Technology Is Making Doctors Feel Like Glorified Data Entry Clerks (fastcompany.com)

An anonymous reader writes from a report via Fast Company: The average day for a doctor consists of hours of data entry. Since the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 took effect in January of 2011, which incentivized providers to adopt electronic medical records, hospitals have spent millions, sometimes billions, on computer systems that weren't designed to help providers treat patients to begin with. The technology was supposed to reduce inefficiencies, make doctors' lives easier, and improve patient outcomes, but in fact it has done the opposite. "Frankly, the main incentive is to document exhaustively so you cover your ass and get paid," says Jay Parkinson, a New York-based pediatrician and the founder of health-tech startup Sherpa. The systems are flooding doctors with important and utterly meaningless alerts. One of the biggest problems is that the systems have made it very difficult for doctors to share information between one another, which is what the systems were intended to do all along. Why? "Because it doesn't help the bottom line of the biggest medical record vendors or the hospitals to make it easy for patients to change doctors," reports Fast Company. Since it often takes weeks, or months for data to be sent to and from facilities, that, according to Consumers Union staff attorney Dana Mendelsohn, increases the chances of doctors ordering duplicate tests. All of this reduces the time doctors have with their patients. A recent study shows that the average time doctors spend with their patients is about eight minutes and 12% of their time, down from 20% of their time in the late 1980s. "This group is 15 times more likely to burn out than professionals in any other line of work," reports Fast Company. "And much of the research on the topic concludes that 'documentation overload' is a key factor." To help alleviate this pain, medical groups are working to reduce the data-entry burden for doctors, so they can in turn spend more of their time with patients.

Comments

Re:prior art..

[Anonymous Coward]

Wrong post, numbnuts. :-*

Most "automation" isn't, just like this.

[Anonymous Coward]

Consider: If it absolutely has to involve computers somehow, you're probably still better off using the old paper system and having a secretary scan the doctor's notes, so that other doctors can easily fetch them and read them. And then have the system do nothing but store and retrieve such scans. No database fields, nothing. Just notes. Okay, maybe with a possibility of attaching transcripts. But you don't really need anything else, no.

Of course, as already noted, the actual purpose of what got implemented, as well as the law mandating it, really wasn't to help the doctors at all. So none of it did.

Re:Most "automation" isn't, just like this.

[Anonymous Coward]

It depends on their tech setup. One heathcare provider has a workstation in every room, and it takes the doctor about 1 minute to review patient records and a couple more minutes to update it after the exam is over. Another heathcare provider takes notes and transfers them all at the end of the day. Yet another still uses paperwork and is very much not organised.

Re:Most "automation" isn't, just like this.

[demonlapin]

My hospital does this for handwritten progress notes in charts. It's nice. Especially in anesthesia, which has an elegant (if densely-packed) system of record keeping. For years after the VA put everything in a flat-text note syste, their anesthesia records were done on paper and stored as images.

Re:Most "automation" isn't, just like this.

[BradMajors]

No doctor can review a medical file in one minute. My medical file if printed is about one inch of paper. When I see a new doctor I provide the doctor with a one page printed summary of everything important. The doctors act grateful for me providing a summary.

Re:Most "automation" isn't, just like this.

[Anonymous Coward]

The problem here is just one: (lack of) software engineering, to adequate to the necessities of the health system (including doctors, patients, government and society at all). Unfortunately, our society only know how to produce an adequate piece of software when money is the primary goal.

Re:Most "automation" isn't, just like this.

[ShanghaiBill]

Here is the root problem: America spends 18% of GDP on healthcare. Other developed countries spend 6-9%, yet mostly have better health outcomes. So if we become as efficient as them, 1/2 to 2/3rds of healthcare workers will be redundant. What interest do they have in destroying their own jobs? Our healthcare system will not fix itself from the inside. They have absolutely no incentive to do that.

Re:Most "automation" isn't, just like this.

[rally2xs]

No, "better healthcare outcomes" is a measurment anomaly. When an American CAN PAY FOR his healthcare, either directly or by insurance, the US healthcare systems beats the pants off the furriners. Where the distortion comes in is that many Americans _can't_ pay for healthcare, so they get limited or no healthcare, and they die at accelerated rates that drag down our average. Our average cure rates suck because the less-well-monied have much worse outcomes, which drags down the average. But if you compare out "best" with their "best", we win, hands down. You don't think all those foreign political leaders and rich business guys fly themselves and their cancers to the USA because we do a worse job, do you?

Re:Most "automation" isn't, just like this.

[Captain Splendid]

No doctor can review a medical file in one minute.

I watched my doctor do exactly this with a real folder filled with paper just two weeks ago.

Most doctors are pretty smart guys who've spent decades reading books, charts,etc. and otherwise learning to ingest large amounts of information in the quickest, most efficient manner they can.

Re:Most "automation" isn't, just like this.

[dbIII]

It's 18% because health is a side benefit of an insurance system.

Re:Most "automation" isn't, just like this.

[Waffle Iron]

No, "better healthcare outcomes" is a measurment anomaly.

The fact that the average is dragged down because a large percentage of the US population doesn't get adequate health care is not a "measurement anomaly". It's an epic failure.

It's like a C average student claiming: "I'm really a straight-A student! I got As in all the classes I didn't flunk. (And BTW, for some reason my education cost twice as much as that of any other student.)"

Re:Most "automation" isn't, just like this.

[Anonymous Coward]

You're being sarcastic, right? You're plan is to not count the people that drag down the average because ... they're dragging down the average?

Re: Most "automation" isn't, just like this.

[dunkelfalke]

Don't delude yourself. They fly to different countries for health care. Sometimes to Switzerland, sometimes to France or Germany, sometimes to the USA. It all depends on the particular case.

Re:Most "automation" isn't, just like this.

[cheesybagel]

You don't think all those foreign political leaders and rich business guys fly themselves and their cancers to the USA because we do a worse job, do you?

Actually a large amount of the time they are flying to Switzerland. Putin's main squeeze. That Ukrainian President who got poisoned with dioxins.

Re:Most "automation" isn't, just like this.

[cheesybagel]

Did it really cost twice as much if you got assigned to a classroom without enough seats for all the students and did not ask the teacher any questions?

Maybe they charged twice as much but it did not cost twice as much.

Re:Most "automation" isn't, just like this.

[Anonymous Coward]

You're saying you'll fix it in software? You can't fix people problems that way. This is a people problem. Rather, a problem created by lobbyists and now enshrined in law. The law says to do the software engineering focused on things well other than patient care and doctor efficacy. Even the very best of software engineering can only do so much after that.

Re:Most "automation" isn't, just like this.

[Anonymous Coward]

Interesting. 18% is the Gibbs Phenomenon overshoot.

Re:Most "automation" isn't, just like this.

[sjames]

Not really, no. Countries with socialized medicine use the same drugs, the same machines and doctors with the same skills. They just bargain harder to get decent prices on in all. Some wealthy people do choose to fly to the U.S. but that's more about getting to the front of the line faster for elective procedures than anything else.

But even if you're correct, healthcare you can't afford might as well not exist. In that sense, the U.S. has practically non-existent healthcare.

Re:Most "automation" isn't, just like this.

[Anonymous Coward]

You're trying to look clever and you nearly got there.

If they charged twice as much then it cost him twice as much. I suspect that's what he meant.

Re:Most "automation" isn't, just like this.

[jellomizer]

The cool thing about computers is that they can organize and prioritize data. So that 1 inch thick of printed material can be checked quickly. The problem is most doctors are stuck in the Victorian era and refuse to use the technology properly or even admit that these guys who built the system had any brains at all. They are the doctor they must be right in all things. They went to medical school which was a lot of hard work. So they have to be experts in everything even if they didn't study it.
As a side note medical school doesn't normally teach classes in business operations so they are not as well trained in how the organization works.

Re:Most "automation" isn't, just like this.

[rally2xs]

Yes it is, but it is a delivery issue, not a healthcare quality issue. We need to work on being able to get healthcare to everyone. Unfortunately, this is one of those things that the government absolutely cannot do at the same quality level as people buying their own healthcare. As soon as someone other than the recipient of the care starts paying for it, those providing it start NOT caring how much it costs, and do everything that they can to make it more expensive because they perceive a bottomless pit of money that is supposedly the government, and are going to ensure that they "get theirs." They also cease to seek ways to make it cheaper.

The solution to this is restore prosperity to the USA, and reject this "globalization" idea that has made the rich richer and the poor poorer, and get back to fair trade instead of free trade, and tariffs where appropriate. We ran the whole country on tariffs and excise taxes before the income tax was passed in 1913 (at the behest of the rich, of course, who were tired of paying almost 100% of the costs of running the country, since these were both consumption taxes and the rich were the only ones with significant money to be able to consume. America was hoodwinked into passing the 16th Amendment, and the income taxes have been dragging down the economy ever since. We need to abolish the income taxes, go back to a consumption tax as described by "The Fair Tax", and make the economy roar. Then everyone would have the money to buy their own healthcare, except for those comparative few (compared to the millions on welfare now) that would be left that still couldn't provide for themselves.

"It's like a C average student claiming: "I'm really a straight-A student! I got As in all the classes I didn't flunk. (And BTW, for some reason my education cost twice as much as that of any other student.)" "

I don't think that's a descriptive analogy for this case. I think the better analogy is that the schools in City X are capable of delivering the best education in the world, _if_ you can get into them and pay for all the class fees, but the fact that the residents can't all afford the class fees for chemistry, physics, or even the shop class means that a significant number of students graduate without the skills that are taught in these classes. Those less knowledgeable students are our "lower income" citizens that also don't get the best healthcare that America has to offer. It doesn't change that America has best healthcare on the planet, but the problem is that our AVERAGE healthcare outcomes are lower than the rest of the world because of those not receiving care, or receiving minimal care.

Lets abolish the income taxes, all of them, and make our economy roar, and this problem will become light-years easier to manage.

Re:Most "automation" isn't, just like this.

[tburkhol]

No doctor can review a medical file in one minute.

I watched my doctor do exactly this with a real folder filled with paper just two weeks ago.

No, you watched a doctor scan a folder filled with paper for specific pieces of information. He did this first by recognizing the sheets of paper in order to identify ones that might have a diagnosis or prescription, then looking for the specific lines where that diagnosis should be written. If you think he absorbed the history of your blood pressure, weight, or all of the test results that might be relevant to your current condition, you're deifying a person just because his job is complicated.

Medical charts are like syslogs. You can read through them, and with some practice get pretty good at recognizing 'important' messages, or messages that fit with your personal expectation of how systems fail, but it's much faster and more accurate to have grep do it. This was, in fact, one of the big reasons to digitize those records. Software will miss a lot less than a human doctor who's been awake for 20 hours and is seeing his 25th patient of the morning. Let software compile and prioritize past diagnoses and prescriptions. Let software build a graph of body weight, blood pressure, and blood glucose going back for years. Let software summarize all that data and present it in a compact summary that's easy to absorb and easy to drill into more detail on the bits that turn up.

That's generally not what they have. What they have is record-keeping software that satisfies the bureaucratic requirements of the insurance companies and medicare. Its purpose is less for diagnostics and care; more for billing. It's what you get when you let accountants practice medicine.

Re:Most "automation" isn't, just like this.

[dwillden]

In other words the Doctor reviewed the file, in less than a minute. The GP didn't say read it word for word, but reviewed it.

Re:Most "automation" isn't, just like this.

[tburkhol]

So, the US spends 18% of its GDP on healthcare, but that only covers part of the population. Meanwhile those countries who only spend 6-9% of GDP on healthcare manage to cover everyone. So, that 18-6 cost disparity is actually understated

This is your argument that quality of care in the US is actually the best in the world?

I'm not really sure I care that a US millionaire can get outstanding care, if he can only do so at the cost of forcing the rest of the country to get 3rd-world quality care. I'm sure appropriately rich people in those other countries also get better than local average care. It's ridiculous to compare the quality of care available to the few Americans who can afford it to the quality of care available to an average 'socialized' medicine citizen.

Re:Most "automation" isn't, just like this.

[rally2xs]

The quality of care that is _available_ in the US is the highest in the world. Yep, its expensive - we have a sue-happy society that sends malpractice lawsuits into court more than anywhere else in the world and that is expensive because it causes hideous malpractice insurance premiums. Also, our drug companies spend billions of dollars developing new drugs that they then send to other places in the world out of altruism, because those places have price controls on the drugs. If being straight capitalistic, the drug companies would say, "Nope, this is the price. If you don't want to pay it, you don't get this drug" but they don't do that. What they do instead is to charge AMERICANS enough money to cover the costs of the development of the drug, while giving the rest of the world an almost-free ride. And, of course, you have to pay doctors commensurate with the education required to be doctors. The most intense electrical engineering program I came across when considering careers was Ohio State's at 5 years to get it all done, but doctors are just getting started at 5 years. And, thanks to the profusion of gov't money available to students via the student loan programs, the Universities, as do all similar offerers of goods and services that perceive a bottomless pit of gov't money, have jacked up their tuition prices to suck as much of it as they can out of the students and gov't and into their coffers. Additionally, the US has, more than other countries, a proliferation of illegal aliens are poor, and also put other Americans out of work making them poor as well, so there are hordes of people that show up at hospitals that cannot pay for the services, while the US laws say the hospitals have to treat them. So they do. How do they do that and avoid bankruptcy? They charge those that _can_ pay a much higher price. Hospital bills for the most innocuous visits to the emergency room can range to 1000's of dollars. They're making up for the losses from all corners as just described.

What is not a ridiculous comparison is that, if the USA institutes "socialized medicine", the superior care that is available to US citizens that can pay for it will go away, cease to exist. It will be gov't run boondoggle that takes its place, and our cancer cure rates, for example, will fall to match those in other countries. As a cancer survivor, I'm against that - I may have to attempt to survive yet another cancer before its over, and I don't want _less_ capable cancer care than exists now. I could end up dead before it's really necessary. That's my big objection - dying earlier than absolutely necessary. The solution isn't to degrade our healthcare to the level of the rest of the world, it is to make our healthcare available to all our citizens. As I said, the best way to do that is to restore prosperity. Pass the Fair Tax, and that will happen.

Re:Most "automation" isn't, just like this.

[rally2xs]

"I'm not really sure I care that a US millionaire can get outstanding care"

I'm not a millionaire, far from it. I'm just a retired gov't engineer that worked in the defense industry, never broke $100K / yr except for "hazard pay" when I went to Iraq a couple times, and... I get the best care available in the USA. The middle class has access to the best care in the USA, its not millionaires.

Re:Most "automation" isn't, just like this.

[jbmartin6]

The Doctor is a Time Lord and thus can read it far faster than any human.

Re:Most "automation" isn't, just like this.

[dasunt]

The quality of care that is _available_ in the US is the highest in the world. Yep, its expensive - we have a sue-happy society that sends malpractice lawsuits into court more than anywhere else in the world and that is expensive because it causes hideous malpractice insurance premiums.

We've had tort reform in some states. The effects seem to indicate that the cost of malpractice is responsible for a few percent of our healthcare costs.

I suspect what's driving our healthcare costs is that good healthcare isn't cost competitive. Our healthcare for most of us is covered by insurance companies through work. We change jobs frequently. Yet health problems can take years to have serious (and costly) effects. It's not cost competitive to prevent a problem that another company will likely end up paying for.

It's like the difference between owning a car you know you'll replace in five years and owning a car you will replace in twenty-five years - you're going to be much more diligent about preventing problems in the car you'll own for five times as long, because you'll be paying for the costly effects of poor maintenance.

Re:Most "automation" isn't, just like this.

[Weirsbaski]

America spends 18% of GDP on healthcare. Other developed countries spend 6-9%, yet mostly have better health outcomes. So if we become as efficient as them, 1/2 to 2/3rds of healthcare workers will be redundant. What interest do they have in destroying their own jobs?

Those last two sentences don't automatically follow from the first two: maybe America spends so much because prescriptions are so expensive, or maybe the cost of insurance/lawsuits is unusually high, or maybe plain old fraud has a major impact, etc.

It'd be interesting to know how many doctors, nurses, and other medical professionals there are per capita, in America and in the countries compared against.

Re:Most "automation" isn't, just like this.

[jeffporcaro]

There are so many layers of people siphoning their take that it's become almost absurd. More and more money gets pumped into the health care system, and physicians get paid less and less every year. We're one of the few industries in which an annual salary decrease is expected. It's insurers, more than anyone else - but also administrators, EMR vendors, pharma, device manufacturers, and government bureaucrats. And most of these industries have very effective lobbyists (unlike docs, who have the impotent and uninterested AMA), "representatives" (aka "salespeople") scurrying to & from doctor's offices, and aggressive direct-to-consumer advertising. All of the corporations involved in these activities are "people," of course, and operating completely within the law. Your healthcare dollars do very little to support your doctor - they are funding the medical industrial complex, which pushes the EMR for their own ends, not for the benefit of doctors or patients. I'm a cardiologist, and I can tell you from daily experience that the current practice of medicine has become an unbelievable slog, and EMRs are a large part of that - but the whole culture has become corporatized, to the detriment of the people it's supposed to serve. Hopefully the pendulum starts to swing back at some point, but I'm not holding my breath, and I wonder if it will be too little too late when it does.

Re:Most "automation" isn't, just like this.

[Anonymous Coward]

EHR's do this terribly, and forget it if you transfer your data from one EHR company to another, it just becomes a mess.

Re:Most "automation" isn't, just like this.

[Anonymous Coward]

The real and proper question is if the largest health care system in the world is socialized, do the companies still make the same drugs, the same machines, and do people pursue the same skills in career preparation and do they continue to pursue advances at the same pace? Single is a great idea, but I don't see how we keep it as an honest socialized program without putting strings through the entire world economy.

Re:Most "automation" isn't, just like this.

[sjames]

Well, most of the doctors in socialized systems got their training in their home country with the intent of practicing in their home country, so apparently they will pursue the same level of skill. The sales of equipment and drugs to countries with socialized medicine are voluntary. They choose to say yes and take their fair profit. If big pharma decides that only rapacious profits will do, we'll have to socialize that as well.

Of course, what good is it if they develop a magic pill that cures cancer, the common cold, and male pattern baldness after one dose if there are only 10 people in the world who can afford it?

Re: Most "automation" isn't, just like this.

[Anonymous Coward]

Norway, France and the UK have moved over to computerized prescriptions and notes. Want a medication from a Norwegian doctor? The doctor types in the medication on the computer and the prescription can be collected from any pharmacy. Just bring some ID.

In the UK or France, you get a printed prescription to take to a pharmacy.

Re:Most "automation" isn't, just like this.

[ChumpusRex2003]

Agreed. "Organization" and "Prioritization" are two things, that my experience with EHRs has taught me, are two things that they just cannot do to any meaningful extent.

I recall the pain when we tried to migrate our data on an imaging system (PACS) which has a robust, fully standardized protocol for data exchange. With EHRs, things are much more complex, because most packages on the market use proprietary data formats, and while they can export or message across standard interfaces (e.g. HL7) there will often be loss of data, or a change in data presentation (a common one is loss of text formatting or loss of images embedded in text - e.g. rich text storage is quite common, but the data communication/migration interfaces may not support anything beyond straight ASCII text)

Even with our PACS migration, there was a problem, because annotations to the images were stored in a proprietary format, and were not preserved when the data was exported. "Oh. You want the image annotations? OK. We estimate that will take 5 days and 2 developers for development, testing and deployment of the script @ $5k per day per developer".

Things got better from there. "So, how are you going to get the data off the hard drives? The data is held in a proprietary format, and under the terms of the software licence, you will not be permitted to use or develop any software which uses this format once your licence expires. You are reminded that reverse engineering of the file format is strictly prohibited. We can provide a chargeable service for you. We estimate this will take 12 days of development and consultancy @ $5k per day. We will procure (at your expense) a suitable SAN and windows server. We will deploy a script which will convert our files into an industry standard form, and copy them to the new SAN. Please note that this will be performed at our facility. We will require you to ship the servers and SANs containing your data to our workshop at least 12 working days before your software licence expires. Once the transfer is complete, the new servers will be shipped back to your premises."

In the end, we found a specialist consulting firm that was able to extract the data (sans annotations) over the standard interface (by taking over the IP address and credentials of one of the CT scanners which was not used overnight) and trickling the data out overnight at rate not fast enough to trip the "intrusion detection system" (more like bulk data copy detection system) on the servers.

I can still recall the account manager's face when I told him that we would not be needing his $200k data migration service.

Re:Most "automation" isn't, just like this.

[Anonymous Coward]

"Of course, what good is it if they develop a magic pill that cures cancer, the common cold, and male pattern baldness after one dose if there are only 10 people in the world who can afford it?" Eventually the patent expires and there will be a generic (despite all the games that manufactures play to keep it from happening), unless it actually costs so much to manufacture that there really are only 10 people with the resources to access it.

Re:Most "automation" isn't, just like this.

[sjames]

Don't worry, by the time the patent runs out, it will be banned because it occasionally causes temporary excessive itching of the little finger, but the new just patented formulation will be available (to the 10 people who can afford it).

George Washington took colchicine yet there is now a marketing exclusive on it raising the price of treatment from $4/month to $500. People with asthma used to use cheap generic albuterol inhalers. Now they have to buy them on the black market if they can't afford $100/each.

