Wednesday, January 23, 2013

Obamacare begins to show its true ugliness

Dr. Whitecoat, who works in a hospital emergency room, points out the extraordinary administrative complexities of computerized health care records, now mandated under Obamacare.  Here's an excerpt.

I set out to log the clicks and screens. The first few times I tried, I wasn’t able to do it. Finally, when it wasn’t so busy, I made a conscious effort to stop on every screen and mark down clicks and screens. I use some basic templates, so the amount of clicking that I do is actually less than someone who doesn’t use templates.

For a patient with an upper respiratory infection (i.e. a cough) and no labs, the total number of clicks was 37 and the total number of screens I had to navigate was 17. I also had to enter my system ID and password twice. All these screens and clicks were in addition to all of the information I had to enter by typing.

For a patient with a wrist fracture who needed medications and a splint, I clicked on 52 different variables and had to navigate 41 screens – in addition to the information I typed. On this patient, I had to enter my system ID and password four times. Many of the screens that popped up contributed to alert fatigue, asking me why I was ordering Norco on someone who already uses Norco and forcing me to acknowledge the duplicate medication order and then explain why I was doing it (because the patient hadn’t used the Norco in 3 months and didn’t have any more). I was not allowed to proceed with the patient care until I answered the questions.

The final patient I attempted to log clicks and screens on was a patient with chest pain. I was able to keep things going up until the time the patient was ready to be admitted. Then I had to quit the logging as it was taking too long and a bunch of new patients showed up. Just entering the history, the exam, and the orders amounted to 62 clicks and 27 screens plus 2 episodes of ID/password entry. Admission order entry and result entry were significantly more clicks and screens.

Next time that you wonder why your doctor or nurse always seems to be on the computer, chances are that it isn’t because they’re checking Facebook.

Think about how long it would take you to navigate to 41 different web sites and enter information on each one before being able to complete your work. Oh, and if you accidentally enter incorrect information on any one of the 41 web sites, you could be subject to a federal investigation for overbilling, have to pay for an attorney to defend you, and could be sued for triple damages. That’s what we go through with just about every patient we see.

Makes you happy that the government is pushing all medical providers into electronic medical records, doesn’t it? I know I feel safe realizing that my medical providers spend more time entering information on their computers than they do providing me with medical care.

There's more at the link.

Dr. Whitecoat links to an article by Mickey Kaus, which goes into further detail about such administrative overhead under Obamacare.  A third article claims that 'Obamacare Increases Unnecessary Medical Tests, Wastes Doctors’ Time, Drives Up Billings And Costs'. It's no wonder my own physician told me recently that if Obamacare remains in effect, by the end of the President's second term he'll either be bankrupt, or have left the practice of medicine in disgust!

This, ladies and gentlemen, is the act about which Nancy Pelosi notoriously said, "But we have to pass the bill so you can find out what is in it".  Now that we know what's in it, Ms. Pelosi, would you please take the damn thing back and junk it?



Erik said...

To be somewhat fair, this is not a problem of using computerized records, but of how those records are implemented in a system.

It's pretty common in computer systems, a lot of people designing them come from a technical perspective and wants all kinds of features and security, and dont think twice about the user interface, or how it will be to use it in daily life.

And considering the fact that this system was probably designed by a company that had contacts in high places, so they got awarded the contract to do it, the chance that they didn't consider the users point of view is almost a certainty.

I believe that computerized records, when implemented correctly, could be a huge time saver. Think of something like a surfpad, with a touchscreen interface that's logical from the doctors perspective, and (s)he can quickly scroll through it to fill in the most important info, and then get a summarized screen where he can fill in any questions he missed.

The trick with such an interface is to actually go to the users first and ask them "how do you want a system like this to work", something way too many of the system designers dont bother doing.

Especially not when the doctors aren't the ones paying for the system, the government is. And the government really aren't interested in a user friendly system, they want a system that collects lots of information.

RJIII said...

You're right but there's something
to remember.

"I believe that computerized records, when implemented correctly,"+Gooberment= Ain't happenin'.

Stuart Garfath said...

Look behind, 'it's coming your way!.

bmq215 said...

Having had old paper records "lost" too many times to count I'm all for computerized records. I'm sure there will still be mistakes but the ease of transferring, backing up, and locating them seems likely to be an improvement. Maybe if this had been around years ago I wouldn't have had to redo all of my immunizations not once, but TWICE.

