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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.
might as well "doctor to the data"
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.
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.
"How to Do Nothing," kids activities, back in print!
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...
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.
I know when we go to the pediatrician for a fever, it takes 5 minutes for them to find the code for tylenol.
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.
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.
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.
Mod me down with all of your hatred and your journey towards the dark side will be complete!
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).
Chaos - everything, everywhere, everywhen
Slashdot: News for Americans. Stuff that matters to Americans.
Not everyone operates on a medical system like the weird one in the US....
Hourglass says she knows a kid in Iowa who grows up to be president.
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? $300. Time for me? 20 minutes, plus travel time/making the pile. Time for him? Probably 22 minutes.
I go to my doc (copay) and wait 20-30 minutes. He asks questions, I answer (10 minutes). Odds are, I get sent to a specialist (copay). I wait for the Specialist (20-30 minutes). Specialist orders tests (20 minutes + copays). Back to specialist (30 minutes + copay). Get a prescription, fill it (10 minutes + copay), it may or may not solve the problem. If not go to 1.
Difference? My tax guy doesn't have to answer to insurance companies, nor buy malpractice insurance. My tax guy doesn't have a good 6 feet shelf space of regulations.
Now I realize my tax guy farking up is much less serious than my doc farking up. Still, the crap doctors have to keep track of/order tests for/ just to avoid a lawsuit is mind boggling.
My hospital does this for handwritten progress notes in charts. It's nice. Especially in anesthesia, which has an elegant (if densely-packed) system of record keeping. For years after the VA put everything in a flat-text note syste, their anesthesia records were done on paper and stored as images.
If you want to get a visceral appreciation for the complexity of medical billing today, check out the Medicare Claims Processing Manual.
It almost seems like you can't merely get an administrative assistant, but you need someone with an A.A. in medical billing.
The thing that really left me aghast was the move from ICD 9 to ICD 10 (diagnosis codes and descriptions). Those #$&!!?! 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.
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.
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
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
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.
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 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.
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.
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.
Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
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.
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?
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
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?
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.
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.
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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?
For an actual solution to the medical mess, and not just another screaming person towing a standard party line: http://sti2.blogspot.com/2013/...
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.
Linux, you magnificent bastard, I read the fucking manual!
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.
It's 18% because health is a side benefit of an insurance system.
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.)"
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.
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?
>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.
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."
Table-ized A.I.
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.
"It's such a fine line between stupid and clever" -- David St. Hubbins, Spinal Tap
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.
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.
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.
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.
If something is so important that you feel the need to post it on the internet... It probably isn't that important.
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.
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.
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.
I'm too lazy to compose a creative sig.
My health record can be accessed from any clinic or hospital in the country, quickly and easily.
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.
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?
"Consensus" in science is _always_ a political construct.
The Doctor is a Time Lord and thus can read it far faster than any human.
This posting is provided 'AS IS' without warranty of any kind, implied or otherwise.
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.
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.
I am not a sig.
http://www.nature.com/scitable...
I'll stick with the medical abomination for now.
"Whenever people agree with me I always feel I must be wrong." (Oscar Wilde)
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.
It is not the doing of things that is difficult. What is difficult is getting in the right mood to do them. ~~ Brancusi
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 ....
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.
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.
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.
-- Stu
/. ID under 2,000. I feel old now.
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.
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.
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?
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.
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.
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.
"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.
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.
Linux, you magnificent bastard, I read the fucking manual!
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...
He can when he's your GP and he's already familiar with your medical history.
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.
Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
So apparently we need to quit being chumps and socialize to spread those costs more fairly.
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.
The cheese stands alone...
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
"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.
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.
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.
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.
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
Use way as no way; Use limitation as no limitation
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
Use way as no way; Use limitation as no limitation
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.
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.
PlaynBass
You seem to have forgotten your citations and/or evidence here.
This comment is my opinion and does not represent an official position of Donald Trump or others I do not work for