Re:Most "automation" isn't, just like this.

[NotAPK]

"The quality of care that is _available_ in the US is the highest in the world."

I'd love to see some more detailed information about this, including some references if possible, thanks.

Re:Most "automation" isn't, just like this.

[Captain Splendid]

If you're going to attempt to be a pedant on this site, might I suggest a couple of tips?

First, keep it short.

Second, don't forget to be right.

Hope that helps.

Re:Most "automation" isn't, just like this.

[rally2xs]

http://www.ncpa.org/pub/ba649

http://www.ncpa.org/pub/ba596

https://riffenberg.wordpress.c...

http://mjperry.blogspot.com/20...

http://talkbusiness.net/2009/0...

Re:Most "automation" isn't, just like this.

[jon3k]

He can when he's your GP and he's already familiar with your medical history.

Re:Most "automation" isn't, just like this.

[Anonymous Coward]

More that the US is effectively paying for the research costs for the drugs.

Re:Most "automation" isn't, just like this.

[sjames]

So apparently we need to quit being chumps and socialize to spread those costs more fairly.

Re:Most "automation" isn't, just like this.

[NotAPK]

Good links, thanks.

But why does the USA let babies die?

http://www.nationmaster.com/country-info/stats/Health/Infant-mortality-rate

http://www.huffingtonpost.com/howard-steven-friedman/infant-mortality-rate-united-states_b_1620664.html

http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_05.pdf

http://www.nber.org/papers/w20525.pdf

Re:Most "automation" isn't, just like this.

[rally2xs]

"But why does the USA let babies die?"

I think "let" is too strong a word, implying willfulness. We certainly fail to prevent these infant deaths, but lightly tromping thru the linked documents didn't come up with a reason for the differences. It seems nobody knows how to get the IM deaths to decrease, although the last paper hints that at-home nurse visits would help a lot. But, after reading them, I don't know. The 1st paper says something to the effect, "No, its not because we don't have universal healthcare" which I find surprising. So, I figure that I now "know" less than I thought I knew about the subject before reading the 4 linked papers. No, I didn't read 'em in full, I have other things to do today, but read the conclusions, and... the solution just doesn't seem to be there.

Re:Most "automation" isn't, just like this.

[Anonymous Coward]

no depending on where you live you get variable levels of care, if you are in poorer areas you definitely receive poorer care (ontario is a good example)

Re:Most "automation" isn't, just like this.

[NotAPK]

I didn't post my links to be a flamer: the topic, as you indicate, is truly fascinating.

It was first brought to my attention by a Swedish sociologist, Hans Rosling, with his presentation here but even better is this one.

In the second video he shows trends in infant mortality and it is a fascinating watch. The most alarming statistic is that while worldwide infant mortality trends against GDP, the USA is a clear outlier.

You are right, why this is the case is difficult to understand.

Re:Most "automation" isn't, just like this.

[NotAPK]

If you don't have 20 mins for the full presentation (second link) then start watching at 9:30 for the most relevant part.

Though I recommend the entire presentation, and really anything else from Hans, he's a great presenter with access and the ability to communicate some incredible statistics.

Re:Most "automation" isn't, just like this.

[jwhitener]

The quality of care that is _available_ in the US is the highest in the world.

The quality and outcomes of care for rare cancers and other rare diseases is higher in the US. But our quality of care for regular stuff, like 95%+, is no different than single payer countries. And in fact, for many outcomes, we are lower than other countries.

well, they "teach to the test"

[turkeydance]

might as well "doctor to the data"

Fix the link

[Anonymous Coward]

This is doctors, not "How Tech Giants Helped After The Bastille Day Attack (And A French App Didn't)"

hookers cost less and you get a full hour

[Anonymous Coward]

$300 for 8 minutes

Re:hookers cost less and you get a full hour

[Anonymous Coward]

$300? One doc charges $95/45 minutes, another $100/10 minutes, another $125/10 minutes. Besides... You go to the doctor to cure what you got from the hooker.

My PCP has a "scribe!"

[dpbsmith]

My primary card doctor is reasonably young and when I started seeing her, she keyed in notes about treatment plans and such right into the office computer. So I know she's comfortable with computers and that's she's a fast typist.

About two years ago, when she came into the exam room, she was followed by a young person with a laptop whom she introduced as "my scribe!" Her scribe was constantly tapping away at the laptop, taking notes and entering orders and so forth.

I don't honestly know whether this is good, bad, or indifferent, but it certainly is evidence that the burden of data has become so overwhelming that doctors need assistants specifically to help with that.

She works for a gigantic megapractice that is proud of being a Patient Centered Medical Home and an Accountable Care Organization and all that good stuff, so I think they are following current "best practices."

Geezer reminiscence on. When I was a kid, the doctor's office had a big lab, where they had microscopes and hemocytometers and did their own lab work, and a small business office. Now the labs are gone--they send all the lab work out. The business offices occupy a third of the floor space, because they need room for people waiting all day long on hold to talk to insurance companies. And they have to hire scribes to help the doctor with the data entry. Maybe it's progress.

Re:My PCP has a "scribe!"

[Actually, I do RTFA]

Good. A doctor (not a surgeon) is mostly making technical decisions. Expert systems tend to be better at that kind of thing. I don't see much value in onsite labs (immediacy, I suppose). Why not make it all standardized, auditable, and cheaper by eliminated glorified, failure-prone human symptom lookup tables?

Re:My PCP has a "scribe!"

[Hadlock]

I had to get my hand looked at after a bicycle accident about 2 years ago that could have impacted my range of movement. The doctor turned on a recorder that had a foot pedal as a sort of "push to talk/record" system. Every time he put his foot down it would start recording, and stop when he let off. This tape then got labeled with my case number and sent off to a transcriptionist/service. I don't know why you need the scribe in the room but whatever. The transcription cost gets passed along to the insurance company. No big deal.
 
The big bonus here is that me, the patient, gets to hear exactly what is going in to the doctor's notes, not getting the sanitized version. Also the doctor doesn't have to mentally repeat themself hours after the appointment.

Re:My PCP has a "scribe!"

[peragrin]

More on site labs though would push through better and faster ways to get results back. What if doctor could have your blood work done while starting the next patient? That by itself would save billions of dollars.

Re:My PCP has a "scribe!"

[Actually, I do RTFA]

My doctor does have onsite labs, and they do do exactly that. Rarer labs I assume they send out, and I have to comeback.

You're correct that the cost savings of outsourcing labs are really partially costs externalized to patients by forcing them to come back. I imagine that there would be some way to solve for that.

Re:My PCP has a "scribe!"

[JoeMerchant]

Modern practice of medicine absolutely does make doctors into data entry clerks. Big data is telling them what works, what doesn't, improving diagnosis and treatment, the volume of data and pace of discovery are such that no human being could possibly keep up with it in the traditional med school + residency + practice & annual CE fashion. If your doctor isn't "jacked into the cloud," you're not getting the best out of modern medicine.

This is ABSOLUTELY not to say that the best medical care comes from doctors who attempt to practice cloud connected medicine, effectiveness of practitioners varies tremendously, and the best traditional doctors are far far better than the worst "big data" based doctors - but, if you think you might need a procedure performed, it's probably best to consult with an MD who is "up on the cloud" in your area of need, and simultaneously guaranteed NOT to profit from you going ahead with the decision to have an expensive procedure performed.

Re:My PCP has a "scribe!"

[Flozzin]

I came here to post this as an idea. If they are burdened with having to do data entry, hire someone to do it for them. It's easier to talk than to type for most people, especially when it takes mouse movements to go each of the correct textareas I'm sure they have. Or as another poster pointed out in his office visit, record the conversations and send them off to get transcribed.

Re:My PCP has a "scribe!"

[WalrusSlayer]

Your PCP (as well as you) are lucky. My PCP spouse is a total burnout case because of the data entry problem and lack of organizational support. I see two factors here: (1) the doctors just suck it up and put in countless hours of unpaid overtime to feed the beast, and (2) the suits that run the place don't have the business acumen to realize that a scribe would easily pay for themselves in increased billings since the doctors could handle a larger panel.

It kills me because it seems like the specialists have figured this out, just not Primary Care. My eye doctor always has some sort of assistant present to help out with the mechanics of dealing with the electronic charts. Been that way for years and years. Why the hell have the highest paid guy in the room be spending time that doesn't require his skillset when that can be offloaded by someone cheaper? Seems like a no-brainer to me.

Re:My PCP has a "scribe!"

[h33t l4x0r]

I agree, that's why I always just google my symptoms and self-medicate.

Re:My PCP has a "scribe!"

[Anonymous Coward]

Yeah, the funniest part of this is listening to the doctors whine that this is some new thing, but you can go back decades and find late night infomercials about how medical transcription is the hottest thing, and call now to get your transcriptionist school certificate for just 10 easy payments of 99.99!

I wonder how many doctors whining about it now couldn't be bothered to handwrite their own notes then. Lazy doctors gonna laze.

Re:My PCP has a "scribe!"

[0100010001010011]

Because people keep demanding that it gets cheaper so that tape gets sent off to India where it's transcribed by someone that barely speaks english.

Re:My PCP has a "scribe!"

[Anonymous Coward]

I'm a doctor and I can tell you the transcription cost does NOT get passed along to insurance to reimburse. Same thing as a scribe. Doesn't sound like much but now I get $15/Hr taken out of my paycheck to pay for a scribe because of these EMRs. It's either that or I get to stay 3 hours late doing it myself.
Amazing that we have iPhones with such amazing software while I'm using a MS-DOS looking EMR because my hospital requires me to use it.

Re: My PCP has a "scribe!"

[Anonymous Coward]

Scribing is usually the way premeds get experience without getting in the way. Not so much an indicator of technical inefficiencies.

Re:My PCP has a "scribe!"

[NoKaOi]

but it certainly is evidence that the burden of data has become so overwhelming that doctors need assistants specifically to help with that.

The burden isn't on the amount of data, but rather the absolutely horrible systems that doctors have to use. Every major EMR out there is a flaming pile of crap. The thing is, they really don't care about investing in improving usability. They get selected for contracts with hospitals and clinics based off a checklist of features along with getting to tell them that so many other places use it, and the initial deliverable isn't even usable. So then they charge big, big dollars for "implementation" to make it "usable," and what they end up with is something that works but takes an order of magnitude more time to use than it should.

Re:My PCP has a "scribe!"

[Anonymous Coward]

I spoke to a medical secretary, who's company tried sending tapes off to India. It took the secretaries longer to correct the typos afterwards, and double/triple check medication and illness names.

Re:My PCP has a "scribe!"

[houghi]

My doctor types in what I am there fore, print outs the prescriptions (so they are readable) and papers for the insurance. If he would have a scribe, I would ask that scribe to leave.

Once every 2 years I need to sign a paper that the other doctors in the office are allowed to access my data. If not, they will not see it.

I do not need to wait that long as I make an appointment online. I calculate an hour when I go to the doctor. It is a doctors group that has 6 or 7 doctors. I choose that, so when the doctor is on a holiday or sick, I can go to another one. Happened already.

One time I had somebody else in the room. They were students and he asked first if it was ok, they did a diagnose and then were asked to leave again by him.

But a scribe? I would throw that person out as fast as my sick body can manage.

Re:My PCP has a "scribe!"

[tomhath]

A doctor (not a surgeon) is mostly making technical decisions. Expert systems tend to be better at that kind of thing.

Completely wrong on both points. Every step of a surgery involves making decisions. Expert systems are useless at examining people and making sense of the symptoms.

Re:My PCP has a "scribe!"

[tburkhol]

My doctor types in what I am there fore, print outs the prescriptions (so they are readable) and papers for the insurance. If he would have a scribe, I would ask that scribe to leave.

If you imagine that your records are only seen by people who are in the room at the time the diagnosis is presented to you, then either you have a very small, backwards and inefficient doctor, or you're very naive. The part of his office that collects payments from the insurance company and matches them with payments will see your name, diagnosis, and treatments. The part of the insurance company that receives your paperwork will see your name, diagnosis, and treatments. If you're happy to pay your doctor $150/hour to fill out insurance forms for you, good on you, I guess. I'd rather pay the $150/hr doc for medical care and let a $20/hr transcriptionist do the paperwork.

Re:My PCP has a "scribe!"

[Anonymous Coward]

The value I see in onsite labs is that it could be possible that the same person that talked to the patient that did the analysis.
This means a more in-depth knowledge of what was tested for and what wasn't.
On paper it doesn't matter and is probably inefficient but in reality that would mean that the doctor could have a "gut feeling" about what other tests to run or if there might have been a mix-up.

Re:My PCP has a "scribe!"

[Anonymous Coward]

Amazing that we have iPhones with such amazing software while I'm using a MS-DOS looking EMR because my hospital requires me to use it.

That is because the iPhone with the amazing software works most of the time but gets a word wrong every now and then. Sometimes that word is important.

Re:My PCP has a "scribe!"

[Anonymous Coward]

I doubt you'll find much sympathy for unpaid overtime on a forum frequented by IT personnel.

Re:My PCP has a "scribe!"

[jittles]

Modern practice of medicine absolutely does make doctors into data entry clerks. Big data is telling them what works, what doesn't, improving diagnosis and treatment, the volume of data and pace of discovery are such that no human being could possibly keep up with it in the traditional med school + residency + practice & annual CE fashion. If your doctor isn't "jacked into the cloud," you're not getting the best out of modern medicine.

This is ABSOLUTELY not to say that the best medical care comes from doctors who attempt to practice cloud connected medicine, effectiveness of practitioners varies tremendously, and the best traditional doctors are far far better than the worst "big data" based doctors - but, if you think you might need a procedure performed, it's probably best to consult with an MD who is "up on the cloud" in your area of need, and simultaneously guaranteed NOT to profit from you going ahead with the decision to have an expensive procedure performed.

I'm not sure that I believe this. For one thing, anything that is "in the cloud" I can look up myself. For another thing, sometimes solving a patient's healthcare problem is more about being a good problem solver than knowing the latest and greatest anything. I once had extreme pain when urinating. All of the symptoms pointed towards one of two things: an STD or a kidney stone. An expert system would have said kidney stone since I (being a basement dwelling Slashdot user) was not exposed to any STDs prior to the onset of the symptoms. Did I have a kidney stone? No. It turned out that I had a hernia that was not causing me any discomfort whatsoever. At least, it hadn't for years until it finally pushed against my urinary tract and caused a very serious kidney infection. Not being in the right risk category for a kidney infection, my doctor decided to do a full physical and that is when he discovered the cause of the problem. The expert system could only indicate where there was a symptomatic problem, the doctor found the asymptomatic cause of the entire mess.

Re:My PCP has a "scribe!"

[Anonymous Coward]

Check list of features...i.e. state mandates and business efficiencies...not patient care...I 3 free health care...take care of me state rationed medical care...as long as it is free.

Re:My PCP has a "scribe!"

[Anonymous Coward]

HOT DAMN! I wish I were rich enough to elect to have $15/hr taken out of my paycheck. Then again, I would rather just work those extra 3 hours a day to keep that $15/hr for myself.

Re:My PCP has a "scribe!"

[Walking The Walk]

Because people keep demanding that it gets cheaper so that tape gets sent off to India where it's transcribed by someone that barely speaks english.

Not true. Medical transcriptionists need to have a vast understanding of medical terminology, have to turn around transcriptions usually same day, and their transcriptions are reviewed by the doctors. Any outsourced contract that didn't provide above 90% accuracy would be cancelled by the hospital.

My sister in law and her mother are both medical transcriptionists for a company based out of Toronto (Canada). The pay isn't great, but the hours are somewhat flexible and they work from home. They're able to work from home because the recordings are all digital these days. The recordings go on to the server, tagged with the doctor's name and a session id of some sort. The transcriptionists pick it up from the queue, and type it in as they listen to it. They have an SLA with a minimum turn around time for transcriptions, based on the type of recording and duration (eg: transcriptions from a podiatrist might be fairly short and straightforward, while those from doctors in emerge or ICU might vary wildly in length and complexity.)

FYI - it's not easy work at all. Many doctors have different accents or don't dictate clearly, use different terminology or abbreviations, etc, and there are often many names for each drug (eg: acetaminophen is the generic drug, also called paracetamol, which might have 200 trade name variants such as Tylenol.) Hospitals have to pay licensing fees to companies that maintain drug information databases for them, such as Vigilance. Transcriptionists often run over the same recording multiple times to figure out exactly what was said, and have an open voice chat to each other to discuss anything they're unsure of. As a last resort they can send it back to the doctor to re-dictate, but you can see how that would be frowned upon.

Re:My PCP has a "scribe!"

[Anonymous Coward]

"When I was a kid, the doctor's office had a big lab, where they had microscopes and hemocytometers and did their own lab work, and a small business office. Now the labs are gone--they send all the lab work out. The business offices occupy a third of the floor space, because they need room for people waiting all day long on hold to talk to insurance companies. And they have to hire scribes to help the doctor with the data entry. Maybe it's progress."

It shows you what activities pay a reasonable return on time. As Medicare/CMS cuts reimbursement for lab services, the margins on running your own lab grow tighter and tighter. Not sure if what you're seeing is progress - closer to a response to evolutionary pressure.

Re:My PCP has a "scribe!"

[tsstahl]

Modern practice of medicine absolutely does make doctors into data entry clerks. Big data is telling them what works, what doesn't, improving diagnosis and treatment, the volume of data and pace of discovery are such that no human being could possibly keep up with it in the traditional med school + residency + practice & annual CE fashion.

This is handled by increased specialization, not surfing medical google for wth is wrong with you.

The big data of which you speak is not on the diagnostic side of things, it is mostly dealing with billing and metrics of clinicians work.

Evidence based medicine is founded on clinical studies, not SQL queries for sore throats.

Re:My PCP has a "scribe!"

[Anonymous Coward]

Sounds like you work at a shitty hospital (The only place I know of that still uses a DOS-based EMR is in Australia?). I'm in healthcare IT at a smaller rural hospital in the US and we have at least three ways doctors can dictate. Immediately after a visit or consult (or depending on how they handle their own workload) they can call a phone number to start dictating, they can grab a microphone attached to the PC they use and dictate via Dragon directly into the EMR, or they can enter their notes directly into the EMR. We also have scribes too for direct entry, but they're for our ER where providers are more on their feet than anything.

Maybe you should push for your hospital to get out of the 80s?

The scribe comes out of your paycheck? What? Do they charge you hourly for your white coat too?

Re:My PCP has a "scribe!"

[JoeMerchant]

Yes, I suppose if you put your mind and wallet to it, you could access all the paywalled medical journals and learn navigate the system of publications to find what's relevant to your particular medical need. If you took that a step further and gave yourself a "full workup" examination, you, too, would have found your hernia - that's standard practice dating back 50 years or more.

The point is, doctors do this daily, they're practiced, and they have a fair idea about common problems and how to spot them - you should go through the "front line" of diagnosis of common problems, like hernia, before digging deeper into the latest research. But, when you fall into the group of people with medical needs that aren't adequately addressed with common, front line diagnosis and treatments, that's where the new stuff becomes valuable. Things that would have gotten a shrug of the shoulders and Rx for some pain killers last year might actually be treatable today. I remember in 1991, a colleague had ulcers, and his doctor was stuck firmly in 1989, telling him to avoid food and drink that irritate the ulcers and basically hope they'll go away on their own - thing was, in 1990 they published the causal connection between H.pylori and common ulcers, making them curable with a short course of antibiotics, which is common practice today, but his doctor wasn't "up on these things" so he was left to suffer.

Re:My PCP has a "scribe!"

[Anonymous Coward]

OMG you have to pay someone what 1 whole patient copay to transcribe all of your work for the ENTIRE day?

How unfair to you, and I can see how it would impact your tee time.

Re:My PCP has a "scribe!"

[Archangel Michael]

It isn't the hospital that requires it, it is the government regulations that prevent anything resembling an upgrade. The amount of red tape that is assigned to anything "medical" is astounding, all in the name of making things "safer". In the end, things are NOT safer, and hospital systems running on older, exposed versions of software is a huge liability, but nobody really cares, just as long as it is "certified". That certification prevents lawsuits, and passes the buck when shit hits the fan to the point where nobody can actually address the issue that caused it.

Re:My PCP has a "scribe!"

[jittles]

Yes, I suppose if you put your mind and wallet to it, you could access all the paywalled medical journals and learn navigate the system of publications to find what's relevant to your particular medical need. If you took that a step further and gave yourself a "full workup" examination, you, too, would have found your hernia - that's standard practice dating back 50 years or more.

The point is, doctors do this daily, they're practiced, and they have a fair idea about common problems and how to spot them - you should go through the "front line" of diagnosis of common problems, like hernia, before digging deeper into the latest research. But, when you fall into the group of people with medical needs that aren't adequately addressed with common, front line diagnosis and treatments, that's where the new stuff becomes valuable. Things that would have gotten a shrug of the shoulders and Rx for some pain killers last year might actually be treatable today. I remember in 1991, a colleague had ulcers, and his doctor was stuck firmly in 1989, telling him to avoid food and drink that irritate the ulcers and basically hope they'll go away on their own - thing was, in 1990 they published the causal connection between H.pylori and common ulcers, making them curable with a short course of antibiotics, which is common practice today, but his doctor wasn't "up on these things" so he was left to suffer.

