Wednesday, August 12, 2015

On the Origins of Note Bloat

"If all clinicians needed to do with our documentation was practice medicine, our notes would be more logical and much less bloated. Laundry lists of irrelevant and inaccurate diagnoses would not populate into every note. Copy and paste would occur a lot less often, and likely could be limited to appropriate uses such as carrying over past medical history (which should always be copy and pasted after verification to reduce errors). Only relevant physical exam findings would be reported, so these would not be lost in a sea of normals. Useful information that is not valued externally, such as personal touches – i.e. patient’s wedding anniversaries, achievements of their children, would have it’s own optimized workflow.

Regulatory compliance and malpractice protection, are responsible for the large majority of the drivel that shows up in our notes. Believe me, we doctors would all love to confine our work to health care delivery, but external forces box us into this uncomfortable place, and this creates junk documentation."
Read the whole thing.



Mad as Hell said...

Very important discussion by the author.

I am mad as Hell over the spying by government and corporations.

Hope he puts no on his Ohio license renewal to find out what happens. Then he can refuse to use electronic records next.

I personally don't want my record in Kansas City, Chicago, or Venice. I want it
with my doctor in their office. I want my record private. I don't want to be analyzed even for statistical purposes. I never agreed to that.

Did the government ever ask us what we want as patients?

Hell no! I say reverse it all and go back to paper. Just flip and jot.

This is corporate take over of medicine with government complicity and funding.

Citizens are the last to find out anything about the reduction in health care benefits and the diabolical digital "optimization."

Creole Gumbo said...

The primary reason that hospitals and private physicians use EHRs is to game the payment system. Since the 1980s when EHR booths began to appear at medical conferences the selling feature has always been the same: "Buy our EHR system and your profit will increase by X%." In 2015 I have yet to see any other selling line for EHR vendors. The increase in payment is usually accomplished by a ROS that keeps getting repeated even for a brief return visit. Every level 2 service becomes a level 4. Of course data entry uses so much physician time that the added profit becomes questionable. The solution is now to invite scribes into the office visits to further impinge on patient privacy.

One solution is for physicians to eliminate insurance company billing for routine outpatient care - the oil changes and gasoline. If patients have insurance then the company should reimburse the patient. This would bring the patient into the decision making process with respect to cost and remove the control that the insurance companies and government have over physicians. Once freed of the dictates of the insurance companies and government physicians could dictate or write their notes and keep them secure in their own offices.

But this is an unlikely scenario since most patients have come to resent any out of pocket payment for medical care. As long as that is the case things will only get worse. You cannot control your own health care if someone else pays the bill.

Anonymous said...

Good points. I have come to look at the ABIM as a branch of the federal government, partner of insurance companies, and servant of the large corporations. They do nothing for the patient or physician; leadership does everything for themselves to profit and sustain that easy excessive way of life, which is now the motto for the ABIM. "Physician administrator, serve thyself to as much of the expenditure pie chart as you can."

In fact all 24 certifying boards harm patients with distracting demands for time and money. They harm physicians. Absolutely a fact that this submissive type of relationship with the ABIM/ABMS involves politically motivated coercive methods of entanglement, binding deceptively-created rules, policies, mandates and their linkage to the creation of new and onerous health care laws.

ABMS organizations are ruinous to the healthcare system and destructive to fundamental principles of true education in terms of how human beings learn and continue to educate themselves. Totally destructive.

It is necessary to propagate, not what is profitable to Lynn Landon or Rich Baron who protect self-interests and the political ideologies institutionalized in that multistory compression of heavily guarded fallacies, housed on Walnut Street, regarding a body of pseudo-scientific arguments, financial misstatements, and all the rest that makes up the ABIM. This is all epitome of the same troublesome unregulated and underreported operational irregularities found in Chicago at the ABMS.

These self-serving corporations educate us about nothing more that how corrupt human being can become in the pursuit of money and lordship over their own peers and equal members of society. The patient is medically ignored by the organization as is proved by swelling personal bank accounts and prescription for the healthcare system which serve corporate/political agendas. In course, these things lead to policies becoming enacted into law; legally binding frameworks which are counter indicative to the real diagnoses of what ails medicine and patients' increasingly complex array of sufferings and hapless dilemmas.

It is time to step out of the way of these giants as they fall under the weight of their own bureaucratic corruption.

Anonymous said...

Cerner News

On July 29, 2015, Leidos Partnership for Defense Health, which includes Cerner, Accenture, and Leidos, was awarded a 10 year, $4.3 billion contract to overhaul and manage the electronic health records for the Department of Defense.[22]

Anonymous said...

Sporting Kansas City (Cerner Sports Neil Patterson buy major league soccer team funded in part by huge taxpayer contributions. 30 billion for infrastructure spending to promote EHR.

On August 31, 2006, Patterson and five other individuals purchased Sporting Kansas City (then known as the Kansas City Wizards), a Major League Soccer team, from Lamar Hunt. The other members of the ownership group at the time of purchase were Cliff Illig, Rock Island Capital’s Robb Heineman, Greg Maday, David French, and Pat Curran, founder of C3 Holdings. The group stated its intention to keep Sporting Kansas City in the Kansas City area

Anonymous said...

"In 2005, Cerner and other companies paid for a report by the RAND Corporation which predicted great efficiencies from electronic health records, including savings of $81 billion a year or more, which RAND now says is overstated. This report helped drive growth in the electronic health record and billions of dollars in federal incentives to hospitals and doctors. Cerner's revenue has tripled from $1 billion in 2005 to a projected $3 billion in 2013. The study was criticized by the Congressional Budget Office for overstating potential savings. A 2013 reassessment of the 2005 report by the RAND Corporation said that the conversion had failed to produce savings and had mixed results in efficiency and patient care"

Watch out for Cerner's aggressive practices. I have seen them absorb physicians into their corporation as they install and try to maintain the EHR which, btw does not perform as advertised. Repeated attempts to get features to work or to add/customize ends with minor disasters or just giving up. "Can't do that." Can't figure it out." Their skilled teams are hopelessly useless. If your hospital opts for Cerner insist on them sending techs that are not just a bunch of trainees.

There is a lot of fraud in the EMR business.

I am shocked to see they also are opening their own clinics for corporations and hospitals. Children's hospital in Kansas City for example is tied in to Cerner. This will quickly will swell into a Wal-Mart style clinic operations everywhere for employers. Cerner has the leverage to push this as the product is damn expensive overall to install and run. We need to step back and take a look at all this and how to manage the conflicts and abuses that are already rampant with a company that once you go with them your basic two options are to sue them or end the relationship and start all over again with someone else. All are fraught with problems.

You need to look at the implications when a company like this goes global. Talk about the ABIM out of control. Cerner got government money and it is totally in charge of the government it seems. The idea that we have so much data entrusted to any of these behemoths is frightening.

I followed some university studies of the inherent flaws in Epic and how to get around them. None of the EHR's perform as they should imo, but the reality of how we/others store data, manage, have access to patient data and how that data is passed around from these major corporations who are entangled monetarily beholden to government and that big digital web with insurers and other "stakeholders" makes me want to unplug from the Borg/Matrix.