Follow the Money
Sometimes comedies are really tragedies.
The Electronic Health Record has become required by government fiat. It has promised much – better care, better health, lower costs. About $24 billion in subsidies have been spent, with total costs in untold billions. The end result – a colossal boondoggle proving – beyond the shadow of a doubt – that health is not the end product of American medical care. Your health – physical, mental, social and spiritual – doesn’t have a chance against protected monopolistic profits.
Other countries don’t have this problem – go to Sweden, Britain, Norway. Electronic health records allow for rapid dissemination of information; national public health indices; cheap clinical trials; and the increased ability of administrators to figure out what works and what does not.
But those are also countries with far better health statistics than us – and with medical care that costs vastly less. Better results for far less money – who would ever want to copy that?
The answer – us. And we better do it soon.
So here are just a few issues that the highly regulated yet unregulated IT Health Industry has created:
1. Privacy. Worried about your nude photos appearing everywhere on Facebook? Perhaps you don’t have nude photos.
What about your medical records?
One NYU professor reckons 10-12 million Americans will have access to your medical records. If you’re selling your business and your buyers want to know your private medical story, how hard will your records be to obtain?
Given the poor functionality of many of these IT systems you should not feel very comfortable. When cybersecurity firms try to track these cases, they often find they can’t.
We’re “sorry everyone knows your business – but that’s the way it is.” Just like the banks, where it was acknowledged 83 million households were recently hacked. Without clear, convincing criminal penalties – and a lot of work and effort by law enforcement – your medical records will not be close to private.
2. Functionality. Few people know about physician revolts.
They don’t make the nightly news.
One hospital I know in New England had to shut down its electronic health record program. It did not want to. It happened because the physicians and nurses refused to use it any longer.
They were spending two to three hours each night “inputting data” – getting their records into required formats. The work was on their own time. And the data entry did not work.
To treat congestive heart failure you need to know someone’s weight. Except that item did not appear in the electronic health record.
Nor could you put it there.
There are many other examples of EHRs impeding care. Physicians as a group are trained – through an educational program that includes many, many opportunities for public humiliation – to complete tasks however onerous. Lots of docs tell me they spend – in “well functioning” medical record systems – an extra hour to two each day “working” the record. It is often the biggest item on their minds, just beyond the immediate worry of what to do for the patient in front of them.
Medical records are so onerous in their demands that the new job of “scribe” (think – ancient Egypt,] someone who goes around with physicians primarily to get their records right and navigate the ordering system – is considered a new “breakthrough” in care. Medical record absurdity – including generating 16 page insurance friedly reports for short visits – has led to doctors hiring more PAs and nurses to handle the astounding paperwork and frustration. The result – patients have less and less “face time” with doctors.
It is also leading more physicians 50 and older to rapidly leave the profession. Many plan to pull out just before the requirement of ICD-10, already postponed, is brought forth in 2015, with its approximately 140,000 diagnostic codes, including diagnoses like water skiing burn injuries and nine forms of parrot attacks. Get them wrong and your Electronic Health Record will lock up – and you won’t get paid.
3. Communication. The industry term is “interoperability.” In English this means you can send records around from place to place – perhaps the main selling point of EHR when first proposed.
How many American systems presently accomplish this? According to the NY Times – 14%.
Just as entrepreneur Peter Thiel predicted, the real way to profits in IT is through monopolies. So instead of making your records available to other “competing” systems, just put up huge silos and turn communicating records into a “profit center.” Many of the “big operators” do exactly that.
In other words, they make impossible or charge through the nose for something that should be built into the system’s basic foundation without cost. What, allow our “rivals” to see “our” precious medical records?
If Google or Apple can obtain, process and send all that information on you seamlessly, why can’t health records? Why can’t physicians transmit their records across town to another hospital?
Becomes someone is making money on keeping it locked up. Which in medical emergencies, is less of a scandal and more of a national crime.
The government has set up a task force to try and fix the problem. They hope to have it solved – sometime in the next ten years. Given lobbying and its effect on the best government money can buy, plus the many major corporations making billions on this mess, we can quote Robin Williams:
“Good Morning, Vietnam.”
4. Inaccuracy. Do you think your medical records are true?
One internist’s family got a call from the Health Department. They were tracking his Medicare age wife for her newly diagnosed gonorrhea.
She did not have gonorrhea. Despite the fact that its transmission in this case was actually impossible, the health record on a routine surgical procedure declared she was infected with gonorrhea. And that was that.
As the physician’s wife was also allergic to the main treatments of gonorrhea, he particularly wished it stricken from her record. The first response of the doctor representing the hospital records committee was to threaten his hospital privileges.
Next up, he was told for $15-25,000, maybe more, he might be able to hire someone to strike it from the electronic record. However, it turned out the result was already “in the system” with servers that “could not be reached.”
Could you put out a general statement that the record was inaccurate? Ah, that was “difficult.”
Much of what appears on the Net is false. So will be parts of your medical records.
The Way Out
This farce does not need to continue. The Health Care “Industry” loves to talk about best practices.
Let’s fox them for a change and actually demand it:
Create a consortium from a great underused national resource – our Public Health Schools. Give the consortium $100 million in government money to create two to three non profit companies that will use EHRs based on and perhaps licensed from civilized countries that have worked cheaply and effectively for decades. Have those non-profits compete with our silo creating IT companies – but only after giving them 5 year Medicare contracts that will keep them alive through the start up phase.
The promise of national records that are cheap, accurate, easy to use and private, and that allows decision makers to figure out what of the nearly $3 trillion we spend every year on medical care is actually worthwhile – that promise remains. Now it’s time to make that promise real.
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