Skip to comments.ACAs EHRs: 16 Pages and No Info to Help Physicians
Posted on 02/09/2018 5:39:27 AM PST by spintreebob
My pediatric practice is one that harkens back to days long ago when physicians knew their patients and pertinent medical histories by heart. My 81-year-old father and I were in practice together for the past 16 years; he still used the very sophisticated "hunt and peck" to compose emails. The task of transitioning to an electronic record system seemed insurmountable, so we remain on paper. Our medical record system has not changed in almost five decades. I would not have it any other way.
This past spring, he walked into my office shaking his head in disbelief after thumbing through a stack of faxes.
"Can you believe this 16-page emergency room note has no helpful information about the patient?"
This was not a shock to me. The future of medicine will include robots who are paid to collect reams of useless data to provide nothing in the way of health or care. Regardless, the government and third-party payors will extol upon the virtues of their inept system as life expectancy falls.
Fifty years ago, there was a close relationship between a physician and their patient grounded in years of familiarity. Physicians took a history, performed a physical exam, and developed an assessment and plan. Diagnosis in a child with fever would be descriptive, like bacterial infection, otitis media, fever of unknown cause, or viral illness. Parents were advised to provide supportive care, involving clear liquids, fever medication, and follow up precautions if the child worsened.
At the dawn of the technological age, the effortless simplicity previously existing between physicians and patients has all but evaporated. It was traded away without our consent, relegating the role of physician to that of a data-entry clerk. Physicians are discouraged from synthesizing information and utilizing it to guide our decision making. Today, a 16-page document "appears" to contain crucial elements such as chief complaint, past medical and surgical history, medication list, and allergies. However, the information is then followed by more than a dozen pages of waste.
The particular case to which my father was referring involved a 5-year-old child with fever. The provider documented the sexual history of this child, whether he was single or married, and whether or not he had children of his own. My dad and I started chuckling as we contemplated collecting this kind of extraneous information from a child who had not even entered puberty. As one would suspect, our young patient was single, as in not married; he had no children (which is physiologically impossible), and his years of formal education were noted: "not pertinent to his medical situation." Interestingly enough, I volunteer at the school where this young boy attended kindergarten; his classroom was next door to the one with my second oldest child. Three of his classmates were out with febrile illnesses. However, technology cannot incorporate this kind of alternative data.
We kept reading and laughing. Occupational history was recorded as not on file; running a bustling lemonade stand in his neighborhood apparently was not clinically relevant. It came as quite a relief that at the tender and impressionable age of 5, this boy had managed to steer clear of regularly smoking cigarettes. It was comforting to discover he had never used smokeless tobacco either. And for some reason, I never thought to inquire about such things before (insert eye roll). He also denied alcohol use, restoring my faith in the fact that not every youngster was consuming alcohol during their formative childhood years.
Just when I thought things could not get more absurd, I came upon the sexual history; contemplating whether or not a five-year-old child was engaging in consensual intercourse was nauseating. I reminded myself that data entry clerks were devoid of emotion and instead were tasked with collecting "critical" details to practice by protocol. Sexual history: Not on file.
The final summary and diagnosis section was the most entertaining part, which read: "primary diagnosis: none." Seriously, are you kidding me? No diagnosis? This is the future; technology will seal the fate of our profession as one entirely devoid of the need for any cognitive skills. This earth-shattering conclusion after 16 (!) pages of documentation was utterly astonishing. Despite the considerable time and effort invested asking a febrile five-year-old whether he was married or having consensual sexual intercourse in his spare time, little to nothing was provided in regard to healthcare.
At this point, my father and I laughed so hard that tears were running down our cheeks. There is no other reasonable response to the sheer waste of time, resources, and education invested in becoming a physician. Doctors have spent decades honing their clinical skills and should be entitled to choose the documentation method they find most effective and efficient. Some physicians find electronic records helpful and should be encouraged to use them. My pediatric practice will keep surviving on a shoestring, a prayer, and good old-fashioned paper. It warms my heart to know each chart note contains helpful information and not one human being leaves with "none" as their diagnosis.
Footnote: Page 16 states, "This chart is intended to document the majority of the information from this patient's visit today. Other items, such as the patient's care timeline, are reported elsewhere and should be reviewed to better understand this encounter." (More eye rolling.)
By all means, if 16 pages did not cut it, twenty more should make sense of arriving at no diagnosis. Forgive me for not running out and requesting those records immediately.
some older doctor in Maine had her license yanked because she wouldn’t switch to computers
Yup. Even before the ACA, the whole coding and documentation game became about jumping through hoops for reimbursement, not contributing to patient care.
This goes back to long before EMRs. As a Resident in the 80s one learned that while a hospital chart may be 4 inches thick there were only about 6 to 10 pages in there that were really relevant. Everything else in there was only relevant to some other profession, accountants, lawyers, what have you. As a Resident you learn where the pages you need are quickly. Same goes for EMRs. I remember being shocked when I finally went on Active Duty in the Army and started handling records from the 60s and 70s. Sick call entries of one line, Cold, Sudafed. 20 years of health care annotated on 2 pages. It was like opening a timecapsule from a different world. I learned from oonlighting in ERs you could tell what the priorities of the institution were pretty easily. If they wanted you to see patients they gave you plenty of nurses and you space on the form was about 2 inches by 1 inch. Nurses discharged patients and handed them pill bottles and instructions. You could see and document 75 patients in 12 hours pretty easily.
