims and EOB’s, track their deductibles and track their FSA balances in real time – giving employees those tools makes them more self sufficient and reduces the employer’s administrative costs and burdens. They can also get real time information on their 401k account balances, make deferral changes and fund changes, view any fund prospectus on line without having to wait for quarterly statements or on snail mail.
Being a manufacture, we have some employees who do not have personal computers or work computers or smart phones and are still rather computer illiterate but they are the exception rather than the rule now days. We accommodate them by providing an on-site computer kiosks with a printer in a private area and if they need help or support, we in HR provide it but they still must use the electronic systems.
There was a time when these sorts of systems were only available to large employers but now days companies like ADP and Ceridian offer affordable e-processing, direct deposit, scalable solutions for even very small employers. Employers that still rely on manual time keeping systems, manual live paper payroll checks and paper insurance enrollment forms and other HR forms and employees who cannot adapt are dinosaurs and will soon either adapt or go extinct. The same can be said for healthcare providers.
I can’t wait until they do a database merge with the DNC’s Votebuilder.
I’m sorry (insert your name here) but our data base shows not only are you a registered Republican but you have been identified as spending time on the subversive site FreeRepublic. Take a number while we take care of loyal patients. Please stop bleeding on our floor while you wait.
In fact, I'll use your records to track you down, stalk you to the local Denny's where you're having a cup of coffee together, and plunk myself down in your booth and initiate a long and intimate discussion of your medical history and nagging problems that my patented Little Liver Pills can help you with. You'll be so glad you met me -- I'll be totally informed with a 360o panoramic perspective of your personal health, and several suggestions how you can make me rich.
And speaking of "three-sixties", I'll of course have access to your psych evals, workplace colleague- and supervisory-evaluation 360's and personality-sorter results, so I'll know you better than you know yourself, which will come in handy if I need to manipulate you a little bit.
We're going to have so much fun making me rich and powerful together!
That's how they do it in China.
Visitors there notice two things about Chinese health facilities.
Yeah, we should do it like those Workers' Paradises (R). Then we'll be all advanced and stuff. You know -- civilized.
All the advantages you mentioned occur only if the systems communicate. They don’t. Also, again you mentioned how much the doc does to keep the info flowing. Abstracting charts is done poorly by most people so when you request the records they are frequently out of place. BTW, I’m not in the VA system and to look at VA records I have to have the records printed off and it’s extremely volumonous just for the most simple of records.
Again, I’m not saying that EHR won’t work but it is many upgrades from being useful to busy practives. That’s not to say the tests etc. aren’t better electronically. They are. But all tests are not linked to exery system and therefore must be scanned into the chart. That’s not useful.
You absolutely know what I’m talking about. The systems don’t communicate. You CANNOT get a report from Johns Hopkins and it immediately show up in your EHR. It has to be printed off and scanned in the chart. The EHR does not recognize the scanned article as anything. What BS!!
I’m a MIT grad and have worked with computers my whole life. The EHR opush is a scam that will take some time to work through. Although I agree it will someday be useful.
While electronic records may be a good idea for the VA and the military, they are a bad idea for medicine. I observe this daily as my wife, a general surgeon in private practice for 27 years, has struggled to implement the EMR boondoggle in her small practice. Not only do the docs have to pay attention to their computer during patient visits, it has cost her virtually all of her limited free time. She works every day on EMR. The regulations are onerous, the system is slow, and it is costly.
If you think doctors are overpaid and underworked, I’d suggest you spend a day with my wife - the standard issue day starts at 0630 and ends when she arrrives home at say 1830 or later. This is straight through, with no “break” for lunch and little time to even sit down. On her “day off” she spends 6-10 hours doing EMR; she typically spends much of each Saturday or Sunday at the nook table, doing EMR. Part of this is because she sees 25-30 patients in office before operating on them - she is busy. But she never had this much time commitment in her “off hours” Those really don’t exist anymore - because of EMR.
I had a long chat yesterday with a high school classmate. She just had a hip replacement.
The hospital & doctors that were her providers use the EPIC system. They had her make 5 trips to have blood drawn & a urine sample taken BEFORE she went under the knife. She would no sooner get home than a call would come for her to come back and give more blood. Mind you- she was preparing for a hip replacement surgery and was losing her mobility more each day.
She was so frustrated because the nurses and staffs of the hospital couldn’t seem to look up her records and determine the first time—or the second—or the third time— how many samples of blood they needed and take it all at once, along with the urine.
