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View Diary: Medicare: What can we do about it? (314 comments)

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  •  RE: EMRs (4+ / 0-)

    I know I've been a relative naysayer on this, but the productivity increases have absolutely not been realized; in fact, almost all of the companies who produce these systems recognize a 5 to 10% cut in productivity even out as long as two years - at tremendous cost. Any idea what the licensing costs are for them?

    I've worked on three systems. At the beginning of the visit it's okay, I can pay attention to the patient and type at the same time. It's when it comes to ordering things that I have to completely divert my attention from the patient to the computer. Part of it is that the system I'm on now is, frankly, awful.

    And here's another thing: they don't talk to each other and unless there is access to the information contained within, they are fairly nigh useless. Not so bad for putting information in, but lousy for getting information out. And generally when administrators are looking at systems, they aren't looking at whether you can get information out or not, other than what can be audited for "compliance."

    I've said it before, but I have a good friend who is a reasearcher in AI and works on one of the major systems in this country, who says we are not going to have a truly functional system in our lifetimes. When I talk to programmers and systems analysts among my patients, they almost universally agree.

    Not only is medicine not as static as a Beethoven quartet, medical decision making is very complex and does not lend itself well to the I/O quality of computer systems, nor to the silo approach to medicine that is all that these systems are capable of - and which Medicare is looking at in terms of its so-called "quality" measures.

    Frankly, no wonder so many good docs are going the retainer route. It's about more than money.

    Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

    by stitchmd on Sun Aug 21, 2011 at 12:46:38 PM PDT

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    •  no question, and yet... (0+ / 0-)

      within large groups I have seen the pt visits icrease (eschaduling a huge help, now and not in the future), e-billing and collection improve and _within the group who call all read the damn thing-  less duplicative tests ordered,.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 21, 2011 at 12:55:59 PM PDT

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      •  Re: billing (0+ / 0-)

        really, that's what the systems are all about, and that's how administrators choose them. Not all systems are set up well for coding, however (the one on our current system is flat-out terrible.)

        I will agree about the duplication of tests, but that is dependent on the ability to get data out. And if the test is done on a system that doesn't talk to the current system, then you're just back to the same old, same old crap of calling, dealing with HIPPA, etc.

        The wide variation in systems, and the proprietary nature, can make many providers especially ones in smaller groups or independent practices feel like it's a huge boondoggle.

        Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

        by stitchmd on Sun Aug 21, 2011 at 02:44:08 PM PDT

        [ Parent ]

        •  yes (0+ / 0-)

          as i said, the potential, not the actuality, but in some cases benefits are seen now.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 21, 2011 at 03:04:46 PM PDT

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          •  and while I agree in part (0+ / 0-)

            the problem is that the mandates, and the costs, are out there already. And penalties are about to kick in. Asking small providers to pay these costs with minimal benefits to themselves or to their patients, especially with the limited systems available out there (and the better products aren't even really available to independent practitioners or small groups) is extremely hard to defend.

            Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

            by stitchmd on Sun Aug 21, 2011 at 03:18:30 PM PDT

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            •  there'll need to be partnering with local hospital (0+ / 0-)

              systems, and there'll be a need for integrated health systems. The future, like it or not.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Aug 21, 2011 at 03:57:20 PM PDT

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              •  I recognize the benefits (0+ / 0-)

                and I recognize what is probably greater, the potential for benefits. I don't mind using them, either; I've gone back and forth over the past 2 years and I feel like I see the good and bad of both.

                What I don't like, however, is the idea that this is going to be the "savior" of medical care, that it's the best thing ever. There are limitations. And these systems do nothing to support complex decision making; in fact, in some cases, the limitations on documentation (linked into the horrendous coding system) impede it. The other thing I don't like is the imposition of the system on physicians who really can't afford it and the restrictions the mandate places on their ability to practice medicine (and I say that as someone who has always been employed.) When we got to EMR, the hospital takes the overhead of the cost and supports the salary during implementation. No such benefit for private practitioners.

                We have a long way to go and there's a whole heck of a lot of room for improvement.

                Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                by stitchmd on Sun Aug 21, 2011 at 04:22:31 PM PDT

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                •  heh (0+ / 0-)

                  you remind me of me. ;-)

                  we are dinosours.

                  "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                  by Greg Dworkin on Sun Aug 21, 2011 at 04:46:16 PM PDT

                  [ Parent ]

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