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Destroying healthcare, one form at a time

Destroying healthcare, one form at a time

Professional death by a thousand forms.

The Washington Post article below documents one doctor’s experience with federally mandated electronic health care records.

The story is familiar, as I’ve heard it myself from doctors. Doctors always had to spend time filling out insurance forms, but now it is so much worse. To comply with federal Medicaid and Medicare regulations (plus new Obamacare regs) not only means having the staff to comply (hence, doctors moving to larger practice groups or hospital-affiliated groups), but also more and more time spent trying to comply with electronic medical records requirements.

Read the full tale below. It’s how we are destroying medicine one form at a time. Here’s the punch line:

When I get back to the office, I turn on the computer to write a progress note in Mr. Edgars’s electronic health record, or EHR. In addition to recording the details of our visit, I must try to meet the new federal criteria for “meaningful use,” [explanation here] criteria that have been adopted by my office with threats that I won’t get paid for my work if I don’t….

I spent more time checking boxes than talking to patients and their families.

I could see twice as many patients if I could write their notes at the bedside while visiting with them. I would happily do this on paper or using an EHR that created a logical note within the same amount of time. But that is not an option.

The reality is that I spend more time talking to the Information Technology people about Internet connections, firewalls and box-checking than I do answering messages from concerned family members.

As a teaching doctor, my feedback to the residents now consists mainly of explaining how to document their visits so that we will all get paid, instead of teaching them how to take care of frail elders in their homes.

It’s professional death by a thousand forms.

(Featured Image source: CMS)


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For what it’s worth, many of the doctors here in our area are saying they will not comply. I agree! Do not be assimilated. #ObamaCare

    rinardman in reply to redbirdacres. | December 25, 2013 at 11:03 pm

    For what it’s worth, many of the doctors here in our area are saying they will not comply.

    Seriously? Do Doctors really think they have a choice in the matter?

    And, if they do now, wanna bet they won’t in the future?

But EHR is creating a tremendous amount of Big Data that can be used to plan a society that enhances positive experiences and limits negative ones. It cannot actually, but it can certainly create a large bureaucracy of loyal public sector employees trying. In early December, the National Research Council released a report making Subjective Well-Being the new US government domain. I wrote about it here

As a lawyer who recognized the similarities to education from working through the Clinton’s 90s attempts at both radical ed and healthcare reform, the EHR regulations and all that language about objectives mirrors the kind of data gathering going on now in K-12 education. And it is on the Whole Child. Social and emotional learning and changing values and beliefs are the whole point.

Ed and healthcare now turn into gigantic data gathering operations providing politicians and bureaucrats intel on what public policies are having what effects. We are all fast becoming passengers who exist for the sake of the salaries and benefits of the ship’s crew. With no effective input into where the ship goes with us anymore.

I hope their data collection infatuation continues unabated.

Like every keystroke I make, the NSA needs to find a terrorist in Yemen.

Like 20 bureaucratic Oz’s behind the curtain collecting Dorothy’s story, then issuing a directive for her to click her heals three times. Not going to happen.

Peter Drucker hit the nail on the head in 1989, when he wrote in “The New Realities:”

Above all, any government activity almost at once becomes ‘moral.’ No longer is it viewed as ‘economic,’ that is, as one alternative use of scarce resources of people and money. It becomes an ‘absolute.’ It is in the nature of government activities that they are to come to be seen as symbols and sacred rather than as utilities and means to an end. And then the absence of results does not raise the question: ‘Shouldn’t we rather do something different?‘ Instead, it leads to a doubling of effort; it only indicates how strong the forces of evil are.

I just glanced through a book published by Evolvent Technologies, a computer systems purveyor with only one customer – Uncle Sam. One thing I learned – Health Care is no longer one-sixth of our economy now it is now “nearly one-fifth.”

