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As a person that used to be a “human scribe” but for emergency dept doctors. I would say the ER doctors shared the same experience as the one depicted in the ne
by xyst 3y ago
As a person that used to be a “human scribe” but for emergency dept doctors. I would say the ER doctors shared the same experience as the one depicted in the news story. For a doctor that was nearing the age of retirement or had very poor keyboard proficiency. scribes were a godsend.
Doctors worried less about documentation and focused more on patient care. Of course they still wrote things like admission orders, prescriptions, and nurse orders. Scribes were often told to avoid doing these but sometimes the doctor was okay with it. I personally just told them to do it. Too much of a legal liability for both of parties.
But capturing all of the details of the history of present illness (HPI), patient medical history, review of systems, physical exam, procedures (if any) and medical decision making during patient visit can be a time consuming issue. Time increases with significantly more complex cases, especially one with more than one procedure.
Documenting it so that it can be billed appropriately is also crucial.
Prior to scribes, doctors would describe forgoing writing documentation all together at the end of the shift and writing it the next day or shift.
Obviously, this caused very poor documentation and opened up the doctor to legal issues (if they arise). Ambulance chasers can easily call out these inconsistent details between doctor notes, patient outcomes, and cross check with nursing notes.
Additionally, this caused cases to be billed incorrectly or “down coded” as well.
I don’t agree with allowing private companies unfettered/unregulated access to what is considered private medical information. But with appropriate controls on the data and who has access to it with full transparency, I think it can help in alleviating physical burn out.
- forgetfreeman 3y agoYeah but you can't get that genie back in the bottle. Once these data are made available to private industry it's only a matter of lobbyists chipping away at whatever protections were initially legislated. See Also: your TV, phone, car, fucking doorbell, and fridge are all spying on you.
- tim333 3y agoThe HIPPA rules on health data are fairly strict, otherwise your doctor, hospital and so on could already be doing wrong. Personally I have a dumb TV, car, doorbell and fridge so not much spying there. The phone I'm less sure of.
- chimeracoder 3y ago> The HIPPA rules on health data are fairly strict Depends on how you define "strict". They're pretty onerous to comply with, but they don't really provide patients with anywhere near the level of protection that most people think. It's better than nothing, but in reality, your data is being legally shared with an arbitrary number of entities, without your consent, and without any way for you to even know who has access to that data. If that data is breached in any way, in theory the reports are supposed to trickle up the chain eventually. In practice? If it's more than one or two subcontractors deep, you'll probably never find out (unless the breached data is posted publicly and you stumble upon it that way). Also, the cap on penalties is shockingly low: $2 million for all violations of a given provision per calendar year. And that's for willful neglect. If the cause of the violation is determined to be lower than willful neglect, the maximum violation is even lower. For a very large and well-capitalized company, that might as well be a cost of business.
- peteradio 3y ago> your data is being legally shared with an arbitrary number of entities And ILLEGALLY shared via non-conformance with federal laws and data breaches. Just look at the Boeing fiasco and the serious normalization of deviance. You think that doesn't happen when you outsource your entire IT operations offshore to a populace that literally has zero skin in the game.
- benmanns 3y agoAnd what is your recourse? There's no private cause of action for HIPAA violations.
- adzm 3y agoFinally someone uses the correct acronym
- tiahura 3y agoBingo. As a new ambulance chaser, I was having some real difficulty getting the medical records for a client - no response for weeks and weeks and weeks. Aha! I thought. HIPAA gives them 30 days(sortof). We'll sue, and surely there's an attorney fee provision in there. Easy money. GOOGLE Wait what? No private cause of action! All I can do is file a complaint with HHS! That said, depending on your state, you may be able to make some sort of colorable common-law claim.
- loceng 3y agoWell, the reality is likely once they get access to the data, are allowed to use it - they will likely be happy to be grandfathered into their accelerated position if legislation passes to create barriers of entry by preventing such mass data gather/access without express permission - to have an advantage on competition; but generally this won't be a winning tactic in the end because trust is the most important factor, even if consumers aren't driven by that yet as their primary driver.
- forgetfreeman 3y agoThe mere implication that consumers can be driven by privacy concerns flies in the face of 20 years of observed reality so I'm not sure where you're getting the idea that that is credibly possible. Objectively consumers are driven primarily by convenience, with cost coming in a close second.