And how quickly do you expect that research to be available in an expert system? Or are you imagining that these record systems are automatically indexing these journals as they publish?

Re:My PCP has a "scribe!"

[sessamoid]

Scribes are almost always paid by the physicians themselves. Onerous documentation requirements by the gov't and insurance companies make them almost mandatory for some of the more antiquated EMRs. Who else is going to pay for it?

Re:My PCP has a "scribe!"

[sessamoid]

Specialists have figured this out because their time is more valuable (as judged by what the pseudo-market is willing to pay them), so the marginal benefit of scribes is much greater. The cost of a scribe is a much higher percentage of an average PCP's hourly earnings than a plastic surgeon's. That makes the cost-benefit analysis a bit different.

Re:My PCP has a "scribe!"

[WalrusSlayer]

Fair enough, but it seems like all that gets focused on is the cost without weighing in the (lower than for specialists, but non-zero) benefits. Even if it isn't a zero-sum outcome, I would think at this point that most near-the-brink-of-burnout doctors would seriously consider absorbing some of this load.

It's not a given mind you, as when I witnessed controversy over what should have been the no-brainer of adding a Hospitalist staff into the mix. That meant there was an inpatient-specific doctor staff to offload torturous middle-of-the-night admissions, among other things. Most of the doctors were fine with the tradeoff of losing some of the billings associated with the admissions, as it turned "on call" in being a telephone-only affair, rather than a Russian Roulette game of "am I going to get any sleep tonight this time?". There was a small but vocal contingent that balked, but in the end the Hospitalists were hired, which was a win for both doctors and patients alike.

Re:My PCP has a "scribe!"

[JoeMerchant]

Evidence based medicine is founded on clinical studies

Most, current evidence based medicine is, but more and more "SQL queries" are making their way into the researchers' input data pool - it's not just CDC anymore.

It's actually quite sad what proportion of "work" that goes on in a hospital is focused on serving the reimbursement bureaucracy, but there is some patient care and even research happening there too.

Re:My PCP has a "scribe!"

[sjames]

That's great if you're a zebra, but most patients are horses and a good doctor can quickly do a clinical diagnosis that separates patients into "fluids and rest, take aspirin", "infection, take antibiotic", and "this could be serious, you need a detailed workup".

Sadly, more and more that step gets skipped and all patients end up treated as the third category where $500 in tests later they are told they have a cold.

Re:My PCP has a "scribe!"

[Anonymous Coward]

In my experience that MS-DOS looking stuff tends to *work*.

Re:My PCP has a "scribe!"

[Lieutenant_Dan]

I used to run the IT department at hospital years ago. There was a sizeable budget set aside for transcriptionists, who entered written/scanned notes or recorded notes into the medical IT application. There are even managed services that offer that to hospitals which don't have their own transcription department.

Major critical piece; my director was demoted after a VPN outtage affected a lot of remote transcriptionists for almost a week and he had made the decision all by himself to do with vendor support for the VPN appliances. Things I learned don't mess with pager systems, telephone, transcription and the main medical app; everything is best effort including e-mail, Internet, Wifi, printing, etc.

Re:My PCP has a "scribe!"

[Anonymous Coward]

That's the modus operandi of the 21st century: reduce every middle class salary position to the level of a low caliber drone position and whomever does so gets a small percentage of the overall savings in the industry.

Re:My PCP has a "scribe!"

[Anonymous Coward]

Expert Systems have been proven to make correct choices more frequently than a doctor given the same information.

You sir should check your sources.

Re:My PCP has a "scribe!"

[Actually, I do RTFA]

Surgery requires making decisions (duh). It also involves a lot of physical manipulations, image recognition, tactile input, difficulty in human review, and other reasons why automation on surgery is likely to far trail behind diagnostics.

Expert systems need humans to do the evaluation, sure. But nurses can do 90%+ of the observations, quantitize them, and feed them into an expert system. And in fact, this article was about how doctors, more and more, are being relegated to this role.

Re:My PCP has a "scribe!"

[judoguy]

Good. A doctor (not a surgeon) is mostly making technical decisions.

Not in my experience. The doctors I've seen in the last couple of decades are basically insurance company and pharmaceutical company lackeys. Not exaggerating here at all. For example, I went to an endocrinologist not long ago and after looking at my records showing a loss of 40 lbs, great cholesterol panels, great blood sugar, blood pressure, etc., said, "That's really good!" and then I swear to god, his eyes went a bit blank and he started encouraging me to consider a statin and a diabetes medicine because that's what his patients normally get.

No, the majority of doctors in America at least, work directly for the insurance and drug companies.

Re:My PCP has a "scribe!"

[Anonymous Coward]

It's bad. Having a "scribe" in during your doctor visit may have detrimental effects. One such effect is the patient not being forthcoming with embarrassing complaints because there is a stranger in the room with you and your doctor. Besides that a job as a "scribe" reminds me of driving for Uber--you may have work now, but given time, your doctor visit will be recorded and transcribed by computer. Give it five years and we may seldom see a doctor; your computer will see you now.

Re:My PCP has a "scribe!"

[Anonymous Coward]

I'm curious as to whether anyone has rebuilt a decent EMR from the ground up. I used to support Sage Intergy and Intergy EHR and it was a huge steaming pile of shit and heard the majority of others were as bad or worse. I couldn't conceptualize how that was even possible.

Re:My PCP has a "scribe!"

[Taxman415a]

It kills me because it seems like the specialists have figured this out, just not Primary Care. My eye doctor always has some sort of assistant present to help out with the mechanics of dealing with the electronic charts. Been that way for years and years. Why the hell have the highest paid guy in the room be spending time that doesn't require his skillset when that can be offloaded by someone cheaper? Seems like a no-brainer to me.

It's simple. It's because of reimbursement rates. For some reason primary care physicians have lower reimbursement rates, so they can't as easily justify a scribe. It's possible it's because as a whole they don't negotiate as effectively with insurance companies. Generally PCPs choose primary care over more lucrative specialties because they want to help patients more than they just want to make a few more bucks. That seems to self select for less successful businesspeople.

Speaking as someone with long time chronic pain...

[Anonymous Coward]

Thats pretty much what they have been like for the last 50 years....

You list your issues, they follow through the motions. And people wonder "why" its so easy to get prescription meds these days (here is a clue, ITS ALWAYS BEEN EASY!), most doctors are up shit creek without a paddle. When you have nearly an entire lifetime of student debt to payoff what else can you do? When every soccer mom has an "emergency kid sniffle", well its better to over prescribe than under, because it beats being a health clinic doctor making nothing....

It really does take a special kind of person to be a doctor, unfortunately its about 50/50 when it comes to people that actually give a fuck and people that just want to pay off deblt, get benzed, get boobjobbed, and get a mcmansion ,ect...

The mighty data

[Mandrel]

It's not only outside of consultations that doctors can spend time entering data. I once switched doctors because he spent most of every consultation oriented towards his screen and keyboard, entering symptoms, treatments, and medication into my medical record, and little time speaking with me face-to-face.

Re:The mighty data

[ShanghaiBill]

I once switched doctors because he spent most of every consultation oriented towards his screen and keyboard, entering symptoms, treatments, and medication into my medical record, and little time speaking with me face-to-face.

So you switched because your doctor focused on medical issues rather than providing you with emotionally comforting talk therapy?

You are not alone. If you look at doctor review sites, by far the biggest reason for low ratings is a rude receptionist. The 2nd biggest reason is doctors that avoided chit-chat. Actual quality of treatment and medical outcomes are rarely even mentioned.

 

Re:The mighty data

[Mandrel]

So you switched because your doctor focused on medical issues rather than providing you with emotionally comforting talk therapy?

You are not alone. If you look at doctor review sites, by far the biggest reason for low ratings is a rude receptionist. The 2nd biggest reason is doctors that avoided chit-chat. Actual quality of treatment and medical outcomes are rarely even mentioned.

It wasn't chit-chat I was missing. It was someone who could concentrate on listening to me and asking the right questions, instead of on data entry. My current doctor does this. He must update my record after I've left.

Re: The mighty data

[Anonymous Coward]

Actually, I just don't bother to update it unless its billable. Best of luck tho!

Re:The mighty data

[Anonymous Coward]

Information to make decisions about you is in the chart, information for future decisions has to be put in the chart. If you are not putting it in the chart and updating you are receiving poor care. Congrats you played yourself

Re:The mighty data

[Anonymous Coward]

I switched doctors because he kept me waiting for over an hour after my appointment time, came in spent less then 5 minutes with me, misread the lab results, and told me I was fine but gave me something to put on it, that didn't appear to help.

I requested a copy of my results and went to a small practice run by an actual doctor. Was seen ten minutes early, had the labs looked over again, and spent a good 15 minutes discussing treatment options, none of which included the catch all skin creme the first Dr gave me.

There was no unnecessary chit-chat. I saw a Dr, discussed my medical issue, discussed my treatment options, and then got better.

Re:The mighty data

[internerdj]

One of the goals of medical organizations are to keep treatment reasonably consistent across practices. Certainly it is a real world system with real world flaws, but if they are regularly meeting that goal and you don't have either abnormal problems or abnormal side effects from the standard procedures, the vast majority of patients should experience similar quality of treatment and medical outcomes if they visit the vast majority of practices. That shouldn't really have to come up in a review.

Re:The mighty data

[Anonymous Coward]

how many hours a day do you think he does that, charting at the end of the day is a pile of shit, you forget some of the subtlety's and just enter enough to get a 99213, honestly you loose a tonne of revenue and a lot of useful info for later is lost (your not remembering it at a later visit unless it is massively significant)

Re:The mighty data

[Anonymous Coward]

Patients are terrible customers. They don't know what they need. This is why classical economics don't apply to health care, and why the free market leads to perverse outcomes.

Re:The mighty data

[Anonymous Coward]

If you look at doctor review sites, by far the biggest reason for low ratings is a rude receptionist. The 2nd biggest reason is doctors that avoided chit-chat. Actual quality of treatment and medical outcomes are rarely even mentioned.

And the 3rd biggest reason was no Fox News in the waiting room!

Slow data entry

[vossman77]

I know when we go to the pediatrician for a fever, it takes 5 minutes for them to find the code for tylenol.

Re:Slow data entry

[Anonymous Coward]

Usually because of bad UI. All knowledge has been replaced with codes and it's our job to learn the codes to find anything. ...and tomorrow the codes will change, because fuck you.

Jesus fucking christ, didn't we invent "Search" to solve these problems?

Re:Slow data entry

[Applehu Akbar]

"Usually because of bad UI. All knowledge has been replaced with codes and it's our job to learn the codes to find anything. ...and tomorrow the codes will change, because fuck you."

Doctors shouldn't have to think in terms of the codes that the billing system runs on. Have a Siri-like voice interface that translates a doctor's spoken summary of procedures into the current codes. It could provide feedback (through an earpiece inaudible to the patient) when the doctor's description of something is imprecise. Over time, the system and each doctor would cooperate with each other to arrive at a precision spoken language of treatment summary.

Re:Slow data entry

[WalrusSlayer]

Yes. The UI's I've seen suck to high heaven. It's not hard to be five levels deep in nested dialog boxes as they have to navigate checkboxes and codes that are spread all over the place. The visual context-switching that has to be done to enter the information for a single visit is staggering. Not only is it slow as hell, but mentally taxing. A huge waste of the physician's mental bandwidth.

Re:Slow data entry

[0100010001010011]

It's coming.

Re:Slow data entry

[Anonymous Coward]

Fuck yeah we've implemented the hell out of "Search". Too bad the database of drugs is utter and absolute fucking shit. Here, have some tylenol: https://www.findacode.com/ndc/... Oh wait, that's just the FDA's database We'll need to cross reference that to the FirstDataBank database or possibly to RxNorm to actually figure out what's in the bottle and what a patient can actually get at a pharmacy, because all of this shit is self-reported by the drug manufacturers, who can't even bother to let anyone know which of the listed packagers are pressing the pills this month, and especially recently where generic lines are getting shut down left and right to create scarcity and justify jacking up prices. Where's my drug? FDB says it's gone, NDC says it's here. Oh, there's an FDA notice buried on their website that it's "in shortage" due to manufacturing being discontinued, but that's apparently not enough of a reason to terminate the NDC listings.

All knowledge has been replaced with codes

Knowledge was replaced with a 2-year-old picking up a bottle of something and numbering it "1". Then picking up a bottle of something else and numbering it "2". This bottle is the exact same drug as the first one, just with more pills in the bottle: "3" All of the knowledge is gone now. There is zero knowledge in the codes, which is why FirstDataBank makes a killing selling their database. Legend has it, once upon a time someone tried to create a coding system based on the ingredients in the pill, that person is spending the rest of his life rocking in the corner of an insane asylum. Sad, really, because it at least had a shot at coming close to dealing with reality, but I guess staring reality in the face like that will break the strongest of minds.

In other news, we have always been at war with drugs, and the Ministry of Drugs has declared that the acetaminophen ration for all schedule-3 opoids has been decreased to 350mg per dose. In other news, we have always been at war with eurasia, and the Ministry of Drugs has declared that all opoids are now schedule-2 regardless of acetaminophen content.

Re:Slow data entry

[Anonymous Coward]

Usually because of bad UI. All knowledge has been replaced with codes and it's our job to learn the codes to find anything. ...and tomorrow the codes will change, because fuck you.

Jesus fucking christ, didn't we invent "Search" to solve these problems?

That's because the programmers all suck at UI. They all enter text and memorize codes well, because that's their job. They can't and won't think in terms of how people actually use things. A lot of developers have a "my way or the highway" approach to development and think that other people are too stupid to do it their way, so "fuck you!"

It's the future

[Anonymous Coward]

Only a matter of time before real doctors are relegated to overseeing lowly paid "medical technicians" or automated robots. Same thing happened with nurses and doctors are next.

Re:It's the future

[Anonymous Coward]

I thought the nurses were the ones doing most of the actual work?

GOD HELP US A!!

[Anonymous Coward]

Ever seen one of these quacks enter data? No wonder a hospital admission puts you at grave risk of death!

The 8 minutes stat is BS

[Anonymous Coward]

I work IT for a medical billing software company, so I'm in a lot of offices. The time is much closer to a minute or less. Three of the last four times I've seen a doctor, it was for a sore throat, and she didn't even spend thirty seconds with me. The fourth time was in the ER after a motorcycle accident. She looked at my chart, ordered a CAT scan of my pelvis and then never returned. She sent a nurse to tell me nothing was broken. That was $8k for about twenty seconds with the doctor.
 

Re:The 8 minutes stat is BS

[Anonymous Coward]

Three of the last four times I've seen a doctor, it was for a sore throat

I haven't been to a doctor for anything like a sore throat since I was 8 years old. WTF are you doing? I'll bet you left with a pair of antibiotic prescriptions every visit as well. No wonder they are becoming ineffective.

Re:The 8 minutes stat is BS

[Anonymous Coward]

Sore throats can be serious. A friend recently lost his son to Scarlet fever, and when I was in middle school, a classmate died after his parents didn't take him to the doctor after he had strep throat. Also, my grandmother ended-up with serious life-long kidney problems a couple of years ago after she had strep throat and didn't tell any of us or anyone at her nursing home.

Re:The 8 minutes stat is BS

[ShanghaiBill]

Three of the last four times I've seen a doctor, it was for a sore throat, and she didn't even spend thirty seconds with me.

In countries with much lower medical costs than America, routine ailments like sore throats and sniffles are handled by nurses or pharmacists. You only see a doctor if your problem is serious and/or non-routine.

Re:The 8 minutes stat is BS

[cheesybagel]

I guess you never heard of liabilities and losing your license and so on. A pharmacist isn't support to give medical advice.

I remember when they did though.

Re:The 8 minutes stat is BS

[tomhath]

In the US they're called nurse practitioners and physician's assistants.

Brazil wasn't far off

[Anonymous Coward]

I have stage 4 cancer and spend a few hours at the doctor's office every month. The phlebotomists spend a solid minute selecting my record, marking off all the tests, verifying id, insurance, etc. The nurses go down the list of 50 prescriptions I have, asking me if I'm still taking them, even when I say nothing has changed. They're all very polite and nice, but the whole system fails at easy things should be easy, hard things should be do-able design. You can tell that no one who designed the system ever actually performed the tasks at hand (or they were bound by absurd requirements). And all that isn't including the massive bureaucracy of insurance or scheduling that will sink days of your time pressing buttons on your phone trying to talk to an actual person.

In my experience american health care is an inefficient, bureaucratic mess manned by very friendly medical professionals.

Re:Brazil wasn't far off

[Hans Lehmann]

I just went to a doctor this week, and they also asked me about my current medications. I also said "same as last time", so they printed out a form with the medications I mentioned in my last visit and just had me initial it to make sure. They don't just do this to cover their ass, they also do this to cover yours. For every ten patients that insist that "Oh, nothing's changed", they'll probably have one that eventually says "Oh wait, I stopped taking that one two months ago, I forgot to mention it". When it comes to my health, I'm glad they double check their work, and mine.

Re:Brazil wasn't far off

[Anonymous Coward]

I just went to a doctor this week, and they also asked me about my current medications. I also said "same as last time", so they printed out a form with the medications I mentioned in my last visit and just had me initial it to make sure. They don't just do this to cover their ass, they also do this to cover yours. For every ten patients that insist that "Oh, nothing's changed", they'll probably have one that eventually says "Oh wait, I stopped taking that one two months ago, I forgot to mention it". When it comes to my health, I'm glad they double check their work, and mine.

One would think that with all that technology and double-checking, doctors wouldn't be attributed to 100,000+ premature deaths per year.

Guns are dangerous? By comparison, hardly...

Re:Brazil wasn't far off

[Anonymous Coward]

To put that in a way we slashdotters should all understand:
You are a production system.

Re:Brazil wasn't far off

[thegarbz]

Patients are horrendously unreliable. The classic is hospital surgery. "Have you had anything to eat since last night." "No, just a bacon and egg McMuffin on the way in this morning." *

*actual conversation I heard while waiting for surgery. The person didn't think don't eat meant don't eat.

Re:Brazil wasn't far off

[jittles]

Patients are horrendously unreliable. The classic is hospital surgery. "Have you had anything to eat since last night." "No, just a bacon and egg McMuffin on the way in this morning." *

*actual conversation I heard while waiting for surgery. The person didn't think don't eat meant don't eat.

TO be fair to the patient, I would hardly call that food.

Re:Brazil wasn't far off

[mlw4428]

They confirm those because there's always that one patient who will say "nothing changed" and forget that they aren't taking that ONE medication regularly enough and then they get sick. They sue every doctor, nurse, and patient care tech. The hospital loses money and finds it harder to get paid because everyone from regulatory bodies to insurance companies points their fingers at them and say "it's your fault."

Blame the litigatious society we live in. Blame it on the anti-intellectual patients who'll believe in Dr. Quack on TV and their magical rotten grass drink that replaces immunosuppressants.

Re:Brazil wasn't far off

[Anonymous Coward]

I would also add that patients lie. All the damn time. Between that, and the unreliability, we HAVE to go through every single thing, even if everything is the "same as last time." Sure, I could write "patient reports everything is the same", but in court, I'm pretty sure the question is going to be "why didn't you confirm that, doctor?". Hooray for lawsuits...

Re:Brazil wasn't far off

[Anonymous Coward]

I get the jibe at McDonald's or fast food in general, but a homemade bacon and egg sandwich on an English muffin (or just some good toasted bread) is god-damned delicious. It doesn't take very long to fry and egg and sausage patty in the morning and slap it between your preferred toasted bread product and eggs are rather nutritious.

Re:Brazil wasn't far off

[Anonymous Coward]

They confirm those because there's always that one patient who will say "nothing changed" and forget that they aren't taking that ONE medication regularly enough and then they get sick. They sue every doctor, nurse, and patient care tech.

Wait, so you believe they confirm it not because they don't want people to get sick, but only because they don't want to be sued? That's wrong and exactly why we need such lawsuits. Their job is to confirm these things to that people don't get sick.

Blame the litigatious society we live in.

Or blame people not doing their job.

Re:Brazil wasn't far off

[PCM2]

Yeah, but you understand the reason you're not supposed to eat is that you could be risking your own life if you have food in your stomach while you're under general anesthetic. You can puke and choke on it. (Risk may be doubled depending on origin of meal...)

Re:Brazil wasn't far off

[Anonymous Coward]

In a thread started by a guy whining that someone was doing their job and confirming that the patient really was taking all 50 drugs.

Re:Brazil wasn't far off

[jittles]

Yeah, but you understand the reason you're not supposed to eat is that you could be risking your own life if you have food in your stomach while you're under general anesthetic. You can puke and choke on it. (Risk may be doubled depending on origin of meal...)

Hahaha of course I understand the reason for fasting before a surgical procedure. The McDonald's likely congealed in the patients stomach and would not have come up without tearing a hole in their esophagus anyway ;)

Re:Brazil wasn't far off

[Agripa]

Patients are horrendously unreliable. The classic is hospital surgery. "Have you had anything to eat since last night." "No, just a bacon and egg McMuffin on the way in this morning." *

*actual conversation I heard while waiting for surgery. The person didn't think don't eat meant don't eat.

I am probably atypical. The actual conversation I had while being wheeled into surgery right before Christmas went:

Anesthesiologist, "When was the last time you ate or drank something?"
Me, "I have not eaten or drank for more than 48 hours."
Anesthesiologist, "Perfect."

