Tuesday, March 15, 2016


Cost and Price of Quality  IT Monitoring
Everything you want is life has a price connected to it.  There’s a price to pay if you
want things better , a price to leaving things as they are, a price for everything.

Harry Brown (1933-2006), Libertarian candidate for president, 2000
Based on a survey of 1000 doctors,  Health IT News reports that individual doctor  in private practice spend more than $40,000 each to monitor quality through their electronic medical records,  for a grand total of $15.4 billion in you include all physicians.    Doctors devote 2.6 hours on a week on this effort,  and they and their staff spend 15.1 hours a week  feeding data to their electronic records.   Seventy five percent of the  surveyed doctors say they waste time and  money on measures that aren’t clinically revelant.
In 2009,  the Obama administration decided to pay $27 billion to doctors and hospitals to encourage them to install electronic medical records (EMRs).   These EMRs would allow government and insurers to gather  data that would allow them to measure outcomes,  and supposedly, to identify doctors with good outcomes,  to weed out doctors with bad outcomes,  and to reward the good doctors,  and penalize the bad doctors. Today 83% of physicians have electronic medical records.
Collectively doctors  spent $15.4 billion  in 2015 –  to maintain their  EHRs,   hiring of staff to enter data,  time spent figuring out what codes to use,  grappling with indecipherable  computer screens,  with  less  patient eye contact,  less watching of  patient  body language,  less  listening to patient  histories,  less physician contact during  examinations,  all  of which doctors claim,  does not advance quality of care.
In other words,  in the opinion of  3/4s of doctors surveyed,  the price of measuring “quality” are high overhead  costs,  less patient contact,  and time spent on busywork.   Unfortunately, to  escape  time, money, and effort expended on EMRs,  many  physicians are escaping electronic hassles and drudgeries by becoming hospital employees,  retiring early,  or entering concierge  practices,  where EMRs are not required.
It’s important, of course,  to put EMRs in perspective.  In the opinion of federal overseers,  “In God we trust, all others use data.” The  theoretical  virtue of EMRs is that  the records contain essential information on the patient’s  medical history, including past medical records, lab tests, X-rays and other imaging studies.  
If  only every patient  could carry their medical record from doctor to doctor in a thumb drive and could insert it into the new doctor’s EMR,  the patient’s record  would end  misunderstandings and duplicate testing,  But we are not there yet,   and many EMRs do not accept data from other EMRs.  
 Ideally,  EMRs could reduce medical errors, end duplications, engage patients in their own care, create coordination of care.  Presently, however, EHRs are clunky to use and to interpret,  and most do not contain a narrative history of the patient’s history and do not accept doctors’ dictations,   their normal way of communicating with other doctors.   And most physicians do not consider to be either doctor-friendly or useful. Perhaps some day we shall total transparency ,  even total access to charts and doctors’ clinical notes,  but we are not there yet.
"On top of the obscene waste of billions of dollars each year on quality measures, the most alarming thing about this study of MGMA member practices is that nearly three-fourths of the groups reported being measured on quality measures that are not clinically relevant," said Halee Fischer-Wright, MD., MGMA's president and CEO, in a statement.
"The vast majority also stated current measures are useless for improving patient care," she added. "This study proves that the current top-down approach has failed. It serves no purpose to have over three thousand competing measures of quality across government and private initiatives."

Quality  remains subjective and like beauty, is in the eyes (and pocketbooks)  of  federal and  physician beholders.

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