Erik is right, whether or not you agree with the regulation, a poorly designed system is not the regulatory agency's fault. Someone needs to talk to the users and redesign this thing from the bottom up. I hate to say it (because they scare me more and more) but I bet Google would do a good job of it.

Anonymous said...

". . . a poorly designed system is not the regulatory agency's fault."

Sorry, but I believe that's exactly backwards. This hasn't been done with health care in mind. It is designed from the ground up for the benefit of government agencies so they can control ALL of what goes on. Any benefit to doctors and patients is secondary.


Anonymous said...

Here's the thing--while Bush was still in office the last stimulus bill he passed and then handed to BO had a small change hidden in the paperwork. It gave the government the right to implement its new record keeping system called Athena. Now the Doctors have to utilize the government system. This also gives the government access and insight into who is costing them what amount of funds for obamacare. The doctors are doctors, not transcriptionists. The government now has access to everyone's healthcare information. Wake up. We are in serious trouble. If you have ever been to any sort of counseling, you will have your gun rights either terminated or questioned beyond your ability to stand the scrutiny. If you have ever had an antidepressant you will be in jeopardy of adopting or owning a gun. If you are costing them too much money you will eventually be denied the care you need because you are or will be a casualty of the system. LOOK it UP! ATHENA--(along with a second program that eludes my by name for the moment). You are in a big fat rabbit trap and they are getting ready to jerk that string. Heck just for fun, look up the greek goddess athena and see what all she is famous for. Even that will tell you something about how she wins her battles through knowledge and not war....

Anonymous said...

My own doctor told me that consultants he hired told him he would be out of business - bankrupt - within a year.

Failure is not an option; it's standard equipment. It was designed that way.

SiliconGraybeard @ work

perlhaqr said...

Crappy electronic records systems for hospitals have been happening a lot longer than Obamacare has been around. Hell, I worked on one back in early 2001.

Yes, the systems suck, but it's not government mandated suckage. (For once.)

bmq215 said...

Anonymous, can you provide any links with information about how doctors are forced to use Athena? I've never heard of this and can't seem to find any information. In fact, all that I can find about Athena is that it's a relatively small company used by ~17,000 physicians (there were about 850,000 practicing physicians in the US in 2011).The CEO is Bush's cousin but I can't uncover anything about a legal mandate to use it.

Goatroper, if the gov specified a certain system then I would totally agree. However, as I understand the law they're only required to keep some sort of electronic record. The choice of system and software are up to the organization. As a capitalist I would tend to think that this would lead to more physician-friendly systems in the long run, as well as stimulate innovations in medical IT.

Anonymous said...

I'm a firefighter in one of the 10 biggest fire depts in California. Recently we went to electronic EMS forms and mobile computers on calls.
We're a 3-person company. If my medic firefighter is busy working, my engineer is busy helping, and I'm stuck tapping away at the computer. 33% of our effectiveness gone. If I drop the computer and get hands-on, now I'm in trouble for not documenting the call...

Erik said...

The other posters are correct.

It's very unlikely that a Government organisation will implement a useful system, simply due to who is paying for it. The person ordering it will be some beurocrat that has hardly ever set foot in a hospital, and he will order it from a big company with lots of government contacts, and very likely owned by someone with friends in high places.

A company like that will be more interested in racking up expenses to make as much profit as possible, than to design a good system. In the business, it's jokingly referred to as a "consultant friendly system" as opposed to user friendly.

They want it complex so it takes time to write it, lots of bugs so it takes time to implement it, and complicated so it cant be fixed by anyone, it has to be done by them.
If it's really hard to use, they can also sell instructions in how to use it, which is even more revenue.

Yes, if the law allows for it (I dont know what the US law says) then technically other hospitals can buy other and better systems.

However, that means that they will be under immense pressure from the big hospitals and government oversight to use the same system as the big places use. They have to carry the development cost themselves, and they will have to work around the problem of transferring records.
The big systems will simply not allow transfer of records to or from other systems, or if they are forced to do so they will make it as hard and difficult as possible. For instance by changed the record format frequently and force other programs to keep up.

For most smaller companies/hospitals, it's simply easier to go along with the big bad system than to try and go your own way.

Firehand said...

Have a friend, nurse, who works in recovery, and she's been raising hell about this(along with everyone else who actually has to use it).

It's slow, intrusive, and getting it done takes a LOT of time away from that apparently unimportant task of dealing with the patient. But hey, it makes the .gov happy.