A couple of minutes later:

Me, "And doctor, if you find an alien embryo inside of me, just use your best judgement."

Re:Brazil wasn't far off

[Agripa]

Patients are horrendously unreliable. The classic is hospital surgery. "Have you had anything to eat since last night." "No, just a bacon and egg McMuffin on the way in this morning." *

Also, this reminds me of some engineering support conversations I have heard:

Engineer, "So exactly when did the Interocitor stop functioning?"
Customer, "At about 1 PM."
. . . much back and forth . . .
Engineer, "Did anything else happen at 1 PM?"
Customer, "Oh, that was when lightning struck the building."
Engineer, "..."

Re:Brazil wasn't far off

[level_headed_midwest]

You must be an oncologist or rheumatologist, or at least know some. The current drug class "on the outs" is clearly the statins. Even people who have had several MIs and a stroke still think that some random Guy on the Internet stating that statins cause everything from their penis flying off (as in what gluten did in the funny South Park episode) to anal leakage is much more credible than millions of patient-years of studies which clearly prove that these medications work and just about all of them are a "couple of lottery tickets a month" generics as well.

Time with patient, negative pressure

[grasshoppa]

Is data entry really the negative stress on the "Time with Patient" stat? I'd guess it's more likely organizations pressuring Drs to treat more patients in a single day; documentation is only a part of that equation.

Re:Time with patient, negative pressure

[Anonymous Coward]

Still an unnecessary burden dumped on doctors other then makes lives worse. But is all part of the Democrat's plan to destroy our health system so the Government (i.e. Democrats) can have control over it.

Expected 'Outcome'

[rtb61]

This is the exact 'outcome' you would expect when corporate lobbyists write government policy. Instead of that policy providing the maximum service at the lowest cost, it provides the least service at the maximum cost. That cost being to the end users and not of course the lobbyists funders, for them it is as cheap as possible and hence maximises profits, 100%, 200%, 1,000% unlimited profits and unlimited power. Pretty 'sick' stuff (snark).

Point of sale tech companies should be writing this, a range of confirmed, emphatically confirmed (use big fonts on confirmation with details to ensure readability, really big fonts, mistakes will kill, so confirmation buttons at the end of each sentence, think plane take off check lists), selection through a menu structure with additional comments and possibly a patient screen so they can see what is going on. You really want the doctor inputs to occur as they treat the patient, medium sized touch screen with a readily and cheaply replaceable cover (swap between patients, doctor touches patients, doctor touches screen) and a camera for close ups and photo record, possibly video elements of doctor patient sessions (all suspended on an adjustable arm from the ceiling) with a smaller smart phone styled extension (corder, doctor patient privacy requires a completely wired system) for greater flexibility. A smarter system would have some idea of what it is 'looking' at and recording ie it can recognise parts of the human anatomy arms, eyes, ears etc (helps guide the menu structure, don't let M$ touch this bit, they always fuck this shit right up, no Mr Paperclip fuckups).

Re:Expected 'Outcome'

[Anonymous Coward]

Point of sale companies don't want to go withing a mile of anything involving HIPAA restrictions and the liability it entails...

Re:Expected 'Outcome'

[Anonymous Coward]

your system is going to take forever to enter even the most banal of visits. Patient comes in on 6 meds (has diabetes, htn, hyperlipidemia, obesity, hypothyroid), wants to talk about erectile dysfunction, some tingling and numbness in his feet and has noticed he is a bit more short of breath with exertion, also you notice he is overdue to have his prostate checked and to get his colon cancer screening done oh and he is 65 and has a > 30 pack year history of smoking so he should have a low dose chest ct and a screening u/s of the abdomen. so in the visit you have to ask all the pertinent questions, auscultate the heart, get a height, weight, waist circumference, check his feet with a microfillament, discuss whatever you find, discuss risks and benefits of any meds you perscribe, discuss why you are ordering certain tests, and oh shit you have to update the god damned cumulative patient profile, reconcile all his meds and type a note which reviews all this shit and this is an easy visit so far, as you head to the door he wants some viagra and you to check his spots and possibly refer to derm and oh he forgot his disability forms need updating. This happens over and over every day, it took that much to just show you a slight picture, what needs to go in the reccord is vastly more (and you have to review all the stuff that comes back from the visit also)

Re:Expected 'Outcome'

[level_headed_midwest]

And then you get a patient complaint and a crappy Press Ganey survey as the patient wanted you to bill this as a "free wellness visit" so they didn't have a co-pay, you didn't give him Soma, Dilaudid, and Xanax, and also dared to tell him to quit smoking, take evil statin medication, get a colonoscopy, and get shots, as some porno actress 15 years ago said would cause autism. Oh, and then since the patient refused their colonoscopy and the MAC didn't get billed with charges for a colonoscopy, your "quality" metric suffers and you get paid less...because you suck as a doctor. And then you get to repeat that again 20+ more times the next day, and the next day, and the next day, and the next day...

Slogan

[Rei]

Slashdot: News for Americans. Stuff that matters to Americans.

Not everyone operates on a medical system like the weird one in the US....

Re:Slogan

[Anonymous Coward]

This idiotic medical system has huge impact on the entire world. Doctors in other parts are dying to get to America to make that private $$$ that they can't make back home.

Re:Slogan

[whoever57]

Not everyone operates on a medical system like the weird one in the US....

In the UK, GPs working for the National Health Service have all sorts of financial incentives, which means that when you visit your GP, 2/3 of the time will be spend on things unrelated to whatever took you to the office in the first place, but very closely related to those incentive payments that the GPs can receive.

Re:Slogan

[PopeRatzo]

Doctors in other parts are dying to get to America to make that private $$$ that they can't make back home.

Is that why our hospitals are filled with doctors who have come here from the UK, Canada, Sweden, Denmark, France and other countries with universal public health care?

Fucking knuckleheads don't take ten seconds to think about what they're typing before they hit SUBMIT.

Re:Slogan

[Anonymous Coward]

Slashdot: News for Americans. Stuff that matters to Americans.

You should really go start your own site... about shit that matters to you.

Re:Slogan

[Anonymous Coward]

Well, let's see, back home, at the hospital in town, the anesthesiologist is Pakistani and the cardiologist is Indian. In the town I grew up in, the general practicioner is an NP, and the MD shows up once a week to do token oversight.

Re:Slogan

[TheSync]

The US had 1.8 million foreign-born health care workers (16% of all health care workers).

Among foreign-born workers employed in health care occupations in 2010, Asia was the leading region of birth (41 percent); followed by Latin America (not including the Caribbean) (18 percent); the Caribbean (17 percent); northern America (Canada and Bermuda), Europe, and Oceania (14 percent); and Africa (10 percent).

Re:Slogan

[PopeRatzo]

Well, let's see, back home, at the hospital in town, the anesthesiologist is Pakistani and the cardiologist is Indian. In the town I grew up in, the general practicioner is an NP, and the MD shows up once a week to do token oversight.

This was your statement:

" Doctors in other parts are dying to get to America to make that private $$$ that they can't make back home."

Pakistan and India both have private medicine. If they're coming here from Pakistan and India, it's not because those countries have universal health care.

And why don't you see doctors from the UK, Canada, Sweden, Denmark, etc etc moving here to make those sweet sweet private $$$? If universal public health care is so horrible for doctors, why didn't they flock here before the ACA?

Re:Slogan

[PopeRatzo]

The US had 1.8 million foreign-born health care workers (16% of all health care workers).

How many are physicians?

Among foreign-born workers employed in health care occupations in 2010, Asia was the leading region of birth (41 percent); followed by Latin America (not including the Caribbean) (18 percent); the Caribbean (17 percent); northern America (Canada and Bermuda), Europe, and Oceania (14 percent); and Africa (10 percent).

It's very interesting that they have to add Canada, Bermuda, Europe and Oceania together to get to 14%. Considering the number of nurses from the Philippines, My guess is that 100% of that 14% are from there.

So, where are all the doctors who flock here from countries with universal public health care? Before and after the ACA, you just didn't see them coming. The UK has had a public system for SIXTY-EIGHT YEARS. Where are all the British doctors who came to America to flee the persecution of universal health care?

Re:Slogan

[Anonymous Coward]

Wow.

Australia's system actually tries to help the patient.

Re:Slogan

[dbIII]

Turnbull is working on that. A US style healthcare system would make a lot of middlemen who did not have to do the hard work of getting a medical qualification very rich.

Re:Slogan

[cheesybagel]

And why don't you see doctors from the UK, Canada, Sweden, Denmark, etc etc moving here to make those sweet sweet private $$$? If universal public health care is so horrible for doctors, why didn't they flock here before the ACA?

Job security and a decent paycheck.

Re:Slogan

[thegarbz]

Slashdot: News for Americans. Stuff that matters to Americans.

Not everyone operates on a medical system like the weird one in the US....

And yet despite this you can see the rise in paperwork in the western world too. It's particularly bad with old doctors who aren't touch typists. I actually changed doctors because my visits got too long while waiting for him to work his new and improved computer system.

Re:Slogan

[Anonymous Coward]

So we can't discuss anything that doesn't apply to everyone? I guess the new stream is going to get real light real fast with that in mind.

Re:Slogan

[PopeRatzo]

Job security and a decent paycheck.

It sounds like public universal health care is not the disaster for doctors that some would have us believe.

Re:Slogan

[Anonymous Coward]

canada is becoming similar, it is horrible

Re:Slogan

[Anonymous Coward]

You know its funny, I did the opposite and went from Minnesota to Ontario, my life really was not much different in this respect, medicine is miserable no matter where you are.

Re:Slogan

[Anonymous Coward]

Yes, it is an American centered site. Don't like it? Bugger off.

Looking at your UID there is no reason you don't know this, you just want to be a crotchety old man.

Re:Slogan

[Anonymous Coward]

This is exceedingly relevant in Ontario canada

Re:Slogan

[sjames]

Consider it a cautionary tale for when your politicians start singing the praises of privatization.

Re:Slogan

[desdinova 216]

I keep thinking that the people that are the most opposed to universal health care are the insurance companies.

Re:Slogan

[Anonymous Coward]

And why don't you see doctors from the UK, Canada, Sweden, Denmark, etc etc moving here to make those sweet sweet private $$$? If universal public health care is so horrible for doctors, why didn't they flock here before the ACA?

Some potential reasons, in no particular order... any of these may or may not be true:
1) Board certification in the US take an exceptional long time, and you need to re-do your residency (tons of hours for low pay for several years).
2) They have families or other ties to where they already live
3) Ideological differences
4) Fear of moving
5) Difficulty to move (e.g. learn a new language, face potential xenophobia)
6) Hard to get immigration status in the US
7) The pay/quality of life ratio is better where they currently live
8) Pay in general is better where they currently live
9) Concerns that the US is on the decline
10) Local laws forbid the move

Just saying that "doctors aren't moving so they must be happy where they are" is simplistic. It could be true, or it could be they hate their life but can't move for other reasons (such as #1 and #10).

Re:Slogan

[PopeRatzo]

Some potential reasons, in no particular order... any of these may or may not be true:

"May or may not be true"? Then you might as well add, "Obama is using Hillarycare Benghazi Mind Control to prevent European doctors from moving here. Lock her up!"

Just saying that "doctors aren't moving so they must be happy where they are" is simplistic.

So then so is saying, "doctors are fleeing universal health care and coming to the US to make private $$$, and that's why you see so many South Asian doctors."

Re:Slogan

[Anonymous Coward]

"And why don't you see doctors from the UK, Canada, Sweden, Denmark, etc etc moving here to make those sweet sweet private $$$? If universal public health care is so horrible for doctors, why didn't they flock here before the ACA?"

As a physician I can tell you that different countries have different barriers to entry to the US due to training requirements and agreements. Many foreign physicians must redo residency and fellowship if they come to the US. I know of a Chinese surgeon that is now in medical Big Data due to these barriers after moving to the US. There is a huge barrier to entry. This is partly due to the need to ensure adequate training.

I'm American but have worked overseas in a country with nationalized healthcare. Interestingly enough there was a parallel private healthcare system present that was based on regular insurers and cash. This robust system was utilized by both patients and physicians that were dissatisfied with the nationalized healthcare.

And I thought doctors were People Mechanics

[Anonymous Coward]

Oh wait: https://gopenske.taleo.net/careersection/.penske.ex.jsa.hs/jobdetail.ftl?job=410626&src=JB-10126

Job Description: Diesel Mechanic/Technician III – Entry Level ...

Qualifications

- 1-2 years of automotive or diesel experience preferred
- High school diploma or equivalent required
- Vocational or Technical certification preferred
- Working knowledge in the use of hand tools required
- A valid driver’s license is required, and, must either possess a CDL or have the ability to obtain a CDL license required
- Must have a Positive attitude and willingness to grow in position
- Basic computer skills preferred for data entry into maintenance systems. ...

Easy Fix!

[Anonymous Coward]

Get rid of the insurance companies...

Re:Easy Fix!

[BradMajors]

DONE. I go to a MD that takes no insurance and I pay by cash. If you want to you can get rid of your insurance company also.

While I do have health insurance I go to an MD that doesn't take any health insurance because the quality of care is better and the cash price he charges me is less than an MD that takes insurance would charge.

Re:Easy Fix!

[PlusFiveTroll]

>and the cash price he charges me is less than an MD that takes insurance would charge

Can confirm that one. One MD I work for must charge their clients more if they have insurance, insurance requires them to add a large number of tests and other unnecessary requirements on most visits. For most people the co pay ends up higher than if they just paid cash.

Re:Easy Fix!

[Anonymous Coward]

Get rid of them as they currently exist. Keep insurance for truly financially devastating health crises like heart attack or cancer. I'll happily pay cash for everything else. And if I can't get insurance because I already had a heart attack, there's an opportunity for the government to step in and help.

My tax dude is more efficient than my doctor

[Snotnose]

Time to do taxes, I gather everything up and hand the pile to him. He spends maybe 20 minutes going through my pile, asking me questions, then gives me a pretty good estimate of where I stand. Cost? $300. Time for me? 20 minutes, plus travel time/making the pile. Time for him? Probably 22 minutes.

I go to my doc (copay) and wait 20-30 minutes. He asks questions, I answer (10 minutes). Odds are, I get sent to a specialist (copay). I wait for the Specialist (20-30 minutes). Specialist orders tests (20 minutes + copays). Back to specialist (30 minutes + copay). Get a prescription, fill it (10 minutes + copay), it may or may not solve the problem. If not go to 1.

Difference? My tax guy doesn't have to answer to insurance companies, nor buy malpractice insurance. My tax guy doesn't have a good 6 feet shelf space of regulations.

Now I realize my tax guy farking up is much less serious than my doc farking up. Still, the crap doctors have to keep track of/order tests for/ just to avoid a lawsuit is mind boggling.

Re:My tax dude is more efficient than my doctor

[Trachman]

There is a good chance,your tax accountant spent more than 22 minutes for you. In addition to compiling your tax return, what you do not see is scheduling, archiving work.

Also, you need your tax prepare only once a year, while doctors get a steady stream of patients. In reality you pay to the healthcare industry probably approximately $20,000 in the form of your family insurance premiums and copays.

Tax accountant can only get from you your $300 per year.

You are right and Yes, your tax accountant is more efficient. You also forget to compare $20,000 your family's healthcare premiums versus $300 tax preparer's fee. He has to be efficient since average solo practictioner cannot afford secretary, billers, office managers and entire lobying industry that would force you to pay tax preparation insurance fees.

Re:My tax dude is more efficient than my doctor

[BradMajors]

Your tax professional certainly does have malpractice insurance.

Re:My tax dude is more efficient than my doctor

[Snotnose]

There is a good chance,your tax accountant spent more than 22 minutes for you. In addition to compiling your tax return, what you do not see is scheduling, archiving work.

Granted. What I don't see is the money he spent updating his tax program, nor the 3-4 hours he spent learning the new laws congress, in their ever knowing wisdom, made happen.

That time/money is amortized over a thousand or three tax returns he'll deal with in 3 months.

He's got a secretary and an office manager. He can pull up my tax returns from 12 years back, something my doctor can't do (because I have to change doctors every 3-4 years).

One would think paying 20k/yr would bring more efficiency into a service, over the $300/yr I pay my tax dude.

Re:My tax dude is more efficient than my doctor

[whoever57]

The dirty secret is that if you have a 10% copay, you pay that 10% and then the insurance company company pays a fraction of their "90%".

Once you hit your deductible and start paying only the copays, the doctors receive a lot less payment for their services.

It sounds like your tax accountant is expensive. I was paying my accountant about $700, but that included rental houses overseas and a multi-page FBAR filing.

Re:My tax dude is more efficient than my doctor

[Snotnose]

Also, you need your tax prepare only once a year, while doctors get a steady stream of patients. In reality you pay to the healthcare industry probably approximately $20,000 in the form of your family insurance premiums and copays. Tax accountant can only get from you your $300 per year.

The human body doesn't change much in a year, nor does medical technology. The IT spending a doctor has to spend isn't so much to improve patient care so much as to align with Federal and insurance company requirements.

IMHO, the tax dude has to deal with bigger changes year over year than my doctor does. My doctor is dealing with insurance and the feds, which have nothing to do with my health. My tax dude is dealing with dumass changes to the tax law. Odds are, if something is really wrong with me then the changes the doctors have to deal with won't affect anything other than who pays for them, or which department of who pays for them. OTOH, having a tax dude who can save me $1k/yr (which my guy has done for 12 years) affects my life more than an insurance classification.

My point is, doctors can no longer view patient outcome as their #1 goal. The goals now are:

1) don't get sued
2) if you get sued prove you did every test imaginable
3) If you don't get sued ensure you billed properly
4) Hope for the best in getting paid
5) Patient? Who? Oh yeah, hope they got fixed.

Re:My tax dude is more efficient than my doctor

[Trachman]

If they were more efficient it would be difficult to collect $20K per family.

That IS the point, on spending money on unnecessary IT, consultants, malpractice, lawyers, school loans. Put it another way, inefficiency is a systemic way for a significant part of the economy to make a living.

I am paying for everything out of pocket (high deductible plan). Recently at the doctor's office person in white coat told me: your child has strep, clearly visible. We will still swab you, to make the test (test alone cost me $100).

I am sure somewhere there is an internal office policy to "consider" doing the test, even all the symptoms are obvious.

Mandatory insurance (thx Obama), makes it easier for people to justify parting with the money, which becomes OPM, which then becomes medical industry revenue. There is an old saying: the fool and they money do not stick together for long. I hate to be made a fool and have no say in it.

Re:My tax dude is more efficient than my doctor

[PopeRatzo]

Now I realize my tax guy farking up is much less serious than my doc farking up. Still, the crap doctors have to keep track of/order tests for/ just to avoid a lawsuit is mind boggling.

Next time someone in your family needs serious surgery, or has some life-threatening disease, you should just ask your tax guy to do it.

Because why should we have regulations on the medical industry? Why should there be malpractice insurance?

http://rationalwiki.org/wiki/1...

http://listverse.com/2013/05/2...

Re:My tax dude is more efficient than my doctor

[Trachman]

We agree, and agree to agree.

Both professions, CPA and MD, are subject to "mandatory" annual "trainings"...

Both professions provide as much challenge as one desires. Retail, mainstream tax return filings do not change at all, or all of the changes are understood by tax professional in 5 minutes (change in standard deduction, change in 401k contribution limit, basically, some of the variables change) and can be presented on one sheet of paper.

Same with medical profession: PCP's do get buzzed annually and individually within trainings and by the sales reps by new diabetes, allergy, blood pressure etc. medication.

My PCP is using paper. No time spent by the doctor filling checklist and facing his tablet/laptop. My PCP does not order unnecessary tests. When I forgot to pay $10 copay for 90 days and I moved, I was not sent to collections. Well, she is 5th generation doctor, is disgusted by Obamacare (and democrat party for that matter), and is computer literate. The only difference is that she stuck with paper records. This doctor, old school - no nonsense practice, is a rather pleasant exception.

Problem is, she works and she does not write the laws.

Re:My tax dude is more efficient than my doctor

[0100010001010011]

Does your tax guy have $250k+ of med school debt?

Re:My tax dude is more efficient than my doctor

[tburkhol]

To be fair, the tax code is a complex document with some 4000 pages of specific and detailed rules. By comparison, the human body is a construction of some 40 trillion cells, the functions and rules for which science is still trying to work out.

Tax accountancy is not brain surgery.

Re:My tax dude is more efficient than my doctor

[Anonymous Coward]

The most important transaction in American healthcare is that your insurance is billed for services. Everything else - whether you live or die, have a speedy recovery or terrible complications - is secondary to that business transaction. You may get better, but your insurance will definitely get billed.

Re:My tax dude is more efficient than my doctor

[pnutjam]

Finance guys are like sports guys, they think everything is under their umbrella and easy to compare directly.

If you want to get an appreciation for this

[Beeftopia]

If you want to get a visceral appreciation for the complexity of medical billing today, check out the Medicare Claims Processing Manual.

It almost seems like you can't merely get an administrative assistant, but you need someone with an A.A. in medical billing.