When the priorities changed, things changed. Try seeing half that number today. You cant.
Physician friends tell me that EMR (Electronic Medical Records) now has killed their productivity by more than 30%.
So they don’t spend the day as data entry clerks, many have hired “Scribes” to follow them through a patient visit and who enters the data for the doc so he doesn’t have to do it. Permission is requested asking if the scribe can be present for the visit.
New companies have been started just to be scribes for docs - one I know by the son of a physician (dad’s idea of course).
Thank you government for ruining the quality of our healthcare and raising its cost with your absurd requirements......just as you do with everything you touch........
My ER visit for sudden GI pain, with a CT was 25 pages long. Diagnoised Diverticulitis, but that is not what the CT actually showed, just the lower tip of the colon was slightly enlarged and maybe inflamed per the Gastro’s reading days later.
We can thank W for this, IIRC. The EHR/EMR cr@p started with the first Porkulus bill...
“My pediatric practice is one that harkens back to days long ago when physicians knew their patients and pertinent medical histories by heart. My 81-year-old father and I were in practice together for the past 16 years; he still used the very sophisticated “hunt and peck” to compose emails. The task of transitioning to an electronic record system seemed insurmountable, so we remain on paper. Our medical record system has not changed in almost five decades. I would not have it any other way.”
How long will folks be able to recall and communicate things like above.....and/or.............???
I was an upper exec with an Eli Lilly subsidiary that was focused on EMR in the mid-90’s.......Lilly sold it to EDS when their financial position got bad.....I first got involved with EMR before then.......
Fax’s in 2018?
The guy is so far behind he can never catch up.
His dad is a dinosaur
Having heard about the doctor who had their license pulled; but no clue where said doctor practiced or the gender. Agree, that not only doctors, but patients as well are looked upon as another cog in the wheel of institutionalized medicine. It’s more about shuffling of papers, money exchanging hands,and modern offices/equipment than a doctor/patient relationship. With fewer doctors, and even fewer in the future, IF a really good one is found (very uncommon) suggest you hold onto him/her as you would YOUR life and heritage. Do any remember Marcus Wellby, MD (Robert Young)?
Life expectancy in the U.S. is going down since the ACA kicked in. Funny that you never hear what caused this result.
I got a 6 page report on Amoxicillian to go with my ER Visit last Saturday for suden GI pain and Script for it. Been taking it since I was a child, I’ll be 70 this year. But not 1 word about replacing the ‘good’ bacteria that the Amoxicillian would kill off with the bad bacteria. Good thing I know about Probiotics and those Yeast infections that are all to common from taking antibiotics.
No questions asked about when you noticed the nausea/reflux beginning, just current status. Began with the addition of Cardizem Beta Channel Blocker for the PAIN caused Hyper Tension. Under Educated APN cold turkeyed my Neuropathy pain control med. Not worth risking her license over, but would risk my health.
Wrong diagnosis too of the CT. Which the Gastro caught when he read it.
“We can thank W for this”
I think not. People within the medical industry translated the goal “Electronic Medical Records” into the nuisance we have now.
Physicians, heal yourselves.
Lots of medical practices have stuck with faxes because they are easier to make HIPPA compliant then email or texts. Major hoops to jump through if you try to use those to communicate .
Another example of the law of unintended consequences..
Vets do probiotics. So far, physicians dont. There are probably a lot of reasons for it. Imagine an 80 year old dies from pneumonia that is cultured and discovered to be the same bacteria as in the probiotic. The lawyer would get rich. The problems in healthcare have little to do with what the Brown Shirt Media wants us to believe. EMRs are not the villain, just a tool. I was using a computer to cut and past notes long before EMRs. EMRs can actually save time in documentation, prescribing, and other things if you know what you are doing. Part of the problems with EMRs is that in educating physicians to use them the experts are hired by folks whose priorities are not the same as physicians. Accountants and lawyers, for instance. The underlying problem is priorities. When the healthcare relationship was just the doctor and the patient 70 years ago things were different. As this relationship became more crowded with gummint bureaucrats, then accountants, and lawyers priorities shifted. Now the relationship requires a large boardroom of 20 or 30 people and the patient and doctor come last.
EMRs are coding/ billing platforms.
Any healthcare delivered is incidental.
new codes advertised as “increased precision” is actually screening for denial of coverage, in addition to an administrative burden.
IOW, similar to Billy Preston https://www.youtube.com/watch?v=ghj5V5cUo1s
Well aware of the paperwork and pencil pushers. Just to make an appointment takes an act of congress. The paperwork, phone calls needed. AARP fully on board with this; how are they doing in this day and age?
Personal rapport with the doctor has gone the way of the dinosaur; Marcus Wellby is long deceased.
my doctor does not use the EMR at all, just old faction charts.. mine is thick...
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