- loceng 3y agoHave consumers had any really good or inspiring options yet that put privacy first? Most of the pundits of Bitcoin and similar - an evolution of the finance industrial complex - seem to claim that the reason there isn't wider adoption is that the "first killer app" hasn't been developed yet. I'd argue it's because its adoption is motivated by profit-greed, which requires a wealth transfer from new adopters to the ones passing off hodling the bag. Many of the core-fundamental values put forward, what many hope Bitcoin et al would solve, are virtuous and attempting-hoping to solve complex problems - but Bitcoin from a holistic systems perspective, where all consequences are integrated, doesn't fit the bill for what will become the next stable evolution of how society functions with technology. I'd argue similarly to privacy concerns, the solutions that Bitcoin hodlers are aiming for - if they care about such things other than profit from buying low-selling high during pumps and dumps - simply haven't had a viable non-hype and non-greed-driven solution made available yet. This current wave as a result of industrial complexes forming to maximize their ROI at all costs, first-to-market and maximizing profits allows them to dominate - but for how long? Maybe a decade ago now I wrote a blog post on Facebook's governance, pointing out FB's attempt to maximize profit now will certainly increase annual revenues/profits in the short-term - but would you rather have lower profits for 20+ years or higher profits for 5+ years? Mark not being an idea person, not a creative - where everyone in tech should know his story involving the ConnectU twins who had hired him - and so he wasn't able to navigate to design and evolve a system to fully harness the potential of having what's essentially a free marketing platform for him as the controller - instead mostly depending on network effect defense strategies including buying up feature sets like WhatsApp, Instagram, etc - who gained a critical mass that could begin to become a competitor with FB, so no real innovation. The VC industrial complex has been a driver in selecting for all of this, and where acquisitions also suck up and eliminate any up and coming competition that gained enough market share and momentum to be a threat; the incumbent dating and food-delivery platforms-apps are the most obvious for this; the captured MSM is another less obvious version of this, where conglomeration from consolidation has put the power of information control in the hands of fewer and fewer people - why big pharma has been so successful suppressing the majority of negative sentiment about them, as one of multiple parties who are toeing the line and attempting to maintain control with what I call the censorship-suppression-narrative control apparatus; Elon buying Twitter-X created a #ZeroIsASpecialNumber problem in terms of no longer being able to as easily put their hand on the scale of free speech - a blow to their authoritarian-totalitarian and industrial complex dreams, that combination forming fascism. Another example, I think the advertising industrial complex will collapse within the next decade. Ads are probably tied at first with downvoting mechanisms for how detrimental of an effect they have on society - where I don't have time to dive into detailing reasons for either right now; they are not mimicking natural patterns for how information-attention was distributed prior to digital. Business is war, and there are $ trillions at stake - and so who knows what all the various parties, millions to billions of people who most likely mostly blindly follow the status quo system because they believe that they will do better off - those who struggled to get where they are in the manufactured rat race, and holding on for dear life due to fear, when in fact tyranny and scarcity mindset is very expensive - and where the universe provides all the abundance we need, and we can all thrive with proper organization. “Those who love peace must learn to organize as effectively as those who love war.” — Martin Luther King, Jr. Thanks for the convo! Please continue if you're motivated or inspired to! P.S. I had 2 neck surgeries last week, so my pain level is down a lot - and so words are flowing out of me a bit easier, and apparently you inspired me to say far more than I was expecting, so thank you again.
- j45 3y agoWHile US has private healthcare, Canada does not and data does not belong to the private companies.
- IG_Semmelweiss 3y ago>> Documenting it so that it can be billed appropriately is also crucial. This is literally the only reason why scribes, or pretty much any EMR exist. EMRs are an accounting tool. To avoid "down coding" and legal exposure . Plain and simple. There's a reason that doctors would not adopt EMRs for the longest time (at least in the US, don't know other nations) until actual legislation was passed to force them to do so, else get shut out of Medicare. The EMR, and therefore most note-taking, is not as value add to the patient, or doctor. Its just the only way the doctor will be paid. The EMR of the future will not have an encounter in a computer. It will be computerless. AI will be acting like zapier between payor APIs, doctor's invoicing, and the patient's chart.
- karencarits 3y ago> The EMR, and therefore most note-taking, is not as value add to the patient, or doctor. Its just the only way the doctor will be paid. I don't think this is true as proper note-taking and documentation is required by law in many countries where the doctor is not paid per patient/procedure
- IG_Semmelweiss 3y agoOK, but you need to clarify your statement. As you said, >>> note taking and documentation is required by law. So then, the EMR not a value add, which is also what I wrote. It just so happens that in the US the primary reason is to get paid, and its also why some doctors still eke out a living without an EMR (but still with some kind of paper medical files)
- TacticalCoder 3y ago> For a doctor that was nearing the age of retirement or had very poor keyboard proficiency... I went to a doctor recently who was typing very fast. I did kid with her that she could type nearly as fast as I did and yet she was also using one of this automated note taking thinggamagic (holding some kind of microphone in her hand). She'd type manually for stuff like email/subject, click click one sentence here, click, one word there: for that kind of stuff it's too slow to dictate one word, then click, etc. But in that big empty text field? She'd dictate. As a bonus as her patient I got to hear her report (or "my" report if you want) in real-time.
- Magi604 3y agoI once had to go to a walk-in clinic to deal with a minor emergency. The doctor who attended me was literally typing with his pointer fingers.
- furyofantares 3y agoWere they slow? There's actually plenty of people who can do that at a reasonable or even fast pace. Of course lots of people type reasonably quickly with two thumbs too (or in the case of this comment, a left thumb and right pointer finger).
- nkrisc 3y agoIt’s always slower than typing properly.
- furyofantares 3y agoSure, in the hypothetical where the person also decided to learn to type properly. If someone is plenty fast for their needs then it doesn't really matter, though.
- BenjiWiebe 3y agoI don't type properly (use about half my fingers) but I find 80wpm is usually fast enough.
- whoomp12342 3y agoif AI is hosted in house I think it can have some very wonderful potential. Unfortunately lots of organizations are more worried about covering their asses legally than actually protecting the data