Monday, December 30, 2013

Meaningless Disuse!

Guest blogger Dr. Donald Kamens, MD FACEP gives his take on Meaningful Use and where we are today.

It seems that Uncle Sam, healthcare, and technology mix about as well as oil and water; maybe worse.  The problem is not only the ObamaCare tech debacle, actually. Ever since 2004, when the government thought it had to protect its interests (read Medicare) by assuring that data acquired in health care delivery was accessible, parse-able, and otherwise capable of supporting arguments to decrease reimbursement, it has tried to become a techie agency.  And O, how it has tried. 

At first there was a fledgling effort to create an office in DC to oversee healthcare IT, the ONC (Office of the National Coordinator).  In the near-decade since its instatement, there have been five (5) chiefs, only one of whom lasted for a full two years.  There is currently an acting chief, and likely, he can’t wait to get out of there either.

In its beginning the budget numbers were in the neighborhood of about $24M (thirteenth letter of the alphabet).  Since the advent of incentive programs based on the demonstration by vendors of EHR products of Meaningful Use, the bill is more like $70B+ (that’s the 2nd letter of the alphabet).  What gives?

It is the result of an extreme paranoia.  Clearly a total mental distortion that says:  “if we don’t know what is going on (in there), then we cannot come down on them enough to cut payments.” “So, we gotta know.” “And because we gotta know, we have to bribe the physician population to use devices to record what is going on.” $70B+ is a pretty big bribe.

What baloney.  Recording of medical record information has its historical basis on two needs:  to remind the physician what was done, last time; and to inform anyone covering in case the patient shows up unexpectedly.  Well….you give ‘em an inch…..and what happens… the legal world gets in on it and begins to use these notes to claim malpractice.  And then the insurance companies get in on the deal to determine what the will refuse to pay.

It’s just not needed.  Most all medical encounters can be summarized in just a few words.  If a study is being done on some clinical entity, then a bit more data would surely be of value.  But really, does anyone need 13 pages for an ED visit?  Or 8 for an urgent care stop? 

It’s time to get rid of this Meaningless Disuse program, and its huge expenditures that could otherwise fund significant helpful programs, and perhaps institute a Meaningful Pen/Tablet program. Or even a Meaningful Interface program that works like an ATM, or even as well as iTunes.  Give each doctor a new pen, or an iPad, and let him keep it if he can fill out an accurate chart, or template, in under 2 minutes.

Many physicians like EHRs; most don’t.  Those on the “no” side usually recognize MU is a severe piece of government overkill, that is doing few people any good, while creating long waits in many places as the staff struggles with machines.  

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