This woman managed to raise 4 kids, support them herself with a decent job, and now has grandkids she watches every week. She is over 70 and manages to keep her wits about her and cannot understand why well paid staff cannot get the preparations done swifly and cleanly in a practice that does hip replacements almost exclusively.
At the very least, they should be using a plain check-off list.
I’m a MIT grad and have worked with computers my whole life. The EHR opush is a scam that will take some time to work through. Although I agree it will someday be useful.
Granted I don’t work with EHR’s but I do work with HRIS systems and while yes, some documents have to be scanned in order to be placed in an employee’s electronic record; for one thing, that’s not all that difficult or time consuming, less time consuming in fact that filing and or retrieving paper docs; for another, the HRIS system definitely can open any Word doc or PDF and finally any doc I create such as a Word doc form or Excel spreadsheet can be saved as a PDF right from my computer and uploaded without me having to get up from my desk, walk to the copier/scanner, scan and send to my computer via an email attachment. Just about any electronic records system can store and open PDF’s – PDF’s are not proprietary which makes them the universal e-document of choice. Heck, even my bank stores canceled checks and copies of my bank statements as PDF’s which I can download with nothing more than a free PDF reader, same with my cc statements and all my bills. And if I need a copy of a pay statement or my W-2, all I have to do is log into the Payroll/HRIS employee portal and open the doc as a PDF and either print or save to my computer’s hard drive.
As far as what I said about Johns Hopkins, what I was talking about and perhaps might have been clearer about was communications between and within the same Johns Hopkins health system. So yes, when my doc sent me to a Johns Hopkins lab to have blood drawn or when he sent me to a Johns Hopkins cardiologist for a nuclear stress test, as soon as those results were complete, they were attached to my e-record – noting was printed out on paper and scanned, nothing needed to be snail mailed. And if I were to be admitted to any of the Johns Hopkins hospitals, my e-record - my medical history and all Rx’s and tests and test results as proscribed by my Johns Hopkins primary care provider would be available to the doctors at the Johns Hopkins hospital because they are all on the same system, I note again – they are all on the very same system.
Part of what the HiTech Act does or is supposed to do is provide technical standards that also meet HIPAA compliant security standards so that different EHR systems can effectively communicate with each other, even if they can’t do that today.
Wait a minute. Are you saying your wife sees 25-30 patients per day or is that 25-30 patients per week? Because if she sees 25 patients per day and sees each of them for only 15 minutes - that alone, factoring in no break between patients is over 10 hours per day. When does she find time to operate and when would she find time to update records/charts even the old fashioned way? Would she not spend a considerable amount of time on record keeping even without an electronic system?
Astounded — I don’t know your wife’s workflows or or her practice, so please understand I am commenting generically.
My professional exposure is acute care, in-patient facility-centric. I will say however that my family physician since 1985 has made the conversion to EMR, CPOE and an integrated practice management system quite successfully. All my specialists use EMRs and practice mgmt systems and would never go back, and none lament the change.
I don’t intend to try to defend all the aspects of Meaningful Use either or its execution. I *DO* support the intent.
there Are some good ideas in HIPAA - the P for instance, Portability.
An EMR is just one aspect of a good idea - patient-centric healthcare, as opposed to provider- or even payer-centric health *care* ... and health *records.*
I know from experience that ALL HCPs work hard, are paid less, and have higher stress than ever. I would say that most of that comes from reduced reimbursements and malpractice concerns than EMR worries.
Most physicians, PAs, specialists, nurse, techs and admins (etc) I work with would NEVER go back to paper records.
I would never go back to paper in my business either.
I do not envy your wife’s situation, especially as a small practice (solo practitioner?).
NET: EMRs are a good idea, along with good work flows aligned to the tools capabilities. How the GOVERNMENT gets involved is not optimum.
I wish you the best.
My last observations in the hospital is that the doctors and nurses spent more time with the computers than the patients.
I was not clear. She sees 25-30 in office, twice weekly and operates the other days. She is in a group of three general surgeons and about 6 FPs.
Thanks, Blue. It is getting easier for her, but the EMR still is onerous. Perhaps it is the system her group purchased, I don’t know. I do know that her life has become consumed with EMR. When she did paper records, she worked a little every night by hand while watching TV or listening to music with me.
By the way, her group comprises 3 general surgeons (she is senior partner now....gosh we are getting old....) and 6 or 7 FPs. It’s the oldest group in our small city outside Chicago, formed after WWII. The local hospital network offered to buy their practice this year, but they refused. Didn’t want to be tied to it....go figure.
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