6 ms·

What are the specific requirements? Perhaps there's another way to reduce costs.

by jdc 7y ago

beerandt 7y ago
Sustaining the infrastructure and support to maintain electronic medical records is probably the biggest. There are so many problems with the current systems that it's hard to know where to start. But related to the context of the article: You can't spread that cost out as a stand alone doctor practicing on rural areas. On top of this is added cost of data entry compared to old paper charts, the cost of training staff to be able to do it efficiently, and the extra time it takes doctors to keep notes and sign-off on electronic charts. Check out some of the recent articles on physician burn-out, especially in emergency medicine, family practice, and general practice. Doctors are deciding it's not worth the hassle, financially or psychologically. Edit: a couple of recent related articles on the topic: https://blogs.scientificamerican.com/observations/electronic-health-records-and-doctor-burnout/ https://blogs.scientificamerican.com/observations/electronic... https://fortune.com/longform/medical-records/amp/ https://fortune.com/longform/medical-records/amp/
- perl4ever 7y ago
  If computerizing a business makes it more expensive and labor intensive, someone's doing something wrong.
  - beerandt 7y ago
    Agreed... Yet that's what's happening nationwide. The electronic systems aren't simply recording what the doctor does and making a record of it, as charting is supposed to accomplish. The software is dictating (or at least heavily influencing) the behavior and workflow of the doctor. And anytime something is done out of order results in interrupting that workflow, searching through 10 other screens to find the appropriate checkbox, and then trying to return to your train of thought. The focus ends up being on the data entry instead of the patient. This is amplified the less specialized the practice is, hence emergency medicine, family practice, and general practice being the most affected. And rural doctors being affected the most since: 1) they generally are expected to handle whatever gets thrown at them since there are no specialists around and 2) they have the smallest practices (can't share costs with other doctors). Opting out of the system essentially means going cash only, which obviously limits your patients, among other drawbacks. Which leaves burn-out and early retirement or joining a bigger practice in the city. Or concierge medicine, which is one reason why it's becoming more popular.
    - perl4ever 7y ago
      I applied for a few jobs at places that did things like practice management software over the years, e.g. athenahealth but never worked in the industry, so I don't have any insight on what it's like on the inside. But I assume there are systemic reasons. It's easy to say concierge medicine, but I'm not clear on why that should work, if funneling the same amount of money every month through an insurance company doesn't. What is the difference, other than the marketing terminology?
      - beerandt 7y ago
        Edited: Easy... They don't take insurance. They're typically cash only, which allows them freedom to do things like charge for house calls. Or they have contracts directly with employers to do checkups and on-demand visits onsite. Employers that are either big enough -or financially successful enough- to be self insured are essentially paying cash for office visits and most covered services anyway. (Many companies that are ~200+ employees self insure, but still pay an insurance company just to manage it all. An in house or concierge doctor on contract might cut out enough paperwork to get rid of the middleman.) I've also seen some setup as prepaid membership operations. But the common denominator is they cut out insurance and medicare/medicaid, which cuts out 90% of the regulations... Including electronic medical records.
        perl4ever 7y ago
        I was only aware of them being a thing in the DC area, and not being mutually exclusive of insurance. Anyway, if the loss ratio of an insurance company is more than 85% by law, it seems like you can gain only so much by bypassing them. And why would you want to eliminate medical records?
        beerandt 7y ago
        I shouldn't say they're 100% mutually exclusive, but they tend to be for most routine services. They're probably still going to file a catastrophic claim if they find cancer, etc... >it seems like you can gain only so much by bypassing them. You do, but self-insuring on it's own saves a big chunk, so what's left is really just the complicated paperwork. The only reason it exists is to complicate insurance dictated rate structures, so get rid of the complicated rate structures for the 80-90% most common visits by contracting a doctor directly and there just isn't the need to pay someone else to manage it anymore. Then the real gain is paying the doctor based on a simplified negotiated rate, and in return he gets a whole company of regular patients, and can send just one summarized bill to the company for everyone he sees in a week. Not having to file any additional billing paperwork per patient is just a happy side-effect, for both the doctor, the patients, and the sponsoring company. >And why would you want to eliminate medical records? It's not to eliminate medical records, it's just a matter not being forced to do them in a certain way. I think most doctors would have loved to start by scanning paper charts at the end of the day, then let some data people convert that into something the computer understands. But the way it's setup (and mandated), the database is the official record (not the attached notes) so it all has to be done personally by the doctor, or signed-off by the doctor if a nurse or mid-level or medtech enters anything. They basically make the doctors responsible for data entry QAQC, with their malpractice insurance at risk for a screw up. Doctors are used to mostly freeform notes with a few fill-in-the-blanks and check boxes for orders or standardized info like heart rate, bp, etc. Most software tries to cram 99% of this into a mess of a structured relational database. These also have freeform typing boxes for notes, but getting paid depends on duplicating most of the note information across a huge range of screens and tables so that the billing software understands what was done, and understands it in such a way that is covered by the patient's provider. They are probably a 6-digit number of ways to code for giving the patient aspirin, but half might not be covered, and the other half might range in price from free to thousands of dollars of copay. And this changes with every different insurance policy, and every different doctors office/hospital system, (depending on negotiated rates with insurance) so that even the most expert billing tech might not know the correct way to bill a particular patient the first time. And oh, if they need to change it later to get insurance to cover it, the doctor usually has to sign-off on it again as if he performed a different exam than was recorded the first time. It's a lot easier to just scratch down on paper (or in a computer) "gave patient exam and aspirin, bill for a level 2 and rx" or something similar, and then your receptionist knows what to collect or bill. All of a sudden you don't need a staff of billing techs on the phone with insurance companies all day, or a software support contract that your billing depends on. Now imagine getting all the doctors approaching retirement and working in small practices that switching is worth the expense and hassle. So it's not being against medical records, but the freedom to do them as you see fit, while avoiding the hassle of compliance. And one of the few remaining ways to do that is go for the market that can pay cash, which overlaps nicely with both the concierge market and self-insured employers. (and some niche co-op style wellness "clubs", but I'm not familiar)
  - jdc 7y ago
    I'm just going to leave this link here.. in case anyone else is curious about what it takes to get EMR software certified in the US. https://www.healthit.gov/topic/certification-ehrs/certification-health-it https://www.healthit.gov/topic/certification-ehrs/certificat...

