Never simple, but computers cost money, and so do health records systems, and you are legally required to protect...
Never simple, but computers cost money, and so do health records systems, and you are legally required to protect those computer systems, and apparently this is all now considered just a cost of doing business. Which is maybe sort of ok in a big system that spreads and absorbs some of the cost and the legal, security, and updating responsibilities. How is that supposed to work in little towns and rural communities where there might be just a tiny clinic, or a single practitioner?
And while the system is going to say they were protecting patients from a doctor who could no longer practice safely, what are the system's obligations to the patients left without a doctor? Right now, apparently, nothing. You are on your own.
https://www.npr.org/sections/thetwo-way/2017/11/28/566923402/do-doctors-need-to-use-computers-one-physicians-case-highlights-the-quandary
https://www.npr.org/sections/thetwo-way/2017/11/28/566923402/do-doctors-need-to-use-computers-one-physicians-case-highlights-the-quandary
And while the system is going to say they were protecting patients from a doctor who could no longer practice safely, what are the system's obligations to the patients left without a doctor? Right now, apparently, nothing. You are on your own.
https://www.npr.org/sections/thetwo-way/2017/11/28/566923402/do-doctors-need-to-use-computers-one-physicians-case-highlights-the-quandary
https://www.npr.org/sections/thetwo-way/2017/11/28/566923402/do-doctors-need-to-use-computers-one-physicians-case-highlights-the-quandary
Is this different from any other safety-regulated industry? Little towns still have to build to code, wire to code, licenses and best practices are required for other professional services, etc.
ReplyDeleteUsing computers, per se, hasn't actually been shown anywhere I know of to be a best practice.
ReplyDeleteIt has been legislated in regards to having to do electronic prescribing because that was supposed to prevent errors from reading handwriting, but exceptions were put in for small communities and others where it was ok to fax rather than electronically transmit. Not to mention that you were initially forbidden to use e-prescribing for narcotics. Those had to be on paper, signed, and could not have any refills written on them.
The other major reason I've seen for switching to electronic systems is money. Although it costs a huge amount of time and money up front, (and I'm not sure where that comes back because at one time, it took a long time to recover that initial investment), it turns out that if you get the right system, run by the right people, it exponentially increases your billing and collections. Hospitals and large groups like that part a whole lot.
There are other things I've seen, like a couple generations of people who get upset if they have to write anything long hand, ditto if they have to physically go to a records vault and find things by hand. Those fields where drawings need to be incorporated are still not well served by most of the electronic systems out there, although that continues to evolve.
It is faster to have everyone's complete everything on a machine that you can instantly access, but that is not a standard, just something big systems have been able to invest in and any clinic groups associated with them therefore have it.
If you can go mostly paperless, it saves a lot of space and the cost of that space for storing the records.
Going electronic where the person in the room is supposed to do the data entry (tech, nurse doc, etc.) eliminates the cost of scribes, whether in person or remote services from dictation. Except a lot of things are still dictated, like surgical notes, because it is much faster on the front end.
A lot of patients in research on this have said that they would like to be interacted with more than the computer screen and that the perception, at least, is that people are paying more attention to the computer.
Since you are often evaluated on your records for care standards and billing (see: Medicare audits and various Quality initiatives), you have to input a lot of information immediately during the visit, so it's quite possible that people are more focused on the computer, at least at times.
Lastly, the vast majority of the supposed safety regulation isn't. It's a bunch of organizations that just decided to set themselves up and do the job. This includes state medical boards, which organization (FSMB) has its own interesting history jointly and separately, and is not unimpeachable. JCAHO, JCAHPO, NCQA, and a bunch of others are all out there doing their thing, but none of them is a regulated, legislated body itself. Mostly, I think they are various forms of non-profits.
AHRQ is at least part of HHS. USPSTF is volunteers but they are appointed by and run under AHRQ, as far as I know. But these two are not so much about safety as about actual medical care provision. Like whether you need vaccines, or should get a mammogram.
So there's a bunch of random regulation, sometimes conflicting, and while much of it is treated as if it has the force of law, there is no legislation behind it. It's just customary. As you know, the problem with that is that in addition to becoming conflicting and/or redundant, just because it's always been done that way is often not the best way when someone finally does any rational testing.
I'm not really sure what the real problem here is. I suspect it isn't just the computer. It may be part of the time honored tradition of legislators who don't know or understand something trying to fix it with a one size fits all approach, backed by a medical board that may have good intentions, but has a great deal of power and if she can't afford a lot of expensive lawyers, she's done.
ReplyDeleteIf you're bored, medical boards are an interesting topic for a brief conversation all their own.