Once past the fiasco of accumulating EHR info by having every medical professional administer the Q & A then enter it six times a day into the data base (this is happening, folks), we will encounter Nirvana when all data will be available for use in deciding who lives and who dies. Evolvent claims the new system will eliminate the need for expensive duplicate and unneeded cautionary testing. I say, “When will humans ever learn that more data requires more systems to analyze it – and better healing solutions are not guaranteed?”

I can only conclude that if we thought health care was expensive in 2013 – we will see double digit expansion of these costs for years to come – and providers and insurance companies have all jumped on the bandwagon. If you think that social security and medicare growth is out of control, consider that the government will now drive the actual medical procedures to be used.

Then answer the question: What was the last huge, overarching government program that succeeded in bettering mankind? You can pick any country in the world and any project, including war – and you will not find a winner in the last century because governments have simply outgrown their economic base.

    Crawford in reply to gad-fly. | December 25, 2013 at 7:02 pm

    “What was the last huge, overarching government program that succeeded in bettering mankind?”

    The Apollo Program. However, as it sought to solve merely engineering problems and not repeal the human condition, its focus was limited.

      For whatever “American Dream” reason you pick for starting NASA and the Apollo program, Eisenhower approved it to get on even footing with the Soviets. The Apollo flights cost about $133 billion in 2008 dollars but the entire NASA budget ate up $266.4 billion total through 1972 when Apollo flights ceased. Through 2013 the NASA spending for all time is $888.6 billion. I have the notion that private enterprise could have done the job far less expensively and we would not be saddled with an $18 billion do-nothing agency that perpetuates the Global Warming hoax.

      Did we get benefits from Apollo? I think so – but now we pay and pay and pay …

        KitsapJay in reply to gad-fly. | December 26, 2013 at 5:48 pm

        Benefits from NASA, we did once. But somewhere around the end of Apollo, possibly about the time the last shuttle was completed it became a big football and jobs program.

        The shuttle was going to be the really cheap way to launch satellites. Now NASA is the way to change minds in the Middle East, only because the State Department needs the help.

I’m hearing stories of many of my colleagues deciding, after several years of threats, that 2014 is the year they intend to cut the third-party payment cord and all the hassle that comes with it. They’re going cash only or just calling it quits.

While my particular circumstances make it unnecessary to take either step (yet), I plan to take the 4% pay cut (the penalty for not satisfying stage 3 requirements) after successfully achieving ‘meaningless use’ for stages 1 & 2. May abandon EHR altogether as a nexus of expensive upgrade requirements soon to hit will be far more expensive than 4% of my Medicare business.

The sad fact is most major university hospitals throughout the country are going to try to comply with Obamacare. They, like any other large public institution have policies dictated by state and in-house bureaucracies. It does not occur to the state or institutional administrator to not obey the silliness. They have always followed the mandates handed down from on high and know no other way of working. Here, in North Carolina, UNC and Duke, bastions of liberals and worshipers of Obama, will twist themselves into pretzels to make it work.

    Gasper-it is worse than that. Those university hospitals are considered “ed-med” anchor institutions in the Good Society communitarian vision that is tied to the Subjective Well-being component I mentioned above. That they exist to provide employment under this new low-carbon vision of a redistributional economy. Education and health care are to be life-long activities for all of us with a loss of distinctions between what is public and private. It is a seriously unworkable vision conceived by Troughers who have no idea the economy is actually not a fixed sum or a “system.”

The sad fact is that ALL your information will be combined, medical, financial, social, religious,etc., and used to determine what future, if any, you have. The progs are all agog about how most people want “single payer”. Well, if that happens, look for a similar outcome to England. 18 month waits for surgery where you DIE 6 months before the “scheduled” surgery happens. People starving to death because “health care personnel” FORGOT to feed them. I imagine there will be a “cutoff” for all health care,ie, hit some bureaucrat inspired age and no more health care/social security, etc. We need to stop this now or we will become Cuba.

My university hospital uses EPIC as its EHR. I am told it is not the worst. I hope never to use an EHR worse than EPIC.