What are the specific requirements? Perhaps there's another way to reduce costs.

by jdc 7y ago

What are the specific requirements? Perhaps there's another way to reduce costs.

Sustaining the infrastructure and support to maintain electronic medical records is probably the biggest. There are so many problems with the current systems that it's hard to know where to start. But related to the context of the article: You can't spread that cost out as a stand alone doctor practicing on rural areas. On top of this is added cost of data entry compared to old paper charts, the cost of training staff to be able to do it efficiently, and the extra time it takes doctors to keep notes and sign-off on electronic charts. Check out some of the recent articles on physician burn-out, especially in emergency medicine, family practice, and general practice. Doctors are deciding it's not worth the hassle, financially or psychologically. Edit: a couple of recent related articles on the topic: https://blogs.scientificamerican.com/observations/electronic-health-records-and-doctor-burnout/ https://blogs.scientificamerican.com/observations/electronic... https://fortune.com/longform/medical-records/amp/ https://fortune.com/longform/medical-records/amp/

perl4ever 7y ago
If computerizing a business makes it more expensive and labor intensive, someone's doing something wrong.
- beerandt 7y ago
  Agreed... Yet that's what's happening nationwide. The electronic systems aren't simply recording what the doctor does and making a record of it, as charting is supposed to accomplish. The software is dictating (or at least heavily influencing) the behavior and workflow of the doctor. And anytime something is done out of order results in interrupting that workflow, searching through 10 other screens to find the appropriate checkbox, and then trying to return to your train of thought. The focus ends up being on the data entry instead of the patient. This is amplified the less specialized the practice is, hence emergency medicine, family practice, and general practice being the most affected. And rural doctors being affected the most since: 1) they generally are expected to handle whatever gets thrown at them since there are no specialists around and 2) they have the smallest practices (can't share costs with other doctors). Opting out of the system essentially means going cash only, which obviously limits your patients, among other drawbacks. Which leaves burn-out and early retirement or joining a bigger practice in the city. Or concierge medicine, which is one reason why it's becoming more popular.
  - perl4ever 7y ago
    I applied for a few jobs at places that did things like practice management software over the years, e.g. athenahealth but never worked in the industry, so I don't have any insight on what it's like on the inside. But I assume there are systemic reasons. It's easy to say concierge medicine, but I'm not clear on why that should work, if funneling the same amount of money every month through an insurance company doesn't. What is the difference, other than the marketing terminology?
    - beerandt 7y ago
      Edited: Easy... They don't take insurance. They're typically cash only, which allows them freedom to do things like charge for house calls. Or they have contracts directly with employers to do checkups and on-demand visits onsite. Employers that are either big enough -or financially successful enough- to be self insured are essentially paying cash for office visits and most covered services anyway. (Many companies that are ~200+ employees self insure, but still pay an insurance company just to manage it all. An in house or concierge doctor on contract might cut out enough paperwork to get rid of the middleman.) I've also seen some setup as prepaid membership operations. But the common denominator is they cut out insurance and medicare/medicaid, which cuts out 90% of the regulations... Including electronic medical records.
      - perl4ever 7y ago
        I was only aware of them being a thing in the DC area, and not being mutually exclusive of insurance. Anyway, if the loss ratio of an insurance company is more than 85% by law, it seems like you can gain only so much by bypassing them. And why would you want to eliminate medical records?