The thing that really left me aghast was the move from ICD 9 to ICD 10 (diagnosis codes and descriptions). Those #$&!!?! policy geniuses completely abandoned the ICD 9 codes and instituted all new ICD 10 codes. There was a big infrastructure around ICD 9. There is plenty of overlap in the codes, so it's a recipe for mass confusion. It's stunning that there was not even any attempt to have even a scintilla of backward compatibility.

It is almost like there are no senior database or programming architects involved in any of these decisions regarding medical IT. From what I've seen, it seems to me that it's purely non-technical policy staff driving this stuff. You have to get senior database and programming and UI architects in some of these decisions to reintroduce some sanity and control over the complexity of the solutions.

Re:If you want to get an appreciation for this

[Beeftopia]

You have to get senior database and programming and UI architects in some of these decisions to reintroduce some sanity and control over the complexity of the solutions.

And when I say "senior", I mean SENIOR. Like 15 to 20 years of experience working with databases with lots of tables and millions of rows. Someone who's actually been around the block and understands how things work and don't work. At a minimum, that's the database person necessary. Also having true senior programmers and UI types would be very useful it seems to me.

Re:If you want to get an appreciation for this

[silas_moeckel]

It's the companies that will make billions to implement it that are driving the changes. Yet if I dont get lab work done by an affiliated lab it's shows up as a fax and never gets coded into my online records. My daughters pediatricians electronic records is just a bunch of scans of paper docs to comply on paper without doing anything useful. I've actualy watch the input methods shrink no longer taking electronic weights glucose levels etc rather requiring hand input.

Re:If you want to get an appreciation for this

[Anonymous Coward]

I remember all the stories about that. Like there's 10 diag codes for different ways to get bitten by a snapping turtle or whatever. LOL

Re:If you want to get an appreciation for this

[desdinova 216]

but those experienced people cost money. 10 h-1b's can be hired for the price of the one experienced person and won't complain about working long hours.

Re:If you want to get an appreciation for this

[Anonymous Coward]

You realize the USA is way late to the ICD10 party, right? Canada switched to ICD10 in 2000. Implementation in the US even got delayed for *2 years* beyond the initial mandated implementation date because physicians complained about it. This is not some newfangled coding system that caught the doctors by surprise.

Re:If you want to get an appreciation for this

[Anonymous Coward]

Although I approve of the ICD 10 structure and they should have done it YEARS ago. My problem is that they try so hard to be different from EVERYONE (ICD 10 CM) else, its completely asinine. My other problem is that now ICD-10 has more than just a classification of problems for a patient. Some codes now include a seventh character that could mean which instance of a visit which is completely clinically irrelevant.

Example:
W21.03 - Struck by baseball
but you have to use one of these codes
W21.03XA - initial encounter
W21.03XD - subsequent encounter
W21.03XS - sequela

They already had codes for this but some crack pot decided to JAM these codes in there. Most likely someone who works for insurance companies.

Re:If you want to get an appreciation for this

[Anonymous Coward]

The hilarious part is that the argument is "but the computer should be able to pick the right code!" Obviously, if that were true, the insurance company's computer could do that for me.

The problem with "subsequent encounter" is how does the computer know the difference between the patient coming back for the same accident, or the patient coming back because they were struck by a baseball again? (other than asking, which defeats "the computer picks the code")

Re:If you want to get an appreciation for this

[level_headed_midwest]

That's not even the correct use of the "subsequent encounter." Everything in billing is episode-based as Medicare is episode-based as they deal with episodes of care for bundled payments. You get struck by a baseball and go to the ED, it's an initial encounter. You develop a hematoma that needs drained 5d afterwards by your family doctor, it's a sequela. Then you go back a couple days later to get your sutures removed, it's a subsequent encounter, since you only dealt with the initial issue (laceration) and not the complication (hematoma). Also, you will need to additional code the actual condition the baseball caused (laceration, hematoma) as struck by baseball is a mechanism code and doesn't describe a particular medical diagnosis. If you get struck a second time by a second baseball, it's "initial encounter" all over again plus whatever diagnosis code the baseball injury caused.

And if your EMR is one of the two largest ones in the U.S. you can't even put in a subsequent encounter code as the EMR won't let you put in anything but initial encounter codes. Oh, and most laterality codes also only map to "left" even if there is a separate "left," "right," and "bilateral" ICD-10 code for that condition.

Burnt out doc here:

[Anonymous Coward]

So, yeah. I've come through my training early in the era of EMR's and have seen this clusterfrack evolve over nearly a decade and a half. I've worked with more than half a dozen EMR's over the past 15+ years, and have not only not seen anything more than improvements in appearance (because in large institutions and hospitals the paper-pushers that are actually going to approve an EMR can really only go by how it looks, since they rarely truly understand what doctors need from a record system), and I would go as far as to say many EMR's are becoming actively more difficult to work with, demanding more repetitive entry of questionably valuable data, more and more "billing" specific entry, and, as noted above, more and more URGENT ALERTS that only rarely are actually relevant to my patient.

As also noted above, patient interactions have become the absolute smallest fraction of my work. I spend easily 2-3 times the amount of time I spend seeing and talking to patient in documenting those interactions, and new patients can far-to-often take an hour or more to document "adequately" in many EMRs I have had to deal with. I have colleagues that work from 7A to 6-7P, go home, and then after a few hours with their family, they resume "charting" until 10PM, 11PM, or even later. I've even had emails sent after 1AM from colleagues when I know they were in clinic that day, and have clinic the next day. And these are not periods of "unusually heavy utilization" like flu or RSV season, this is their typical clinic. Visit documentation, lab orders, lab confirmations, insurance issues, finding results in the system. It's disgusting that I spend so little time actually BEING A DOCTOR. It's even more disgusting that I'm told the problem is I'm not "using it right," or that I need to "be more efficient with my documentation," but every time I've requested assistance with "using it right" or improving efficiency (god what an infuriating phrase), I've been either blown off or had someone come by to "listen to my concerns" but never actually stayed to OBSERVE practical use, so nothing continued to change.

The core problem is, I have YET to see an EMR designed by people who actually have gotten down-on-the-ground with medical providers. None of these programers have followed us around, have watched the nurses, have shadowed the medical assistants, and so of course none of them can really meet our needs! Can you imagine the absolute HELL that would be raised if this is how coding was done, for example, in the aerospace industry? If the guy responsible for setting up the pilot's computer never set foot in a cockpit?

I've struggled with bad and worse EMRs (on top of other issues admittedly), and personally I've partially given up. I've left my full-time sub-specialty practice. I'm considering part-time now, though even that would be close to 40 hours a week. Frankly I'm tempted to leave medicine altogether, though I really don't want to give up patient care. As corny as it probably sounds to the /. crowd, I *love* (most of) my patients. I loved being able to help people figure out how to live with chronic issues, helping them get healthy and stay that way, talking with families about their fears and helping them come to terms with major diagnoses or deal with worse... It's an honor and a privilege to have been given this much TRUST by people, and I've done my damnedest to be worthy of that privilege. However, modern medicine has become so obsessed with documentation, and EMRs have become the worst reflection of this documentation, that medicine is becoming ever more toxic a field to work in.

TLDR version; EMRs are not user friendly (they are fairly Admin and billing friendly, though), they are not getting better, and they (in my humble experience) are demanding more and more time for less and less benefit, and in many ways they have become a problem WORSE than the problem they were intended to solve. This is not a "doctors hate technology" problem, this is a "doctors are not being given

Re:Burnt out doc here:

[level_headed_midwest]

Surprisingly, I haven't yet seen anybody here actually say *why* we have this morass. The government forced this on physicians with the HITECH Act and subsequent Medicare dictates because it suits THEIR objectives. The government wants to amass as much information on as many people as they can- just look at what it did (as in "is still doing") with the NSA. They want to be able to pick through that information for their own political purposes, a big one being finding "reasons" to pay physicians less, since the politicians grossly over-promised on Medicare and are unwilling to face up to this. Instead, they want to shift costs to doctors, and it's easier if they are "bad." They also want to use cherry-picked data to back up other political objectives like gun control, food control, etc. EMRs are clearly designed as auditing systems around federal mandates, anybody who has put information into one knows this in spades. Analyzing this data also requires a larger federal bureaucracy which the feds always love. The cronies also love EMRs well. The EMR business grew by several orders of magnitude when they went from optional (and rare) to being mandatory. Ditto with all of the compliance firms that deal with all of the issues that having an EMR now cause. Those firms lobby and "donate" to politicians to maintain their captive markets.

Re:Burnt out doc here:

[dmr001]

I like a conspiracy theory as much as anyone, but I really don't think the NSA convinced Congress to pass the not thoroughly thought out HITECH Act to amass statistics about the home addresses of people with pneumonia or which patients with high blood pressure are smoking. Being able to gather anonymized statistics on public health issues may help, however, to figure out how to improve immunization rates or best help diabetics get their blood sugar under control.

To the grandparent poster, our EMR company actually will pay their own way to have their engineers follow us around and see how we work, and our prior vendor was originally a nice internist who wrote his own code (who then sold the thing to a big conglomerate that also makes microwave ovens and jet engines and curling irons and stuff).

Our current EMR does a lot of stuff well, but I'm hopeful for the day it's more usable by clinicians. The basic process of writing progress notes (in some sense, the evidence of my life's work as a physician) is clunky and hard to correct and even less intuitive for my colleagues who don't happen to have fancy computer science degrees like me. Writing good software is hard, and maybe progress notes have had to wait in line behind revenue cycle and privacy and a bunch of compliance issues.

Re:Burnt out doc here:

[RichPowers]

Thank you for sharing your experiences. Where do you think we go from here? At what point does the whole system collapse? I sometimes think it it will take a prolonged macroeconomic disaster to force a total revamp.

Re:Burnt out doc here:

[Anonymous Coward]

What you wrote is tin-foil hat nonsense, but it would become true if you deleted "government" and substituted "insurance companies".

Re:Burnt out doc here:

[0100010001010011]

EMRs aren't designed by anyone that actually uses them. I keep trying to convince my wife and all of her medical friends to just spend a bit of time picking up some Python or UI tools and the world will beat a path to your door. Imagine an EMR designed by people that use EMRs.

And the default screen for the doctor isn't the default screen for the nurse isn't the default screen for the receptionist.

Re:Burnt out doc here:

[Anonymous Coward]

Surprisingly, I haven't yet seen anybody here actually say *why* we have this morass.

ACA (aka, Obamacare) mandated it.

Obama supporting posters don't want you to know what a mess ACA has made doctor's offices nowadays, that's why it's hush hush. Oh, and three doctors I've spoken to said the increased time spent on the computer is directly due to OBAMACARE. OBAMACARE, that's why.

Re:Burnt out doc here:

[RootsLINUX]

I've worked for the past two years as a software engineer at athenahealth. The experiences that you described are well known throughout the R&D people that I work with. I actually *have* been to clinics and followed doctors, PAs, and other staff around as they went about their day. I've seen them working with other EHR software that looks like it was built in the early 1980s. I've listened to them describe their ideal software solutions and what their biggest pain points are. AFAIK, my company is the only EHR out there that does these "site visits" regularly and encourages people to sign up and go. It's difficult to design EHR software that meets everyone's needs when every clinic likes to do things their own way. Your comments about the over saturation of documentation requirements is spot on, and there are teams at my work that focus on reducing the time spent doing documentation. Especially the "after hours" documentation that you mentioned is something we are trying to kill completely. Whether or not we've been doing a good job making that better, I don't know since I work on something completely different. But I think at least our hearts and our minds are in the right place. Healthcare is a very complex and difficult thing to manage. I wish it was an easy thing to fix, but it is an absolute juggernaut of a problem. I know my company certainly isn't perfect, and some things were designed in a downright idiotic fashion. But I think at least our hearts and our focus is in the right place, and I've seen a ton of improvements in the past two years since I started there. I just wanted to share my perspective as one of those EHR programmers. We're trying to make things better, not worse. But it is a business, and most EHR businesses are focused only on making more money, not making better products. Sometimes, that means they make decisions that harm the industry (like refusing to share patient data outside their systems) because they are afraid it will hurt their checkbooks. Sad, but true.

Re:Burnt out doc here:

[Anonymous Coward]

Unintended consequences of great-sounding laws. Who would ever have guessed that such a thing might happen?

Re:Burnt out doc here:

[Anonymous Coward]

Can you imagine the absolute HELL that would be raised if this is how coding was done, for example, in the aerospace industry? If the guy responsible for setting up the pilot's computer never set foot in a cockpit?

In truth, that is how it's done. Usually some analysts get to go play and sometimes a software architect gets to sit in a simulator, but the actual coding? No, they are code monkeys chained to cubicles.

Re:Burnt out doc here:

[Anonymous Coward]

In the Netherlands an exchange system for medical records has been introduced that gets a lot of criticism, also from medical professionals, for not protecting the confidentiality of medical records well enough. A group of GPs in Amsterdam, together with the University of Amsterdam, decided to develop an alternative system that works the way the doctors themselves think it should work. They are running a pilot[Dutch] with 20 GPs now.

While this does not address the same problem you have, it shows that if you're able to work together with a large enough group of peers you can actually do something about it: develop an alternative that works.

Re:Burnt out doc here:

[Solandri]

The core problem is, I have YET to see an EMR designed by people who actually have gotten down-on-the-ground with medical providers.

This. I've set up a few EMRs for some of my private practice doctor clients. From what I've seen, the software is written to make the programmer's life easier, not the user's. The programmer sees from the government specificiations that he has to implement a list of codes for ailments, and dutifully types them straight into a drop-down list because that's the easiest way to do it. A user-centric EMR would allow the doctor or nurse to describe, search for, or look up the ailment in multiple different ways. Instead, they're being forced to learn the codes to even have a chance to find the ailment in the huge list.

We're forcing doctors and nurses to adapt to computers, instead of programming computers to adapt to doctors and nurses. Ideally, they should never even have to see an ICD-10 code. They should just have to describe the ailment and the computer figures out the appropriate code, with the computer asking for more detail if the description isn't enough to narrow it down to a single code.

Re:Burnt out doc here:

[Anonymous Coward]

If all you say is true, then I'd expect doctors to band together an have their own EMR system developed, that "actually works," instead of buying some overly expensive off the shelf solution that doesn't. Why does this not happen?

Re:Burnt out doc here:

[jbmartin6]

From the other side, I worked at a hospital while it was implementing EMR, and the MDs could not be bothered to participate in anything like what you describe. Not just for the EMR, but for any technology implementation. They did have time however, to get sold crappy Windows NT backed devices by salesmen. To be fair, it seemed to be a problem of incentives, since they had to keep their patient/hour (or something like that) metric up so they resented anything that took their time away from that. I was in one design review meeting where a high-ranking doctor had been compelled to attend. He didn't contribute, just sighed loudly from time to time until the project head asked him to leave. In the end they just ended up replicating the paper forms everyone was already used to.

In the end, they ended up rolling out the EMR to the ED, and were surprised when it actually significantly increased efficiency. I left soon after that, but from what I saw I would be surprised if any lesson was learned from that.

Re:Burnt out doc here:

[mlw4428]

> The EMR business grew by several orders of magnitude when they went from optional (and rare) to being mandatory.

Let me guess - you've never seen a lot of hospitals. I work in Helathcare IT. EMRs were not rare and in many cases were not optional for use. They've been around and popular since the late 90s and early 2000s. The rest of your tinfoil spew isn't true. Yes, if you're using Medicare or Medicaid they NEED to know what was done so they KNOW how much to pay. If you use insurance - yes THEY need to know too. Otherwise HIPPA requires and forces hopsitals to protect that data and admittedly we sucked at it. We sucked at it, because hackers from Russia and China didn't use to think of us as a rich and juicy target. Now they do and in order to comply with the very FEDERAL regulations that you denounce, we are putting a LOT of effort into security practices.

And if you pay in cash then we don't send out your information to third parties. When we do send it's E2E encrypted and it's only a third party that requires it for some reason (such as a health insurance company) or another doctor that you chose to go to and you asked to get your records sent to them.

Lastly, nothing in your medical record points to your use or non-use of guns. Now your mental health state could be a different story and frankly...with what you posted...it's probably pretty evident to anyone who spends all of 2 minutes around you.

Re:Burnt out doc here:

[Anonymous Coward]

The root cause is the American Medical Association constrains the supply of physicians. Therefore, existing physicians work more under conditions they like less.

Re:Burnt out doc here:

[WalrusSlayer]

From my view into what my spouse and the other doctors in the practice go through, this is spot on. Right down to the "I'll just go part time", which actually translates into 40 hours (in our case, 25 patient-hours easily is a 50-hour week, and more when an inevitable heavily-loaded week comes along). The only solutions I see are to either get out altogether, utilize the MD for something that's not patient care, or find one of those rare institutions that's enlightened enough to understand how bad this problem is and takes it seriously enough to keep it under control.

Sadly, the last option is probably all but impossible right now, though there are promising signs that the industry is slowly waking up to just how unsustainable the situation is.

Re:Burnt out doc here:

[Anonymous Coward]

I work for a different EHR vendor. We do site visits too, though our size has made it hard for everyone to get scheduled for them. Your point "It's difficult to design EHR software that meets everyone's needs when every clinic likes to do things their own way." really hits the nail on the head. I feel that too often our customers have issues because they have some feature turned off, or we run into bugs because something has way too many possible configurations.

Re:Burnt out doc here:

[Anonymous Coward]

Appeal to authority is a logical fallacy.

Re:Burnt out doc here:

[fropenn]

Maybe this is a dumb question, but couldn't you just see fewer patients in a day so you have adequate time to spend with each one?

Re:Burnt out doc here:

[Anonymous Coward]

See, this is the thing.

"The government forced this on physicians with the HITECH Act and subsequent Medicare dictates because it suits THEIR objectives." That is correct. Nearly everything else in your post is wrong, or has a slant that I cannot support.

Yes, the government forced the HITECH act. Also the ACA, ICD-10, HIPPAA, and a few more besides. They did it because the medical establishment was dragging it's feet with maniacal determination. The AMA itself is on record as saying they wanted to "burn ICD-10 with fire"!

Ever see the miles of color coded folders in a doctor's office? That was the state of the art in patient documentation. Not just there but in hospitals too. It does a good job of tracing a single patient, exactly and only one patient at a time. Anything else, forget it!

Every industrial sector had computerized except healthcare. Manufacturing, mining, finance, the service sector, non-profits, logistics & transport, you name it. Only medicine held out as an example of workflows from the last century.

Now if you ask me, are EMRs workflow optimized for clinicians? Often, no. Layout and design are issues, sometimes big ones. The vendors have not done a good job there and I won't defend shoddy workmanship. However know this: All that will be fixed in time.

There's another thing. Feedback I receive often says exactly this: EMR implementation is usually more important than which EMR you actually purchase. That's right, shoddy installs and implementation routinely overwhelms the choice of a "good EMR" or a "bad EMR", design-wise. In short nearly any EMR can be made acceptable to the clinicians.

That's another highly solvable problem.

One problem must be addressed with the physician community. Lots of physicians like to complain, but many won't lift a finger to get involved to solve the problem. They think "that's someone else's job". OK, if that's true, then hire the someone else and get to work. If it's not true, then maybe you need to start filing problem reports. Attend a couple of EMR committee meetings and give them your feedback. There are endless ways to get involved; the issue normally is that the physician isn't involved. Instead they want to gripe on a political level, with the goal of turning back time and going back to the color coded folders.

Re:Burnt out doc here:

[Lieutenant_Dan]

I can give another perspective. I have worked with "clinical working groups" that are composed of nurses, doctors, therapists, communicate care, etc. Typically the docs and nurses dominate the conversation because they have complex and heavy workloads (not that the others don't, but I digress). It's actually very hard to get medical folks (even paid) to participate.

So every little UI, technical change, login process, etc get debated for a LOOOOONG time when finally there's finally consensus or quorum on what the decision is made. 90% of the time it's what the doc wants in the various settings; emergency department, general practice, palliative care, etc.

When the change is implemented, half of the people who clearly stated that they wanted something done one way, have had a change of heart or argue that this is not what they wanted. Documentation, sign-offs, mock-ups be damned. "This is not I what I signed off".

When it actually makes it to larger pilot group, we get feedback from one extreme to another. Even when we have colleagues from the same docs AT THE SAME INSTITUTION IN THE SAME DEPARTMENT.

At the core is patient safety and the crazy checklists that come with it. The best thing to do is to pass those check lists to someone specialized (i.e. not a doc or nurse); like a medical cleric (or like someone else mentioned, a scribe).

TL;DR; Everyone has an opinion and every doc appears to have their own preferred way of doing things. This is not unique to the medical field. I see that in CSRs as well.

Re:Burnt out doc here:

[Anonymous Coward]

Especially if you appeal to the wrong authority. EHR regulations are the HITECH act.

Re:Burnt out doc here:

[Anonymous Coward]

Very Small EMR Vendor here. I've dealt with that dozens of times (we have dozens of clinics). And yes, I go and watch them practice.

Doctor A dictates a note and has a transcriptionist write it up, then he signs the writeup. His documentation is stream-of-conscious conversation that might cover all of the requirements to bill at the E&M level he would submit on the claim, but I'm glad it's not my job to audit it. He doesn't understand why the computer cannot find proof of a comprehensive exam in all that mess and consistently recommends he bill at level 2.

