Blog, angry, doctor, computer

Electronic Hell Records

Endless keyboard clicks

The promise of ‘easy to use’ Electronic Health Records has evaporated. Instead, hospital wards echo with the angry pounding of keyboards.

Thanks to clunky, code obsessed software, Doctors have been transformed into the world’s highest paid data entry clarks.

While Nurses spend their time ticking off a tsunami of checklists and answering endless electronic alerts, instead of monitoring their patients recovery.

Go into any hospital ward and you will see the nurses station lined with rows of computer screens, lighting up the anxious faces of nurses and allied health professionals.

They are trying to find the right codes to cover every minute, of every day, and every event that occurs during patients hospital visits –

Admission codes.

Diagnostic codes.

Pharmacy codes.

Pathology codes.

Meal ordering codes.

Discharge codes.

Reporting potential or real ‘adverse event’ codes…

A recent of survey of hospital staff asked –

‘If you had the power to change or upgrade one piece of technology what would it be?’

The largest response was… Electronic Health Records!!!!!!!!!!!!!!



There are no ‘consumers’ in healthcare

As with everything in healthcare, the root of problem lies in the payment system.

The Doctors and nurses who use Electronic Health Records don’t pay for them. They are never consulted about their design. They are not allowed to choose which companies products get purchased. Once the software is installed they have no power to reject the software.

Healthcare is a third party payment system. Both the consumer (patient) and the service provider (Doctor) are for the most part, powerless.

The main power in healthcare is controlled by the ‘middleman’ or health bureaucrate.

In all other industries, the software user is usually the payer. Technology companies know that their financial existence depends on their users experiences. So they put huge effort into a good user experience. Upgrades are frequent, complaints are answered promptly and suggestions are taken seriously.

In healthcare, it the middlemen or bureaucrates who choose the software. They don’t use the Electronic Health Records they purchase. They don’t care how well (or badly) they works. In many cases they don’t care how much they costs.

According to a 2017 study in the Annals of Family Medicine, out of an 11.4 hour work day Doctors are spending an average of 5.9 hours on Electronic Health Records, compared to only 5.1 hours with their patients.

It’s the perfect prescription to produce a terrible product.

Rather than an electronic ecosystem of information, the nation’s thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it… Death by a Thousand Clicks

Patients often complain about lack of a consumer focus in healthcare. ‘I’m treated like a sack of potatoes’ they say. And often they are right.

But Doctors and Nurses are in the same situation.

Instead of healing the sick and caring for the frail and elderly, they have been reduced to being little more than data collection (and billing) agencies for an armies of faceless healthcare bureaucrate.

“…somehow we’ve reached a point where people in the medical profession actively, viscerally, volubly hate their computers.” Why Doctors had their Computers – New Yorker November 2018

Blog, Frustrated, Doctor, Computer

The rising nation of scribe slaves

American Doctors are now hiring human and electronic scribes from all around the world. Their sole purpose is… to fill out Electronic Hell/Health Records.

This international flood of scribe slaves follow Doctors on their ward rounds. They silently sit in on consultations. They sit in the background of telemedicine calls. They accompany Doctors on home visits. And in the background, they click, click, click.

It keeps the bureaucrates happy. The patient actually gets to talk to their Doctor. And the Doctor gets to do his or her job.

In a mad world, only the mad are sane… Akira Kurosawa

Sometimes a medical student is physically following the Doctor around on the wards. Other times a Doctor (from a developing country) is listening in the background, and manually entering all the data they hear.

Sometimes the Doctor wears a multi directional microphone around their neck, that sends a recording to a cloud service. This software transcribes the information, and enters it electronically to the patient’s electronic health records.

Either way, the Doctor pays for their own personal scribe, just in order to manage the impact of badly created software that has been foisted upon them.

…”Rather than an electronic ecosystem of information, the nation’s thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it…” Death by a Thousand Clicks: Where Electronic Health Records Went Wrong – Fortune March 2019

We need to change the funding model of healthcare

One option is a shift away from the middle men of private insurers and governments. In America there is a rise of ‘pay direct’ or concierge medicine. The patient pays for the Doctor’s services direct, with no middle man. The Doctor runs their own practice, their own way, with minimal interference.

Another option is moving away from an individualised system of private health records kept on different proprietary software systems, towards a centralised, cloud-based health records that are managed by AI. This might help manage both the data and payments in a faster and more efficient way.

We owe it to ourselves and the next generation to sort out our current health system problems.

And so far, the computerisation of medical records has failed to bring down costs or reduce errors.

References


Death by a Thousand Clicks: Where Electronic Health Records Went Wrong – Fortune March 2019
Why Doctors Hate Their Computers – New Yorker November 2018

© Wikihospitals March 2019

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