        beerandt 7y ago
        I shouldn't say they're 100% mutually exclusive, but they tend to be for most routine services. They're probably still going to file a catastrophic claim if they find cancer, etc... >it seems like you can gain only so much by bypassing them. You do, but self-insuring on it's own saves a big chunk, so what's left is really just the complicated paperwork. The only reason it exists is to complicate insurance dictated rate structures, so get rid of the complicated rate structures for the 80-90% most common visits by contracting a doctor directly and there just isn't the need to pay someone else to manage it anymore. Then the real gain is paying the doctor based on a simplified negotiated rate, and in return he gets a whole company of regular patients, and can send just one summarized bill to the company for everyone he sees in a week. Not having to file any additional billing paperwork per patient is just a happy side-effect, for both the doctor, the patients, and the sponsoring company. >And why would you want to eliminate medical records? It's not to eliminate medical records, it's just a matter not being forced to do them in a certain way. I think most doctors would have loved to start by scanning paper charts at the end of the day, then let some data people convert that into something the computer understands. But the way it's setup (and mandated), the database is the official record (not the attached notes) so it all has to be done personally by the doctor, or signed-off by the doctor if a nurse or mid-level or medtech enters anything. They basically make the doctors responsible for data entry QAQC, with their malpractice insurance at risk for a screw up. Doctors are used to mostly freeform notes with a few fill-in-the-blanks and check boxes for orders or standardized info like heart rate, bp, etc. Most software tries to cram 99% of this into a mess of a structured relational database. These also have freeform typing boxes for notes, but getting paid depends on duplicating most of the note information across a huge range of screens and tables so that the billing software understands what was done, and understands it in such a way that is covered by the patient's provider. They are probably a 6-digit number of ways to code for giving the patient aspirin, but half might not be covered, and the other half might range in price from free to thousands of dollars of copay. And this changes with every different insurance policy, and every different doctors office/hospital system, (depending on negotiated rates with insurance) so that even the most expert billing tech might not know the correct way to bill a particular patient the first time. And oh, if they need to change it later to get insurance to cover it, the doctor usually has to sign-off on it again as if he performed a different exam than was recorded the first time. It's a lot easier to just scratch down on paper (or in a computer) "gave patient exam and aspirin, bill for a level 2 and rx" or something similar, and then your receptionist knows what to collect or bill. All of a sudden you don't need a staff of billing techs on the phone with insurance companies all day, or a software support contract that your billing depends on. Now imagine getting all the doctors approaching retirement and working in small practices that switching is worth the expense and hassle. So it's not being against medical records, but the freedom to do them as you see fit, while avoiding the hassle of compliance. And one of the few remaining ways to do that is go for the market that can pay cash, which overlaps nicely with both the concierge market and self-insured employers. (and some niche co-op style wellness "clubs", but I'm not familiar)
- jdc 7y ago
  I'm just going to leave this link here.. in case anyone else is curious about what it takes to get EMR software certified in the US. https://www.healthit.gov/topic/certification-ehrs/certification-health-it https://www.healthit.gov/topic/certification-ehrs/certificat...