Doctor B just graduated from school and spends 30 minutes a patient writing up a beautiful textbook multi-page H&P. He is constantly angry that despite spending all this time writing documentation just like he was taught, all of his uncomplicated flu patients with no prescriptions or tests performed are downcoded to a level 2 encounter by the insurance company.

Doctor C is absolutely flabbergasted that we use a SOAP note layout for the doctor's documentation "That's so 80s! I don't need to do a subjective or objective evaluation of my patient in order to assess the problem. Move "AP" to the top so I don't have to scroll past "SO" to get to the important stuff!"

Doctor D has been in business for 40 years and has printed up stacks of forms where he has carefully aligned his checkboxes. A patient comes in for an annual exam, he listens to her heart, her breathing, whacks her knees, ask her how she feels, then he pulls out the "annual checkup form", draws a single line down the column of checkboxes marked "Normal" (it manages to pass through most of them) and checks the box under labs for "annual female physical labs", puts a squiggle on the signature line and puts it in her chart. An M.A., who is used to that, knows what those tests are supposed to be and prepares the requisition. Total time spent on documentation by the doctor: 0.25 seconds. Why can't we do it that fast on the computer?

Doctor E blames us for insurance companies rejecting his claims for office consults with himself as the referring/consulting provider. "But that's what my daddy did to get paid more for an encounter! Why is your software not able to do that!"

It goes on and on. O'Reilly has a book about EMR development (Hacking Healthcare). I think one of the first chapter's subheadings is "You've seen one practice, you've seen one practice." as a play on "You've seen one x you've seen them all." I've actually had doctors get angry at me when I mention to them that I've never seen a doctor do whatever it is they're trying to do (Oh man, Doctor E was quite angry, possibly because of the implication that I thought he was trying to commit fraud). None of that is helped by the insane amount of cargo-culting in this environment, especially on the claims side of things. "I don't know what this modifer means, but 8 years ago my uncle's brother's hairdresser's nephew's dogwalker's doctor used this modifier and got paid so I've done the same thing ever since I found out!"

Re:Burnt out doc here:

[Anonymous Coward]

The funny thing is: MOST of the EMRs out there are developed with lotsa physician input.

So why, Doctor, isn't your EMR system any better? One word: GREED.

There is NOTHING requiring you (or your medical practice) to participate in any kind of EHR system. You could still maintain paper charts if you wanted to. Eventually that won't be true, but it is today. You dictate and let others handle assembling your medical records.

Alternatively, you can build an EHR system where you only dictate. It won't be MU/PQRS compatible, but it would work.

The thing is: You (or your hospital or practice partnership if you aren't a sole provider) would therefore forfeit the meaningful use incentive dollars, take a 2% hit on your medicare receivables for failure to participate in PQRS, and may lose out on any ACO, PCMH, or other programs you currently participate in.

And your EMR companies KNOW that you won't buy a system that isn't MU/PQRS, and now MACRA compatible once we figure out what the hell CMS really means by a macra compatible system. The final rules will be released in September and your EHR company has from then through January to comply with whatever those new rules are, after all. (And, in the meantime, all we get is bullshit from everyone telling us to be fully compliant with PQRS and MU, even though we know that this won't be everything that MACRA will require.) I digress. The point is: You can't have an effective system that captures all the data you need to have captured to take all the money available in without sacrificing either your time or hiring others. (OTOH, how many paper file clerks do you now employ?)

Health and Human Services played every physician in this country for a sucker when then dangled a quarter million dollar carrot per provider in front of their eyes in MU incentives. The physicians didn't realize that implementing EHR successfully would cost them more than that. And now you're their bitch. Don't want to be? Then don't play and accept lower reimbursements.

Re:Burnt out doc here:

[Anonymous Coward]

In all honesty, I'm not sure how it can get better anymore without either major political will on the scale of the Moon shot, or the collapse of the current system. But, as I noted above, I've partially given up. I can't really be a doctor in today's climate, not with the current demands as well as being a husband/father and maintain my OWN health, so I have to go part time, if I remain in medicine at all.

I don't, however, see good things coming in the next 10-20 years. Probably a somewhat over-pronounced level of pessimism given my current exhaustion and complete disgust with the current system, but significant improvements occuring in the system *as well as quality of life improvements* occurring for those within medicine within the next decade would utterly shock me.

Re: Burnt out doc here:

[Augury]

My organisation just invested 75 man years worth of effort building a new Web based EMR from the ground up. The main driver? Ease of clinical use (e.g. 3-click prescribing) based on the most common doctor work flows.
We're based in Australia, but are already looking at the US market.
If you're interested, I'd love to get your feedback on what we've built.

Re:Burnt out doc here:

[level_headed_midwest]

I have seen many hospitals in different states and I was around before EMRs existed. Pre-HITECH Act, EMRs *were* rare. Yes, practices often had computer programs for accounting/billing and sometimes for scheduling, but the physicians didn't input their notes and orders and such into them. (Thinking of somebody typing a note into something like IDX would be ridiculous enough to be funny.) Things were all on paper. A very small number of practices started to use some kind of EMR in the late 90s/early 2000s but these were often little more than a directory of scanned paper forms for archival. It wasn't until the early 2000s that some of the largest systems started to use what we would consider a current type EMR, and even then things were from a physician perspective read-only with dictation transcribed into it and orders were still on paper. Many hospitals didn't "go live" with computerized physician progress note and order entry until the early 2010s when they were mandated to. Been there, done that with several different institutions. MACs only need to know the patient identifying information, ICD code, and CPT code for billing, and you have to be able to provide them a note if they ask for it, which they generally only do if they want to dispute charges. Ironically this is done in many places by printing out a paper superbill and manually inputting the information into the billing software (which may or may not be sold by your EMR vendor but if it is, it may be a completely separate program that may not even communicate with the EMR) to submit to the MAC. We were much better at protecting data pre-HIPAA. It is far, far worse today. What happened was that a some office staff might get a few pieces of hot gossip from perusing through a paper chart of somebody they knew. It is NOTHING like what we see today. You didn't see the equivalent of what happens today as cracking into a buggy EMR that is mandated to be connected to the wider Internet through a software vulnerability and stealing *everything* would have required going to dozens of hospitals with a fleet of semi trucks and copying millions of pages of records. Never would have happened. I'd blame the monopoly EMR vendors that abdicate themselves from any responsibility for their crappy buggy code in their NDAed EULAs for a good chunk of the current security problems. That and if you don't want it public, don't put it on the Internet! HIPAA is intended as yet another way for the government to find yet another excuse to fine private individuals and groups and justify their own existence.

Re:Burnt out doc here:

[level_headed_midwest]

The reason they want the data was to be able to try to write heavily confirmation biased studies to try to find some "scientific" reason to try to bolster their political goals. They want to show that things they don't like such as football, wheat, GMO-containing foods, living outside of a proper giant urban area on the coasts, driving a car, being religious, or the worst of them all, owning a firearm is associated with all sorts of terrible outcomes. Their first attempt with this was to show that healthcare in the backwards flyover country and in rural hick areas is terrible and that no healthcare dollars should be spent there, and instead it should only go towards giant urban and academic hospitals in areas with a proper Democrat majority. Those studies spectacularly backfired with the giant urban and academic hospitals performing worse on most metrics than some dinky red-state place, and that those giant urban and academic hospitals which were so-called "Medicare Centers of Excellence" fared worse than average for surgical outcomes. You will see this tried with the rest of the items on my list and many others. CMS is a political body, and of course what they do is political.

Re:Burnt out doc here:

[level_headed_midwest]

The largest third-party payor in the country is Medicare, which is the government. The other third-party payors largely just follow along with that Medicare does.

Re:Burnt out doc here:

[level_headed_midwest]

The HITECH Act and Meaningful Use, err, "Advancing Care Information" does not consider an EMR to be "Certified EHR Technology" and thus compliant unless it does all of the auditing and reporting tasks that the government states it must. Doctors have no use for that stuff and would not include it as it greatly hinders the usability of an EMR, thus it would never get off the ground. Also, there are very draconian federal restrictions on physicians doing anything that could be considered a medical-related business activity outside of their employment. Add to that the current oligopoly EMR vendors lobby the government heavily to maintain their legislated captive market, and you have the reasons why this does not happen.

The real Fast Company article

[The-Forge]

They have the wrong article linked above. This is the right one: http://www.fastcompany.com/3061860/the-future-of-work/how-technology-is-making-doctors-hate-their-jobs

So, what?

[Anonymous Coward]

20 years from now physicians will find their jobs have been outsourced to AI and robotics.

Re:Technology Is Making Doctors Feel Like Glorifie

[execthis]

Burn down the medical schools and start over. As a society, we need to get back in touch with the basic fundamentals of what constitutes healing and caring for one another. What the modern medical establishment has morphed into is an abomination.

Its excellent news that more and more people are able to bypass the medical establishment in various ways and that the remaining vestiges of it have been reduced to frivolities like data entry. Hopefully it will become completely obsolete before long.

Welcome to real life

[kbg]

Welcome to my life. As a software engineer I must document everything and make reports and tickets for every single change. Even if a single digit code change takes only 2 seconds to make, I spend up to maybe 2 hours documenting, making TPS reports, tickets and work reports for that single change. Most likely that work will never be read again ever.

Re: Welcome to real life

[Anonymous Coward]

Only 2 hours? Defect report, Change Impact Analysis form, Peer Review documentation, collision analysis, change request, deployment plan, fallback plan, parallel test results, regression test results, unit test results, deployment ID approval.

90% CYA for auditing, 7% figuring out what to blame when something goes wrong, 3% actually preventing problems. And then supervisors wonder why we don't get much coded. Maybe if we actually were given time to code...

Re:Welcome to real life

[sconeu]

I spend up to maybe 2 hours documenting, making TPS reports, tickets and work reports for that single change.

You forgot the new cover sheet for the TPS report. So if you could remember it next time, that would be great...

Life is getting better

[aberglas]

It used to be that people got sick so that doctors could get paid.

Now people get sick so that IT consultants can get their finger in the pie. And what a fat pie it is.

As an IT consultant, the more confused the billing system is the better.

Damn

[Anonymous Coward]

then you die.

Here's the world's smallest violin

[DNS-and-BIND]

Yaknow, I might have a sliver of empathy for doctors, if they actually gave a shit. The last time I had a medical issue they didn't pay any attention to what I said, ordered a few tests, and shooed me out of their office lickety-split. If they had actually listened and prescribed a course of treatment, I might feel differently. But nope. One doctor actually had the gall to ask ME what I wanted to do. Like I'm an expert! What the fuck? How do you even ask something like that?! Heal me, you fucking quack!

'Nother reason I want single payer

[rsilvergun]

the constant battles on the part of doctors to get paid by insurance companies who's single goal is to not pay. In no other part of my life are my goals (getting care) and the service provider's goals (not paying for that care) so diametrically opposed. I've got family members with nasty health complications from easily treatable problems that were let go because the doctor didn't want to order tests in case they came back negative. If a test comes back negative the doctors never get paid.

Come to think of it I see this in one other place. B2B transactions. In so many of them business A won't pay the invoice for business B until A needs B's services again. I read somewhere Don Trump is famous for that, but having worked for small businesses it's so common he could just be going with the flow.

Re:'Nother reason I want single payer

[Anonymous Coward]

There is no reason that would change. In my Socialist Paradise country, doctors have more forms to fill every year and it's single payer. In fact, they've gone on strike over this.

Re:'Nother reason I want single payer

[jittles]

the constant battles on the part of doctors to get paid by insurance companies who's single goal is to not pay. In no other part of my life are my goals (getting care) and the service provider's goals (not paying for that care) so diametrically opposed. I've got family members with nasty health complications from easily treatable problems that were let go because the doctor didn't want to order tests in case they came back negative. If a test comes back negative the doctors never get paid. Come to think of it I see this in one other place. B2B transactions. In so many of them business A won't pay the invoice for business B until A needs B's services again. I read somewhere Don Trump is famous for that, but having worked for small businesses it's so common he could just be going with the flow.

I have this exact problem with multibillion dollar corporations. You literally have to hold their own goals and projects hostage to get paid a $20,000 invoice on some travel expenses THEY required. You ask me to fly across the country last minute (read same day) because you can't schedule something properly and then you want ME to float the $2,000 plane ticket until you need me to save your project again? I don't think so.

Re:'Nother reason I want single payer

[pnutjam]

I've got family members with nasty health complications from easily treatable problems that were let go because the doctor didn't want to order tests in case they came back negative. If a test comes back negative the doctors never get paid.I've got family members with nasty health complications from easily treatable problems that were let go because the doctor didn't want to order tests in case they came back negative. If a test comes back negative the doctors never get paid.

Sounds like this doc runs his own lab.

Thank you Democrats?

[Anonymous Coward]

No, Democrats thought that electronic records would reduce paperwork, and redundant tests. So, in 2009 & 2010, they passed bills coercing EHR use. So now medical records suck up doctor time. Wise governance?

Re:Thank you Democrats?

[dmr001]

Good intentions, maybe, and despite the grief there are some advantages. I can see my patient's clinic charts in the hospital - before, I'd have to wait for Monday and a fax machine. I can see what happened to folks in the emergency department. I can figure out my obstetric patients' prior pregnancy history. I can send records to specialists directly, and send requests with an electronic copy of a chart note and pictures of moles and whatnot at no cost to a patient and sometimes save them a visit to another office.

It's not perfect, but it's not a total disaster either.

Re:Thank you Democrats?

[Anonymous Coward]

reduce paperwork, and redundant tests

Is what they said.

they passed bills coercing EHR use

Where EHR use is "use EHR to order prescriptions for 30% of your patients" (this was the original stage 1 requirement). 30% of your patients don't need prescriptions? Start having them all chug penicillin! (thankfully this was fixed in the "modified" stage 1... of course everyone had to pay to recertify their upgraded version lol!)

Where EHR use is "record smoking status for everyone 13 years of age or older". The screen that asks this question must be certified by the government, so it gets a special screen just for that one question. Thanks, Obama!

Where EHR use is "record and plot height and weight and BMI, and calculate percentiles for patients 2-20". You're an oncologist that doesn't give a damn? Tough! Your EHR is certified to have a screen to plot kids growth charts, the button occupying screen real estate whether you want it or not.

Where EHR use is "beg patients to please, please, pretty please care enough to log into my website and click these buttons so you can look at XML files that don't mean shit to you but if you don't, I can't get paid". Last i checked, this requirement was still at the revised level of getting one single solitary patient to care.

Re:Thank you Democrats?

[jittles]

No, Democrats thought that electronic records would reduce paperwork, and redundant tests. So, in 2009 & 2010, they passed bills coercing EHR use. So now medical records suck up doctor time. Wise governance?

I don't believe this. For one thing, every doctor now has to ask their patients if they are a drug addict in order to bill medicare. It doesn't matter WHY you're seeing the doctor. You could have a cold and the doctor is still supposed to not only ask whether you smoke pot but if your parents or siblings do. How does that help anyone?

Re:Thank you Democrats?

[Anonymous Coward]

Actually, asking about drug use is part of a standard medical history taking. Just because you don't think it's important doesn't mean it's not medically relevant. There's a reason people have to go through many years of medical training, and that's because they have to think of other reasons for your "cold" than just some random viral infection.

Example: chronic runny nose could certainly be due to cocaine use or withdrawal.

Re:Thank you Democrats?

[phorm]

In the Canadian system, a big advantage of the common electronic system is when you move between physicians (which is pretty common because a disadvantage of our system is a lot of patients without a family MD).

Went to the clinic for an issue and it got worse late at night? ER doctor can see the clinic's notes

Went to the specialist because the ER doctor sent you there? Specialist can see your info and any previous/conflicting prescriptions or possibly related issues

Got a prescription from the specialist? Your regular doctor can see what you're taking

etc

Bull Stuff

[Anonymous Coward]

It depends on their tech setup. One heathcare provider has a workstation in every room, and it takes the doctor about 1 minute to review patient records and a couple more minutes to update it after the exam is over. Another heathcare provider takes notes and transfers them all at the end of the day. Yet another still uses paperwork and is very much not organised.

It depends on their tech setup. One heathcare provider has a workstation in every room, and it takes the doctor about 1 minute to review patient records and a couple more minutes to update it after the exam is over. Another heathcare provider takes notes and transfers them all at the end of the day. Yet another still uses paperwork and is very much not organised.

I don't want to use explictives, but they are warranted to the most extreme degree possible.
This 1 minute talk, it takes that long to login..if the system is polite, then to open the chart, then to find the actual note, then to load the CT scan...
There are multiple hard studies that show 33% reduction in efficiency that cannot be recouped.

Patients just love when you stare at a computer instead of talking to them....

This is crazy, I fight with my nurses every day. They tell me I have to input codes, I have to reconcile X, or Y or whatever.

F. That! I talk to my patients. I deal with them, and I deal with that screaming on the back end, but I'm not typical. I fight to talk to people like I would want to be talked to if I was a patient. I am burnt out, I can't fight forever. They will wear us down, your care will suffer. You let this happen, you asked for it through shitty laws that paid doctors 20% more to be part of a hospital system. You will suffer and you asked for it.

Practicing Surgeon MD

Re:Bull Stuff

[Anonymous Coward]

When I visited my regular doctor (GP), my Retinologist and Cardiologist, all three have had the nurse bring up the chart on the PC before they leave the office.
The Retinologist nurse even brings up the latest scans as well. I can look at the scans while I wait. Other than a patient reaching out and altering data, there is no reason not to do this. What is there to hide from the patient? If there is new and bad news, the program could be minimized or the screen locked.

Re:Bull Stuff

[rally2xs]

I didn't ask for it, I want the gov't the H out of the healthcare inner workings. I'm just fine with written paper records, and see no advantage to having them in a computer - just lots of disadvantages including malware such as ransomware as well as data entry errors, which had me supposedly taking a drug I've never heard the name of before, as well as the wrong dosage of a drug that I am taking. Got those worked out, but probably the best thing to do for this is to build screens that patients can work with - I'll enter what drug I'm taking, the dosage, how many dozen operations I've had (I'm 69, and have had a LOT of them) and other medical history, yada yada. And you know what? I'll save it off on a CD (not an thumb drive that can introduce a virus to your computer) and sneaker-net it to the next medical provider. Just like the time-honored way of the financiers who use OPM - Other People's Money - this thing needs set up so that much of this burden can be transferred to OPL - Other People's Labor, as in data entry, which I could mostly do... Oh, and give me a scanner, and I'll just bring in my bottles of drugs and scan them in, and it'll be faster yet....

Re:Bull Stuff

[0100010001010011]

Evidence based medicine isn't an advantage?

Re: Bull Stuff

[Anonymous Coward]

Keep the govt out of my MediCare!

Trump2016! The best and last president!

Re:Bull Stuff

[Anonymous Coward]

it takes that long to login..if the system is polite, then to open the chart, then to find the actual note, then to load the CT scan

Eh, you have shitty software it sounds like. Mine works better, I can get results in 4 clicks if the patient is on my schedule, fewer if I made a result an alert on the patient when I reviewed it. 5 seconds tops? 15 if the patient isn't on my schedule so I have to figure out how to spell her name to search for her.

That said, the government's meaningful use bullshit can't just leave well enough alone. Send prescriptions electronically, get test results electronically, medical care is now 1000% better than before. You want interoperability? You want us to stop ordering the same tests over and over? Get Quest to send me my patients' bloodwork for the last five years. Get the pharmacy to send me every prescription for the last year. 1000% easier than trying to get my ob/gyn system to talk to your cardiology system. Does your software even have a spot for my patient's cervical dilation? Even if it did, do you even give a fuck? After 9 hours of labor I sure as hell don't care what her heart wall thickness is. Just tell me if she's going to croak if I augment, please.

Re:Bull Stuff

[guises]

This is not representative. Yes from your perspective you're giving better care when you ignore the system, maybe it's easier and faster to glance through a chart and just remember what you need to know about a particular patient, but this system wasn't established to help you. This system was established to help patients who aren't always being treated by the same doctors, who need to go elsewhere sometimes, and who don't always have the stellar level of care that you no doubt give them. Where would we be if we built our infrastructure around helping only the best doctors and their tiny number of patients?

This same argument comes up all the time in other contexts. Whenever you make a change which helps the group, which provides a net benefit, but which may hinder some individuals you get this complaint. The talking heads love this stuff because anecdote plays very well on TV - put some photogenic people in front of the camera and get them to say, "X didn't help ME!" and then the talking heads turn to the audience: "We're not saying that X is bad, we'll let you decide."

Re:Bull Stuff

[tburkhol]

This 1 minute talk, it takes that long to login..if the system is polite, then to open the chart, then to find the actual note, then to load the CT scan... There are multiple hard studies that show 33% reduction in efficiency that cannot be recouped.

The software is not written for the docs. The software is written for the administrators. It makes sure all the i's are dotted and t's are crossed so that insurance and medicare make timely payments (or at least lack valid excuses for delaying payment).

Docs used to 1) make hand-written notes during an exam 2) quickly dictate a more elaborate summary of the exam/consult by phone or tape 3) let a transcriptionist convert those notes to a permanent record. (maybe 0: have patient history handed to them by PA) Nobody trusted a doc to know how to type or to waste his time figuring out how to fill in some insurance company form. Put those forms in a web-interface, though, and all of a sudden it's something the doc can do. Fire the transcriptionist: doc is making his own records now. Even better, if the doc himself checks a box, the hospital can use it as certification that specific observation was made and that specific treatment or care was delivered. Legal proof that either the individual doc committed fraud or that the insurance company owes them $X.