It takes me about fifteen seconds to write a prescription on a paper script. I cannot do it in less than two minutes in EPIC, and that’s when much of the information is pre-populated.

It took me about half a minute to find and complete a request for a chest CT can on paper when we used paper. It now takes me twice that long in EPIC. Ditto an order for pulmonary function testing. A preprinted form used to offer me the 40 or so most common blood tests I needed in my practice. I have to find them one at a time in EPIC, and if I don’t use the right search term I won’t find them at all.

My hospital has the ability to modify EPIC in response to user requests (me). They are seven months behind, so any modification I want in EPIC will take that long or longer to do, assuming it’s approved. I can create macros for certain things and that can help, but the macros are limited to simple things. I suppose if I learned EPIC really, really well I could find short-cuts, but I’m supposed to be practice medicine, not programming.

An EHR might actually work one day. But we had a pretty good system on paper that evolved over a half-century of use. You can’t throw that out and replace it wholesale with a new system and expect any sort of efficiency.

So even if you have the most benevolent beliefs about where all this is headed, you can see that just in terms of getting health care work done, the EHR is a mess. It might work one day, but it won’t be working any time soon.

In order to control physicians, and standardize (at the lowest possible cost) health care the government must control the data. The instruction book for ‘meaningful use’ is 33 pages long, and that’s just for ‘Stage 1’.

These electronic records severely discourage free text and intelligent thought, it’s all about drop-down boxes and checklists. A healthy 27 year old and a deathly ill 58 year old both get 4 dozen clicks of the mouse and the doctor’s employer gets a bonus. No thinking needed, no skill, certainly no intellectual curiosity that might cure an illness, it’s all about ‘compliance’ and ‘incentives’.

So, all those folks who pony up their $500 per month for an Obamacare policy with a $6500 deductible and then complain they’re treated like a number, well, that’s the idea! I always remind them a lot of this can be fixed in the voting booth if they don’t wait too long…

All part of the plan.

As Crazy Nancy Pelosi might say, we have to destroy our health care system to see what’s in it.

Just as ObamaCare, as designed, is going to put a lot more pressure on the supply of primary care physicians, we make them less productive. Brilliant, positively brilliant.

    KitsapJay in reply to RickCaird. | December 26, 2013 at 6:03 pm

    No ObamaCare will make the physician far more productive, because he has quit medicine and became a music instructor, nutritionist, or moved to a great 3rd world country.

    My county has one hospital, it has about 300 docs with privileges. Six years ago, half of these were in doctor owned practices (individual or group), there was a HMO and there was also a large clinic where the rest worked. The HMO and Doctor’s Clinic are still there, but now over 100 doctors have sold to the Hospital, and the hospital is now in a big Catholic Hospital Group. All to make this work. The hospital and all of the health partners (read employee) are adopting the Epic #FAIL system.

    I am not sure if the health questions I am asked are relevant to my health (but could improve blackmail) as “please provide the number of mistresses and how frequently have you seen them in the last 6 months.” seems too personal

It sounds like some natural language product will eventually be needed for doctors, much like Siri, where the doctor can talk into it during the exam and the program can then do all the form-filling and box-checking to make all the government blowhards happy. Could be a high-dollar niche for Apple. “Siri, call the lab and schedule a cholesterol test for Mrs. Peterson as soon as they can today. And have them run the platelet count too.” (Computer does 37 pages of forms, sends the requests to the lab and insurance companies) “Yes, Doctor. Her test is scheduled for 1:15 PM.”

In order to adopt Socialized Medicine, it is first nec6essary to destroy all the normal means of access to health-care.
This has largely been accomplished.
It also has to appear to be an irreparable situation. This too has been largely accomplished.
And when the general Public is up in arms, completely distressed, and uninsured, then, at that time, Obama will propose full Socialized Medicine.
I expect we are within two months of the announcement.
Everything leading up to this so far has been carefully planned, including and especially the huge failure of Obamacare.