27 March 2018

You Would Know This If You Talked to Doctors

It appears that at least SOME of the mainstream media are beginning to notice that electronic health records are neither saving money nor improving the quality of health care:
We trust computer technology to solve problems, save time and money, and improve our lives. It has. Why didn’t it work with electronic health records?

EHRs are costly, clunky, error prone failures we seem unable to fix. It’s as if we took off in a hastily designed rocket, realize we need to come back, but are stuck in orbit without a reentry plan.

The Obama administration set aside tens of billions in 2009 to forcibly drag doctors and hospitals out of the Stone Age of paper into the brave new world of bites and bits. It promised a Nirvana of heath care quality, efficiency and cost savings. Hundreds of billions more were spent by hospital systems, too, under government mandates. In retrospect much of that money was wasted.

……… Snipping the example of automated check in at the airport.

Assuming [airline] employees get $30 an hour, that’s $1,500 saved for each and every flight. With hundreds of flights from each airport that’s big money. Employees cost a lot ongoing. Touch screens work for years on one investment. We, passengers, were the happy, healthy — and unpaid — labor that made it possible. The airline’s question had been, “How can computers save money and employee time on passenger check-in?” It got the right answer by asking the right question.

In medicine, the customer is the patient, not the passenger. If we could get patients to check into the medical office, hospital or emergency room, go to a touch screen, populate the computer screens with their correct diagnosis, order their tests and imaging and prescribe their own treatments that would be peachy, but unlike passengers, patients can’t do that on their best days. There is almost nothing in medicine that can be done, ordered or documented by the patient/customer. Doctors and nurses do all that.

Before the EHR, I dictated hospital admission histories on a phone and a typist getting $30 an hour typed them. I do that on an EHR now and it’s slower. It takes me triple the time it used to. There is a complex template used, not much like the way I think about care.

Similarly, I used to hand write orders and give them to a clerk. It took but a few minutes. Entering it all by computer is complex. The EHR does not allow me to just write what I want. It offers drop downs, many suggestions, and reminders, and pages of choices to click and to select options, not to mention all the time taken to just get in and out of the triple layer of security built into every such program. That alone takes more time than handwritten orders used to take.

So in the hospital I have become a very highly paid clerk. It is as if Qantas required the pilot to do the data entry for billing and boarding of each passenger. Insane, you say? But that’s exactly what current EHRs do in medicine.
This does not just happen with medicine.


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