Saturday, December 20, 2014

In Data We Trust, All Others Use Their Minds

Big Brother is watching you.

George Orwell (1903-1950), 1984

If George Orwell are alive today, he would understand what Big Brother is doing to physicians and how he is seeking to monitor and control their activities.

As a physician you are under surveillance. The surveillance weapon is called an Electronic Medical Record. If you do not have it, if you do not prescribe with it, if you use it improperly, Big Brother Medicare will cut your fees and fine you and even exclude you from their Medicare.

Big Brother will cut your Medicare fees 1% next year if you don’t meet federal goals for EMRs, if you don’t prescribe electronically you will lose another 1%, if you don’t submit data on such measures as blood pressure, weight, andantibiotic use, you will face fines of 1.5% in 2015, climbing to 2.0% by 2019. Combined cuts and fines could cost doctors a total of 11% by 2017.

And none of this includes the $40,000 or so for installing an EMR, a like amount hiring and training staff to feed it and use it, the time and money spent searching for just the right ICD-10 code, and the 20% of our time away from patients dealing with related paperwork.

Pretty soon, we’re talking about real money, about real control, and about being a unpaid serf of government, unless, of course, you follow the arcane “meaningful use “ EMR guidelines, then you get a bonus for being an obedient government servant.

I understand the government’s EMR rationale. Every doctor has a computer, why not force them to use it? Computers interconnect and can be used to coordinate care. Everyone these days has some sort of computer device, and many devices are mobile, handheld, even wearable . Data can be stored on a cloud. It is impersonal . It is objective. It is clean. It is free of human biases and grievances. It does involve spiritual, emotional, and political issues like freedom to chose your care, or to negotiate with your doctor.

But alas, data is imperfect and full of gaps. It lends itself to glitches and hacks. It may allow massive fraud at the click of a mouse. It lacks the narrative touch. It does not tell a story. EMRs often do not talk to one another. And many doctors do not like them because EMRs get between them and the patient. Often you cannot dictate into them to tell your patient’ story.

And to top it all off, “Data is not information, information is knowledge, knowledge is not understanding, and understanding is not wisdom.” Clifford Stoll, American scientist and data skeptic. Furthermore, try as we may, life and disease are complicated things with never enough sufficient data to explain all. Government experts tend to possess more data than clinical judgment, which you can only gain by having enough time to talk, listen, observe and and examine the patient. Data requires interpretation and is useless without it.

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