Tag: "electronic medical records"

What If the Exchanges Aren’t Ready?

This is from my column today in The Wall Street Journal.

The Obama administration wants something the federal government has never done before: a computer system that connects HHS, the Internal Revenue Service, the Social Security Administration, Homeland Security and perhaps other departments as well. This is a herculean task with unclear benefits. For perspective, consider that the Veterans Administration converted to electronic medical records in 1998 and the VA and the Department of Defense have been unsuccessfully trying to share records ever since. Even though they have spent millions of dollars on the effort, it now appears that the two agencies are abandoning the goal altogether.

Why Doctors Hate Electronic Medical Records

Unsent letter to the Tech Department:

So today I’m doing anesthesia for colonoscopies and upper GI scopes. Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution. I’ll probably do 8 cases today. I will sign into a computer or electronically sign something 32 times. I have to type my username and password into 3 different systems 24 times. I’m doing essentially the same thing with each case, but each case has to have the same information entered separately. I have to do these things, but my department also pays four full-time masters-level trained nurses to enter patient information and medical histories into the computer system, sometimes transcribed from a different computer system. Ironically, I will also generate about 50 pages of paper, since the computer record has to be printed out. Twice.

No wonder almost everyone I know hates electronic medical records! I don’t know anything about computers, and I don’t know what systems other hospitals have. I may be dreaming of a world that doesn’t exist or that world is here and I haven’t heard about it.

HT: Jason Shafrin.

Headlines I Wish I Hadn’t Seen

Sen. Max Baucus: fears President Barack Obama’s health care law is headed for a “huge train wreck.”

Veterinarian punished for engaging in Internet consultations.

The $35 billion initiative to promote the use of electronic health records is actually raising costs; and that’s only one of the problems.

Doctors lobby to reduce health care labor shortage, leaving out nurses, others.

Research Results I Wish I Hadn’t Seen

  • Female mortality rates increased in 42.8 percent of counties in the United States during 1992–2006.
  • The average physician will lose $43,743 over five years after adopting electronic health records.
  • Cost savings from workplace wellness incentives reflect cost shifting to unhealthy workers.

More on these issues in the Health Affairs blog.

Why EMRs are Backfiring

Doctors used to have to fill out a checklist for every step in a physical exam. Now, they can click one button that automatically places a comprehensive normal physical exam in the record. Another click brings up a normal review of systems — the series of screening questions we ask patients about anything from nasal congestion to constipation.

Of course, you shouldn’t click those buttons unless you have done the work. And I have many compulsively honest colleagues who wouldn’t dream of doing so. But physicians are not saints.

Hospitals received $1 billion more from Medicare in 2010 than they did in 2005. They say this is largely because electronic medical records have made it easier for doctors to document and be reimbursed for the real work that they do. That’s probably true to an extent. But I bet a lot of doctors have succumbed to the temptation of the click…

And then there are the evil twins, copy and paste. I’ve seen “patient is on day two of antibiotics” appear for five days in a row on one chart. Worse, I’ve seen my own assessments of a patient’s health appear in another doctor’s notes. A 2009 study found that 90 percent of physicians reported copying and pasting when writing daily notes.

More on how electronic medical records make some things too easy.

The Down Side of EMR

Tasks that once took seconds to perform on paper now require multistepped points and clicks through a maze of menus. Checking patients into the office is an odyssey involving scanners and the collection of demographic data — their race, their preferred language, and so much more — required by Medicare to prove that we are achieving “meaningful use” of our EMR. What “meaningful use” means no one knows for sure, but our manual on how to achieve it is 150 pages long…

When the clicks don’t get me what I want, I naughtily handwrite a prescription. I skip ordering certain tests I might want because it takes too much time — I’ll do it next visit. I dreaded the arrival of this season’s flu-shot supply — now there were more orders to input!

Anne Marie Valinoti’s editorial in the WSJ.

How Kaiser Manages High Blood Pressure

Kaiser used its electronic medical records to identify 88,000 members in the Denver area with hypertension and created a registry to track those whose blood pressure was still too high. It contacts them to come in for hypertension checks annually. And it uses teams of skilled professionals to help patients with lifestyle changes and medications. Kaiser also offers patients home blood-pressure monitors at cost, or about $35, through its pharmacies and provides free blood-pressure checks on a walk-in basis.

Some 83% of Kaiser Colorado’s hypertension patients now have their blood pressure under control. That is up from 61% when the health system launched the program in 2008.

Source: Wall Street Journal.

Headlines I Wish I Hadn’t Seen

Hospitals treating the poor are the hardest hit by Medicare’s readmissions penalties.

NBER study: Average effect of electronic medical records: slightly higher hospital costs.

In most maritime disasters, women and children don’t deboard first. The Titanic may have been a case of noblesse oblige.

Headlines I Wish I Hadn’t Seen

Dozens of hospitals across the country lost access to crucial electronic medical records for about five hours during a major computer outage last week.

Taxpayers are subsidizing junk food. HT: Sarah Kliff.

Private Sector Innovations

  • Defined contribution health insurance (the employer contribution is applied).
  • Medical homes.
  • Re-pricing chronic care.
  • Electronic medical records.
  • Value-based purchasing (patients pay the marginal cost of more costly choices).

Full piece on Dallas-area innovations (gated).