You'd think that there would be a market for software written to make the docs' jobs easier - to automate the back-end of the old process, leaving the responsibility for converting doctors' verbal notes into insurance company codes to back-office transcriptionists - but the big purchasing decisions are made by administrators is organizations that are too big for the admins to actively practice medicine. So, you end up with healthcare software written for accountants.

Re:Bull Stuff

[Anonymous Coward]

A few years ago, my doctor didn't realise I had a burst appendix. In hindsight, I think it was that a) you don't speak to the same doctor twice, b) subsequent phone consultations where I was complaining, didn't raise suspicions, c) even though the doc I saw in person did look at the computer screen, he somehow didn't register that I'd been given strong painkillers two days earlier, by another doc in the same centre, d) he checked my belly but by then there was no strong pain left to feel, e) he seemed to put my weakness down to just having gastroenteritis. To be fair, I didn't collapse, and it was two weeks before I was finally admitted to hospital for being "dehydrated" after getting gradually weaker and weaker. Thank goodness for CT scanners. Anyway, my sense is that there is no substitute for seeing a doc and seeing the same doc again and again, in person. It is too easy for people to look at 2nd hand information, on a computer or via telephone, and conclude you're fine. Again, to be fair, at the hospital they said they'd never seen someone so ill who was still looking so well. All the more reason not to rely on technology, and rely instead on real people assessing you.

Re:Bull Stuff

[tburkhol]

I didn't ask for it, I want the gov't the H out of the healthcare inner workings. I'm just fine with written paper records, and see no advantage to having them in a computer - just lots of disadvantages including malware such as ransomware as well as data entry errors, which had me supposedly taking a drug I've never heard the name of before, as well as the wrong dosage of a drug that I am taking.

Believe it or not, de facto standardization of medical records to meet government/medicare rules is a big benefit to healthcare providers. For a while, every insurance company had different forms that had to be filled out, often by the patient, in order to get reimbursed. Better doctors/hospitals employed people whose only job was to learn the differences between Blue Cross and Cigna forms and language and to either fill out or help their patients fill out those forms. Spend your 15 minutes in the exam room, then go spend 30 minutes with the billing specialist.

You might think there would be some natural pressure to open standards in diagnostic descriptions. You would be forgetting that insurance companies have a vested interest in not paying claims. If they can get you to fill out the form wrong, or to claim treatment for a diagnosis that isn't covered, then they're perfectly justified in denying. If you don't like it, you can go somewhere else - that's also in the company interest, as only ~5% of their customers actually file claims. Fewer claims, more profit.

Re:Bull Stuff

[jittles]

It depends on their tech setup. One heathcare provider has a workstation in every room, and it takes the doctor about 1 minute to review patient records and a couple more minutes to update it after the exam is over. Another heathcare provider takes notes and transfers them all at the end of the day. Yet another still uses paperwork and is very much not organised.

It depends on their tech setup. One heathcare provider has a workstation in every room, and it takes the doctor about 1 minute to review patient records and a couple more minutes to update it after the exam is over. Another heathcare provider takes notes and transfers them all at the end of the day. Yet another still uses paperwork and is very much not organised.

I don't want to use explictives, but they are warranted to the most extreme degree possible. This 1 minute talk, it takes that long to login..if the system is polite, then to open the chart, then to find the actual note, then to load the CT scan... There are multiple hard studies that show 33% reduction in efficiency that cannot be recouped.

Patients just love when you stare at a computer instead of talking to them....

This is crazy, I fight with my nurses every day. They tell me I have to input codes, I have to reconcile X, or Y or whatever.

F. That! I talk to my patients. I deal with them, and I deal with that screaming on the back end, but I'm not typical. I fight to talk to people like I would want to be talked to if I was a patient. I am burnt out, I can't fight forever. They will wear us down, your care will suffer. You let this happen, you asked for it through shitty laws that paid doctors 20% more to be part of a hospital system. You will suffer and you asked for it.

Practicing Surgeon MD

I just recently was consulting with a surgeon (who actually recommended I not have surgery but still took care of my injury with multiple follow ups to see how I was doing) who has his staff come in and prep everything. It looks like their system requires a password to switch charts. So the MA comes in, pulls up your chart and imaging and then leaves it up for the doctor. Of course, I could probably attempt to break into the system but feel like that would be impolite. It might be a HIPAA violation, I am not sure, but it certainly keeps him from looking at the computer instead of me.

Re:Bull Stuff

[Anonymous Coward]

Anyway, my sense is that there is no substitute for seeing a doc and seeing the same doc again and again, in person. It is too easy for people to look at 2nd hand information, on a computer or via telephone, and conclude you're fine. Again, to be fair, at the hospital they said they'd never seen someone so ill who was still looking so well. All the more reason not to rely on technology, and rely instead on real people assessing you.

This is not the fault of computers - this is the fault of the hospital. There is no SkyNetMD system that rotates doctors around so they don't see the same patient twice - that's a (poor) decision made by the hospital.

Re:Bull Stuff

[jeffporcaro]

Please provide a citation for evidence of the benefit of the electronic medical record. I'm a cardiologist, and these have dramatically worsened the quality of care from our perspective; this is a fairly universal feeling among doctors, I believe. I have yet to see any evidence of the benefit - if you have some, please share. The potential benefits, which is what you describe, are still just that, and there are no documented benefits that outweigh the misery the current system inflicts.

Re:Bull Stuff

[computational super]

You let this happen

More than you know. "Professional" project management is just as to blame for the joke that is modern software. My first job out of college, 25 years ago, I was working for the government. I was basically paired up with what we would call a "business owner" in today's terminology: he described what he was thinking, I'd implement something, we'd review it, he'd suggest changes, I'd implement those, sometimes rewriting entire parts of the system, he'd suggest other changes, back and forth. We were both professionals, we both knew what we were doing, we both trusted each other and - here's the part that modern project managers can't comprehend: we treated each other like professionals. If I spent a few days or even a week figuring out how, say, TCP/IP (which was sort of a newish thing back then, at least for personal computers) worked, he wouldn't insult me by demanding a daily status report, or demanding that I break down my tasks in one-hour increments, or insist that I go ask Bob who "knows that stuff". I, likewise, wouldn't insult him by bitching about the fact that he forgot a detail a month ago that was going to cause me some re-work: because neither of us were being insulted by a project manager who insisted that the product, regardless of quality, had to be finished by some arbitrary date because he knew, in his heart, that if he didn't keep his oppressive bootheel on our necks every minute of every day, that we would just sit around all day playing video games and wasting time. In essence, we respected one another and were respected by our employers.

But then came the software project managers. I don't know if a couple of guys peed in the pool for all the rest of us, but within ten years I found myself punching a card like a factory assembly worker. There was a glimmer of hope in the late 90's when "extreme programming" started to take off, which was based on this same underlying model of treating professionals like professionals rather than fast-food assembly line workers, but extreme programming became "agile" which became "scrum" which is the most offensive possible way of viewing the practice of software development as semi-skilled bricklaying.

Re:Bull Stuff

[flink]

Believe it or not, de facto standardization of medical records to meet government/medicare rules is a big benefit to healthcare providers. For a while, every insurance company had different forms that had to be filled out, often by the patient, in order to get reimbursed. Better doctors/hospitals employed people whose only job was to learn the differences between Blue Cross and Cigna forms and language and to either fill out or help their patients fill out those forms. Spend your 15 minutes in the exam room, then go spend 30 minutes with the billing specialist.

This article is talking about the tyranny of EMR data entry, not standardized claim submission. I worked at a medium/largish practice management vendor who also ran a medical claim clearinghouse for most of the HIPAA implementation era (1997-2012). HIPAA gave CMS the power to mandate the interchange format for electronic claim form submission and other ancillary transactions.

This was a huge boon for the IT departments as they got some of their budget back from having to maintain dozens of different proprietary interfaces to the various commercial insurances. However, this did nothing to elide the necessity to have billing and coding specialists on hand who knew how to navigate the various carriers' rule sets. In fact our main value add as a clearinghouse was that we saw so many claims that we were able to develop heuristics for all the carriers we supported and were able to identify claims that were likely to be flagged by the carrier before sending them on. That way the customer could send on an amended claim before the carrier even responded with a status notification or remit.

None of this affects how a doc would document encounters except to whatever extent an organization made procedural changes to comply with HIPAA. Other than that, the claim standardization piece primarily affected billers and IT folks.

The trend to micromanaging everything through the EMR has more to do with several more recent phenomena such as increasing consolidation of PCP practices into hospital networks, the availability of government grants to create RHIOs/HIEs through EMR incentive programs to demonstrate "meaningful use" of shared electronic records, and the increased reporting burdens placed on providers through the implementation of ACOs.

Nowhere that I am aware of is there are particular legally mandated format for EMR records like there are for EDI (ASC X12). However HL7v3/CDA is a de facto industry standard for HIEs.

Re:Bull Stuff

[Anonymous Coward]

he somehow didn't register that I'd been given strong painkillers two days earlier, by another doc

He totally saw it and registered it: "drug seeker". Back again for more pills.

Re: Bull Stuff

[Anonymous Coward]

You do realize that Trump is on record being in favor of single payer health care; praised Hillary for her efforts and was in favor of Obamacare.

He's just another big-government populist know-it-all. //GLMDesigns

Re:Bull Stuff

[Anonymous Coward]

This is not representative. Yes from your perspective you're giving better care when you ignore the system, maybe it's easier and faster to glance through a chart and just remember what you need to know about a particular patient, but this system wasn't established to help you. This system was established to help patients who aren't always being treated by the same doctors, who need to go elsewhere sometimes, and who don't always have the stellar level of care that you no doubt give them. Where would we be if we built our infrastructure around helping only the best doctors and their tiny number of patients?

(AC MD from https://tech.slashdot.org/comments.pl?sid=9407009&cid=52544931 coming back)

You're goddamned right it's not established to help us. But you're so damn wrong about it being there for the "patients who aren't always being treated by the same doctors, who need to go elsewhere sometimes, and who don't always have the stellar level of care that you no doubt give them." (I'm honestly not sure if you're being sarcastic with that last little bit about stellar care. If not, thanks for giving him the benefit of the doubt. If that was sarcasm, well double dumb-ass on you.)

They've been built for the insurance agencies. They've been built for billing. They've been built so administrators can have a pretty looking printout and tell regulators "see, we're meeting all your criteria!" They've NOT built for the MDs, RNs, NPs, PAs or other medical staff, and it sure as pajamas hasn't been built "for the patients."

Ease of use for physicians is NOT anything but a late afterthought, in my experience. The GP is, in my experience, spot on for major institutions and hospitals. His depiction of long log-ins, dead on. Long access times to load charts, dead on. Having to "dig" to find the actual patient record, dead on. More digging to find that radiology report, dead fracking on. Being nagged about "reconciling" and putting in codes, when I'm just trying to get a patient taken care of and discharged? DEAD ON. (In fact, I think I know exactly what EMR he's complaining about, but I'm not gonna give out specifics. Medicine is a small and gossipy world, and I don't want to risk his getting unwanted attention.)

GP could have been me 1-2 years ago, struggling to actually take care of my patient, then dealing with the damn paperwork backlog later. Or, rather, I think I'm who he will be in 1-2 years. Burnt out, not caring anymore. Many of my peers have dealt with this by making quick and crappy notes, things that will keep the bean-counters and number-crunchers happy, but leave our colleagues out in the cold, because those lovely easily read records don't contain anything useful to another physician, resulting in lost time digging up what wasn't included. I'm dealing with it by leaving my group and going part-time elsewhere, or possibly leaving medicine altogether if part-time remains unbearable.

It doesn't matter how much a doctor loves medicine if the profession is actively becoming hostile to the providers. Hell, I've actually strongly recommended folks who ask me about being a doctor that I'm not sure I'd do it over again, especially if I had to start in today's environment.

Don't believe me or GP? Think we're just arrogant doctors that don't think of our patients, that we don't realize there are a metric-fuck-ton of patients who see different providers with depressing frequency, probably because they get most of their care in an ED or different "urgent care clinics," and have seen more providers than are employed by some private practice offices? (Surprise: Yes, we know those patients exist, and you wouldn't believe the amount of effort we often go through to help them find some stability in their medical care.) That's fine, its just my anecdote. And, of course, the plural of anecdote is not data. But I challenge you to find practicing physicians who say "Our EMR made things so much easier! Our patients love the new system, it's help their visits go so much faster!" And reports from or paid for by companies who make those systems don't count.

I think you'll be searching for a long time. But go ahead, surprise me. I'll check back later.

Re:Bull Stuff

[Anonymous Coward]

So, guy who posted https://tech.slashdot.org/comments.pl?sid=9407009&cid=52549639 previously.

It's later. What'd ya find? Anything surprising?

Yeah.

Didn't think so.

Litigation Culture

[ytene]

But how much of this analysis looked at the fact that if a doctor mis-diagnoses something, or misses something, they are immediately subject to massive lawsuits?

The litigation culture that pervades the medical profession, particularly in the US, makes it increasingly difficult for doctor to do their job properly, because if they deviate even slightly from "accepted practice" they end up served with a malpractice suit.

It is going to be fear of litigation, not poor IT, that drives the change in behaviour. That and the fact that a patient who can be sold care of some kind is considered a revenue-generator to be held on to. In other words, the healthcare system is no longer about the health of or care given to the patient, it's all about the relative profitability of the condition they bring.

This is what happens when you operate a health service on a financial model. Why are we surprised by this?

Re:Litigation Culture

[sjames]

That, in turn, is caused by the lack of a social safety net. For the patient that has a negative medical outcome, even an unavoidable one, their choice is die in the street, take a lifetime vow of poverty for themselves and their family, or sue.

Im busy BUT

[Anonymous Coward]

For 150k a year I will do data entry

Funding cuts

[Anonymous Coward]

In Australia, the health budget is a popular target for cuts, at both federal and state levels. The politicians then say they are cutting admin/support staff, and making sure that front-line health workers (doctors) keep their jobs. Which sounds okay, until you realise that this just means doctors have to do the work of the support/admin staff - and they're usually less efficient at it, because that's not what they're trained to do.

It's robbing Peter to pay Paul, really.

ethical drift

[epine]

This is one of my favourite EconTalk episodes of all time.

The guest talks about the "ethical drift" resulting from the imposition of an impossible burden. (My favourite EconTalk episodes are usually the ones where Russ is surprised to discover that the world works as well as it does. In this one, he's shocked by the military's willingness to engage in self-criticism.)

Leonard Wong on Honesty and Ethics in the Military

This one is not unbearably polemic for a general audience, and it's tremendously apropos.

Re:ethical drift

[epine]

I should have included the blurb in my post above.

Based on a recent co-authored paper, Wong argues that the paperwork and training burden on U.S. military officers requires dishonesty—it is simply impossible to comply with all the requirements. This creates a tension for an institution that prides itself on honesty, trust, and integrity. The conversation closes with suggestions for how the military might reform the compliance and requirement process.

What I recall from the episode is that by the end they both dodge the central question: in modern democratic society its politically impossible to give an honest answer to a special interest group (we'd love to add your special box to our form-filling and training rotation, but we simply don't have the manpower available to properly comply).

They do talk a little bit about improving internal honesty, but that remains far from the root cause.

Not everyone accepts it.

[Hans Lehmann]

My internist, who's many years younger me so he's not just some cranky old Luddite, tried the using iPads, etc., for about a year before he threw it all out and went back to a manila folder with the patient's name on it, with all the medical records inside. I feel more comfortable with him than with his associate who seems to look everything up on their phone before making a decision. Just my data point.

It's the insurance companies

[Anonymous Coward]

HITECH was signed in 2009 and implemented in 2011.
The cause and the ever worsening problem long predates 2009 and predates pretty much any government interference.

I speak from working 18 years for a major university's hospital on the business side of things.

It is the insurance companies that are driving this and have been driving it for some time.

They have an enormous say-so in how doctors practice medicine through their contracted "quality assurance" programs, which consist of either over-documenting everything or mandating "cost efficient" practices that are basically just reducing care for patients.

Hospitals must have a contract with an insurance company to submit billing and to get paid. To get the contract, the insurance company mandates all kinds of processes and procedures, almost all of which are obstacles to care. The hospital needs the insurance contract to get patients more than the company needs the hospitals.

The way insurance companies pay the hospital for claims is not like how you are billed. It's more like a base monthly stipend that is modified by the overall patient claim experience over time. The insurance companies goal is not so much to screw you out of paying your claim as it is to lower the monthly base payment to the hospital. The insurance company offers a higher base this year if the hospital agrees to the insurance companies QA plan and suchlike programs, and this is how the insurance companies can mandate some of the ways that doctors practice medicine, none of which are good for the doctor or the patient. Or lower payments if they don't want to play.

When you see in the news that some local hospital is no longer accepting some insurance companies clients, the battle is over some so-called QA program that the insurance company is trying to force down the hospital's throat.

The role of EMR in this is that no one has the resources to examine paper records with big data tools to look for places to cut pennies, dimes, and dollars, but with EMR it's not that hard for the insurance companies. EMR is all about getting your medical records into the hands of the insurance companies.

Admittedly, hospitals are not the only source for medical care, but what happens in the hospital environment drives the industry.
What HITECH did that sucks so bad was that it brought all the private practices and small clinics into the digital fold, and the cost to them to implement EMR is a huge fraction of their operating budget. You may notice that many clinics are becoming associated with some local hospital. This is why - they cannot afford the costs to go it alone.

Re:Litigation Culture - Actual Solution

[Ulfilas2000]

For an actual solution to the medical mess, and not just another screaming person towing a standard party line: http://sti2.blogspot.com/2013/...

it's like ITIL

[uniquegeek]

I used to get work done. Then a whole bunch of middle managers with no UI training discovered the entire ITIL framework.

I work more for the system than it works for me.

heh

[Anonymous Coward]

heh, join the club

Doesn't work for people who use the data either

[Andvari]

I work in health informatics/epidemiology putting together and analysing large datasets for various eHealth projects (government, academia and private industry). The entire system of standardised data formats etc... that makes doctors' lives painful is, in many ways, supposed to make mine easier. Unfortunately nothing could be further from the truth.

Somewhere along the way the message has been lost, and from where I sit it's due to a lack of communication between clinicians, bean counters and IT people. Clinicians often have a rather arrogant view of the world. They tend to assume technology is easy and the only reason they can't do it is that they haven't been bothered yet. The don't treat IT professionals as being specialists in their own right. Rather, they treat them as service people, in much the same way as you would pay someone to mow your lawns (it's menial and I don't have the time blah blah...).

On the other hand IT professionals (the ones that do the UI stuff) rarely seem to understand or care why the data is being collected, just that it is. This of course leads them to make all sorts of assumptions that often turn out to be completely incorrect. One such system that I've seen had 2 options for gender, male and female. This system was supposed to be used in a urology department that often dealt with intersex people.

Finally we come to the bean counters, for some reason healthcare and healthcare IT seem to attract the worst of the worst PHBs which just compounds the entire problem.

Boo fucking hoo

[Anonymous Coward]

I'd type data in all day long if I got a doctor's salary.

Data to track their service upselling effectivenes

[Anonymous Coward]

Here's a real-life scenario of what the data is for.

The dental hygienist who spends 5 minutes upselling things you don't need, guilt-tripping you in almost every way they can, then spending 15 minutes of the hour entering data that whether or not you are "still" taking vitamins (which have absolutely nothing to do with getting your teeth cleaned), or that you have denied their upselling of services. The dentist would spend 5 minutes going over the record on the computer in the beginning, then guilt trip you even more saying that you don't want their extra services. This is a practice that won't even validate your full parking unless you put your credit card on file with them.

Back in the day, physicians would take at most 2 minutes to write things down on a clipboard. Now physicians, especially in the US, are there to constantly upsell you things. Many primary care physicians won't even take new patients if you fall into certain category of insurance, because they feel it's too much work for their profit margin. Look at clinic receptionist job postings online and you see requirements of making sales pitches. What a nightmare.

BigGovt loves paper-push, BigInsur loves BigGovt

[tanstaaf1]

It's a marriage made in heaven. Government gets more power and tax money (with which to reward its "friends") What's not to like about Factory medicine? Plenty - for patients and doctors and nurses; but what do THEY matter? I've got good friends who are doctors and others are nurses. There is little doubt in their minds (and who else would better know) that all the documentation is making both the government and the insurance companies more entrenched and the quality of the care go down. Non compliance with paperwork is unthinkable, while poor outcomes can be tolerated ... as long as the boxes are all filled. (pun noted). The hospitals are now being judged and paid (by both gov regulators and insurance companies) more on compliance with with record keeping than on outcomes. How would you expect this to go? Question: Do you think Obama or the Clintons have to put up with Dr. appointment time being metered? Of course not! “All animals are equal, but some animals are more equal than others.” George Orwell, Animal Farm "Men have become the tools of their tools." -- Henry David Thoreau In another way of looking at the problem: it's all an extension of "free trade", right?

Anecdote (not antidote)

[Tablizer]

My doc asked me about family history of a condition. I told her my mom had surgery for the condition roughly a year ago. She started typing in the date, and paused:

"It requires an exact date. I can't enter an approximation. Can you by chance remember your mom's exact surgery date? They don't like dates that are off in case they want to research it.", she asked. (My mom is under the same provider.)

After pondering a bit, I suggested she see if there is a "notes" fields to indicate it's only an approximation.

"Hmm, let me see...", she replied.

After about 5 minutes of digging between screens, she said, "Okay, here's the doggon note section."

Re:Anecdote (not antidote)

[Anonymous Coward]

I'm designing an EMR system. That's one of the fixes that I'm making dog sure is woven into the design so that it can handle approximates here.

Re:Anecdote (not antidote)

[Anonymous Coward]

Anecdotes and antidotes and little ants eat ivys!

Brazil the Movie.

[Anonymous Coward]

For anyone who didn't catch the reference.

Translation

[Anonymous Coward]

... document exhaustively so you cover your ass and get paid ...

Translation: Billing agencies and insurance agencies know doctors are dumb enough to do paperwork for free.

Why don't doctors just buy the software they like and make their clinic a cash-only business (with an up-front cover-charge if necessary)? If patients had to claim against their insurer (a common option in most countries), the pretentious pricks would lose premium-paying customers very quickly. The point of capitalism is efficiency of supply, so why isn't this happening?

This is why a single-payer system is superior.

It should

[Anonymous Coward]

Doctors ARE glorified data entry clerks. Serves them right to finally learn the truth about themselves!

Glad I live in Canada...

[Anonymous Coward]

My health record can be accessed from any clinic or hospital in the country, quickly and easily.

because thats all they should be ...

[fygment]

Do you want to trust the doc who finished at the bottom of the class?

Or would you rather trust the consistent advice of a machine that actually learns more and more as it deals with more and more cases, or from other machines doing the same?

Re:because thats all they should be ...

[Anonymous Coward]

Yeah if it has any learning. It doesn't.

Good

[Anonymous Coward]

If the medical industry didn't kill so many fucking people through easily avoidable errors, redundant and pervasive data-entry wouldn't have been necessary. As it stands, the risk is too high, so you need to triple check your work and make sure everything is documented.

Oversight and accountability? Cry me a fucking river.

System vs patients

[Anonymous Coward]

This combined with the industry's opposition to legalized or medical marijuana shows that they are only about the bottom line, or rather, profits.

There was another story that marijuana legalization drastically reduced the average doctor's number of pain killer prescriptions, which would in turn reduce the number of opiod addicts. The medical industry lobbies against legalized marijuana for that reason.

Re: Technology Is Making Doctors Feel Like Glorifi

[brasselv]

http://www.nature.com/scitable...
I'll stick with the medical abomination for now.

Re: Technology Is Making Doctors Feel Like Glorifi

[execthis]

Your reasoning makes the assumption that improvements in medical treatment and life expectancy would not have occurred without the medical establishment, which of course is false.

in fact that was exactly the point of my original post: Humans are intelligent enough and quite capable of medicine without the twisted medical establishment that exists. In fact it may be that without the medical establishment we would have better care.

So long as people like you are beset by the delusion that there's no alternative to the medical establishment, then humans are doomed to be limited and stuck.

In fact your puerile attempt to try to prove something by throwing up a graph without actually using your mind to think more seriously is exactly a symptom of the problem.

What the old joke?

[Anonymous Coward]

What's the difference between God and a doctor?
God doesn't think he's a doctor.

Boo hoo.

May be reaching a turning point ....

[King_TJ]

At least speaking to healthcare in the USA, I think the furor over "Obamacare" along with rising medical costs across the board, and doctors' frustrating with increased paperwork, is leading to a tipping point.

Almost all of it boils down to problems stemming from healthcare as a profit-generating enterprise.

I absolutely think doctors and staff need to be paid a fair wage for their work, just like anyone else does. But there's got to be some kind of understanding we come to that medical care is treated differently than regular businesses. (If your car needs repair, for example? You have all sorts of options, including doing the repairs yourself or just trading it in and getting a different one. If your body needs repair, you can't just do a DYI heart bypass surgery or "trade it in". You can live with what's broken if it isn't TOO debilitating OR pay the asking price to get treatment.)

Under those circumstances, I think we need to view medicine as more of a charitable work. Whether you're a researcher or a doctor, your goal should be the motivation to help others and make the world a better place. Medicine isn't an appropriate field to get into if you're chasing maximum profits.

One of the best doctor-patient experiences I ever had was also one of the most basic. I had a red spot that kept appearing on my nose, that would get sore to the touch. After a month or so, it would disappear on its own, only to randomly come back again -- seemingly aggravated by sunlight exposure. People started telling me they thought it might be the onset of a skin cancer. I got worried, fearing the worst, and scheduled an appointment with a dermatologist who my parents had gone for for years. The guy was your typical "grouchy old man" who was "all business, no pleasantries". (I think he was about to retire, actually.) But they kept telling me he was good, so I gritted my teeth and went to see him. The doctor said few words... just pulled out his magnifying glass and studied my nose for 15 seconds or so and said, "Hmm.... yes...." Then he prescribed me medication for it and said it wasn't a cancer or anything like that. It was a type of cold sore. Oddly, the medication to keep it away is typically used for STDs (so it's a bit uncomfortable of a prescription to ask for refills on!), but he was absolutely right. Every time it starts to appear, I take one half of one of the pills (all that he said was really required) and it vanishes overnight. And recurrences have diminished over the last year or so.

My point is ... THAT was the kind of doctor's visit that was really worth my money. Pay once and let the guy use his expertise to discover the problem ... prescribe what's needed to help out, and done. I imagine at most doctor's offices today, the same visit would have involved tons of paperwork, tests being ordered, and follow-up visits. Ridiculous ....

Re:May be reaching a turning point ....

[PCM2]

It was a type of cold sore. Oddly, the medication to keep it away is typically used for STDs

That makes sense, since cold sores are a symptom of the herpes family of viruses. Not necessarily the same strain that you would contract as an STD, but herpes nonetheless.

Dictaphone

[phorm]

This has been a thing at specialists for a long time, except instead of scribes with laptops they often had some sort of "dictaphone" or recording device. Doctors gives a narrative while checking patient, which is then sent to somebody who plays it back and records what was said.

A lot of clinics still do this, although now the recording devices are a little more advanced or could just be an app.

Another One Bites the Dust

[Anonymous Coward]

This is another profession dehumanized by Big Data.
You get unnecessary Government regulations created by lobbyists and politicians who do not understand what needs to be done. Big Insurance and Big Pharma own their politicians. They want systems in place to keep the money flowing their way, they are not interested in getting the job done.

I guess Doctors are not immune (pun intended) to the issues a lot of the rest of us have already experienced with excessive work overhead due to the "Convenience of Electronic Data"

I have worn many hats in my life and currently am in IT, in the Healthcare Industry. EMR is a wonderful concept with horrible implementation.

What's Really Wasteful

[rally2xs]

What's really wasteful is that when I have an appointment with a new doctor, and sometimes one of the old ones I haven't seen for a while, I get a ream of papers with questions and boxes to check, and so forth. I fill them out, it often takes 15 - 20 minutes (How many operations have you had? I'm 69, and that would be answered "a bunch.") and then give all this paper to the office staff. Is there any doubt that some poor schmuck has to enter all this garbage all over again into a computer, maybe more than once? They could easily either send me a web link to fill all that stuff in directly to the computer, or provide computers in the waiting room where I could still do it myself. It would get entered once, and it wouldn't involved doctor or his people expending time on it.

Medical Scribe

[Gunfighter]

I've encountered medical scribes twice now:

1. During a trip to my ophthalmologist, the doctor did the examining and talked the entire time (not to me) while the scribe took the notes.

2. During my most recent trip to the ER (for a relative, not for myself), the doctor came in with a medical scribe. The scribe wheeled in a cart with a laptop and stood quietly in the corner. The scribe's job was to do nothing but take notes for the doctor while he examined the patient.

In both settings, the setup seemed to work very well. Perhaps this is the answer to the "over-data" problem described in the OP.

Government making doctors entry cle

[Anonymous Coward]

It is not technology at fault. Government & insurance companies have done this. Use of existing DB technology was not allowed. Good software design was not allowed. Security was not allowed. Only software built down to government standards was allowed. Purpose of software was to enhance government control & insurance company profits, not to allow good medical practice.

Re:Technology Is Making Doctors Feel Like Glorifie

[Jawnn]

Burn down the private healthcare industry and start over. As a society, we need to get back in touch with the basic fundamentals of what constitutes healing and caring for one another.

TFTFY
Nothing, absolutely nothing, has driven modern medicine so far away from the business of healing as has the insurance industry. Google the term "managed care", and weep for the days when physicians and other caregivers decided how to treat their patients. Worried about "government death panels" that decide who gets life saving care and who doesn't? Congratulations, sucker. That blatant misdirection worked on you too. In the U.S. we spend more (far more) and get less (by any credible metric) than any other industrialized nation when it comes to health care. To blame the physicians for this is absurd.

Re:This is all bullshit

[sjames]

No, it doesn't. Not in the U.S. anyway. It costs twice as much as anywhere else and ends in worse outcomes. Even simple routine care has a tendency to turn into a Kafkaesque nightmare for the patient.

If it gets any stranger, we'll start seeing billing model simulators that iteratively run through the billing process on a supercomputer so the billing person can determine which of 3 to 5 different but equally justifiable billings will result in the best payout for them with the least money out of pocket for the patient.

Curious about single payer. Like the VA?

[tacokill]

I am curious why you think single payer operated by the government (or whomever they outsource to) would better. Would the offering be better than the VA? Medicare? Bureau of Indian Affairs Med System? What would make it different this time around when the government gets involved? I ask because anyone who actually has to participated in those systems knows they suck all over the place. Even the governments own reports say they suck so what would make it different next time around?

The Digital Doctor is a good read about this

[m.w.hurley]

One of my doctors recommended I read The Digital Doctor. Generally it's about "why isn't health IT super awesome like it was supposed to be?!" It covers the focus on getting paid and other changes to practicing medicine.

Re: Technology Is Making Doctors Feel Like Glorif

[Anonymous Coward]

The parent post is not the one not using his mind...

They are support desk

[Anonymous Coward]

Listen to symptoms, diagnose problems then prescribe treatment. Can't be more difficult than supporting Windows.

Re:Technology Is Making Doctors Feel Like Glorifie

[Anonymous Coward]

Burn down the private healthcare industry and start over. As a society, we need to get back in touch with the basic fundamentals of what constitutes healing and caring for one another.

TFTFY

Nothing, absolutely nothing, has driven modern medicine so far away from the business of healing as has the insurance industry. Google the term "managed care", and weep for the days when physicians and other caregivers decided how to treat their patients. Worried about "government death panels" that decide who gets life saving care and who doesn't? Congratulations, sucker. That blatant misdirection worked on you too. In the U.S. we spend more (far more) and get less (by any credible metric) than any other industrialized nation when it comes to health care. To blame the physicians for this is absurd.

Also: "death panels" already exist. They're the penny-wise-pound-foolish monsters (ooh, inflammatory!) who decided they won't pay for management of overweight or obese patients, (likely because some calculation said it was worth it in the "big picture," even if they are stuck paying for a few kidney transplants or covering other morbidities that develop later in these obese patients due to the diabetes and hypertension that is difficult to control because they're so damn obese now. (I wouldn't be surprised if those calculations included likelyhood those patients would be dropped from the insurance before their health got bad enough that they would need care for severe complications.)

Folks were so fracking scared of "government death panels" that they were completely distracted from the fact that the "death panels" have been privatized for decades. They're your friendly Private Insurance Provider who will refuse to pay for so many treatments but who have been only too happy to jack up your rates or (until recently) drop you like a bad habit if they think you're gonna actually cost them money.

Ain't that just a kick in the pants?

Can't speak to Indian Affairs

[rsilvergun]

but everybody I know on the VA loves the stuff and would sooner chop their own arms and legs off than go back to "private" insurance. I do know one bloke who's a friend of a friend that says medical care on the Res is fine, but it's one of the tribes flush with Casino money out of Arizona so take that with some salt. Things could be different for the poorer tribes.

Re: Technology Is Making Doctors Feel Like Glorifi

[spazzmo]

Yes, it's true that the health improvements from increased sanitation and nutrition were well under way when modern "doctors" were still rating their abilities by how much gore was caked on their jackets: if your jacket couldn't stand up by itself you were no good yet.

And what about pharmacists ?

[Anonymous Coward]

Time to replace them with a DB coupled to an expert system for over the counter med and automated pill distributor for prescriptions because frankly, they are glorified pill counters.

Government interference

[BubbaJonBoy]

I worked for a company that had an EMR application. Meaningful Use and bICD10 and now ICD11 are killing them by requiring vast amounts of documentation for the Government. One doctor I know was spending 85% of his gross in overhead directly attributable to MU2.
So as usual Ayn Rand was dead on as to the reason businesses go tits up.

First order of business: Eliminate doctors

[Anonymous Coward]

I for one can't wait to see doctors replaced with doctors techs, more technical nurses. They will fight it but this is where we're going as AI will eliminate costly doctor mistakes and negligence and can do it in half the time.

Technology is bad becaise of.....

[al.mr.professor]

I had to put it in ellipsis because of the limit. But my comment subject means several things. First and foremost...I am on the medical professionals side with this. The problem starts at the THE TOP. Meaning the federal government. When I skimmed over the comments and one that mentioned about the ICD 9 and ICD codes not making sense. They are right. I downloaded them.. They are free for anyone to download. If you think writing writing programming code is crazy. But even moreso, there was another comment about and it was on the tip of my tongue, that is even more important than the ICD codes. Man! I wish I can remember what it was. Maybe I'll remember as I type my comments. I think it has to do with what I'm going to say. Now I remember!!! The next comment was someone made the comment about that having to do with having experience with Billing and that you had to have an A.A> in Billing or something to that effect. This goes to my main thoughts. The program the federal government came up with some years ago for Health Information Management. And of course where it involves HIPAA and all that other stuff. What came from that was a program to get persons to come into that field, mainly those from the medical field and secondly, those from the IT field. There are programs set up at 2 and 4 year colleges/universities where you can get either a certification and or an undergraduate and or graduate degree in Health Information Management or a variation of the like. That's all well in good. When looking for a job in the field..the problem is this. They are usually looking for a a nurse or a medical professional with a nursing skills and/or nursing background with the wit usually at least 5-10 years work experience, 5 at the least. But here's the kicker. They want all of that and at the same time, they want equivalent high level IT skills as well and the same time frame.IT skills they want...database programmer/developer/better than entry-level networking skills, better than entry-level desktop support, training/trainer, advanced server skills to even sometimes Linux. Can you all see where I'm going with this???? Unless that nurse was an IT person in another life, they WON'T have those skills, much less have those advanced skills. And it would take them years to amass those skills. So, imagine asking a physician to take that on to their daily tasks? I think it's easier if IT people where being "the scribe" . They could be the perfect people to teach the medical professionals the needed skills. It would be easier for an IT person to pickup the data entry skills because that basic Computer 101 stuff to us, the networking, the database, the programming...all that would be basic stuff to us. 3 of my doctors come in with laptops now when they see me, the rest, the rooms have workstations in them already. And yea, they spend their time now, at least the ones that have to, entering in data. And I feel so bad for them, because I have some very unique health issues and lots of medicine allergies. . And I have doctors that are spread out that are at 2 different hospitals where their systems are not compatible, as it appears. I wish all of my doctors were all at the same hospital, under one system. There was another comment I remember where someone talked about User Interfaces. (I'm paraphrasing) And that if the programmers shadowed the actual medical professionals to see how they worked with the actual data, then the UI and I would guess the programs as a whole would be designed much much better and be much more user-friendly and be more beneficial to them. That would make sense. That goes to another comment I remember reading someone say that the people who come up with the guidelines for the functionality for the technology that medical professionals use and the federal government IT guidelines dealing with heath information are not IT persons, or specifically database professionals. I agree 100% they are not. These are people with no IT tech experience at all. This keeps reminding me of that hearing about the Healthca

Technology is bad because of...

[al.mr.professor]

I had to put it in ellipsis because of the limit. But my comment subject means several things. First and foremost...I am on the medical professionals side with this. The problem starts at the THE TOP. Meaning the federal government. When I skimmed over the comments and one that mentioned about the ICD 9 and ICD codes not making sense. They are right. I downloaded them.. They are free for anyone to download. If you think writing writing programming code is crazy. But even moreso, there was another comment about and it was on the tip of my tongue, that is even more important than the ICD codes. Man! I wish I can remember what it was. Maybe I'll remember as I type my comments. I think it has to do with what I'm going to say. Now I remember!!! The next comment was someone made the comment about that having to do with having experience with Billing and that you had to have an A.A> in Billing or something to that effect. This goes to my main thoughts. The program the federal government came up with some years ago for Health Information Management. And of course where it involves HIPAA and all that other stuff. What came from that was a program to get persons to come into that field, mainly those from the medical field and secondly, those from the IT field. There are programs set up at 2 and 4 year colleges/universities where you can get either a certification and or an undergraduate and or graduate degree in Health Information Management or a variation of the like.

That's all well in good. When looking for a job in the field..the problem is this. They are usually looking for a a nurse or a medical professional with a nursing skills and/or nursing background with the wit usually at least 5-10 years work experience, 5 at the least. But here's the kicker. They want all of that and at the same time, they want equivalent high level IT skills as well and the same time frame.IT skills they want...database programmer/developer/better than entry-level networking skills, better than entry-level desktop support, training/trainer, advanced server skills to even sometimes Linux. Can you all see where I'm going with this???? Unless that nurse was an IT person in another life, they WON'T have those skills, much less have those advanced skills. And it would take them years to amass those skills. So, imagine asking a physician to take that on to their daily tasks? I think it's easier if IT people where being "the scribe" . They could be the perfect people to teach the medical professionals the needed skills. It would be easier for an IT person to pickup the data entry skills because that basic Computer 101 stuff to us, the networking, the database, the programming...all that would be basic stuff to us. 3 of my doctors come in with laptops now when they see me, the rest, the rooms have workstations in them already. And yea, they spend their time now, at least the ones that have to, entering in data. And I feel so bad for them, because I have some very unique health issues and lots of medicine allergies. . And I have doctors that are spread out that are at 2 different hospitals where their systems are not compatible, as it appears. I wish all of my doctors were all at the same hospital, under one system. There was another comment I remember where someone talked about User Interfaces. (I'm paraphrasing) And that if the programmers shadowed the actual medical professionals to see how they worked with the actual data, then the UI and I would guess the programs as a whole would be designed much much better and be much more user-friendly and be more beneficial to them. That would make sense. That goes to another comment I remember reading someone say that the people who come up with the guidelines for the functionality for the technology that medical professionals use and the federal government IT guidelines dealing with heath information are not IT persons, or specifically database professionals. I agree 100% they are not. These are people with no IT tech experience at all. This keeps reminding me of that hearing about the Health

Medical Record keeping

[PlaynBass]

My impressions: 1) As long as healthcare is monetized for profit, only the wealthy, the insured, or those on Medicare will get good access to healthcare. The politicians have rigged the system so that the primary concern is billable procedures, not favorable outcomes, and the various insurance companies have been given the power to determine how much healthcare may be dispensed. 2) Record keeping is an essential and critical element in providing continuing healthcare. The information routinely "charted" falls into easily recognizable patterns, and if the healthcare providers were not so concerned with their profits (gleaned from the misfortunes of their fellow human beings), they would be able to institute a universal charting system that begins in medical and nursing school and is a core feature of a robust healthcare system. Access to the information collected should belong to and be controlled by the patient: NOT the doctors, hospitals, insurance companies, or the government. We have the technology to store this information in encrypted personal record accounts that are established when a child is born. Is such records are permanently linked to the individual, these records could be stored (or backed up) on secure cloud servers, while the patient would approve access, perhaps by assigning a public/private key as a part of the check-in process. I find it unfathomable that untrained patients are required to recite their complete and complex medical histories to every new doctor they need to consult, when that information should already be available: this is hubris, not good medicine. 3) The human race seems to be hell-bent on profiteering its way to oblivion, due to the adoption of the religion of capitalism and the misinformed and incomplete theories of Adam Smith, and those who followed him. The fact is that an economy based on continual growth is impossible to maintain on a finite planet, and in reality is a vast Ponzi scheme in which the .01% win and everyone else must fight over the scraps. It is also totally unnecessary and incompatible for human survival, since it leads to decisions based not on practical outcomes, but merely who can amass the most "beans"! As for the medical profession, any doctor that refuses treatment based on the ability to pay is violating his Hippocratic oath to do no harm. 4) The inability of most humans to see past personal profits to release the potential for every person on the planet to be able to live a comfortable and secure life is the hubris that will cause us to over-consume every resource until we become yet another extinct species of life on a planet that could have been a paradise for everyone. 5) I don't think the planet will miss us at all.

Re: Technology Is Making Doctors Feel Like Glorifi

[slashdotwannabe]

Your reasoning makes the assumption that improvements in medical treatment and life expectancy would not have occurred without the medical establishment, which of course is false.

You seem to have forgotten your citations and/or evidence here.

Re: Technology Is Making Doctors Feel Like Glorifi

[Anonymous Coward]

you seem to have your head up your ass

do you need a citation and reference to take a shit also?