Your Career on EHRs

Someone told me a story from the long ago, that while visiting family his aunt brisked into the kitchen and asked whether he would like eggs for breakfast.  “No ma’am”, he politely replied.  “Fine”, she answered, “and how would you like them cooked?”  This has been and remains the state of EHR’s and health care IT with respect to physicians.

Any doctor wishing to abandon all hope should read How ONC is Addressing EHR Clinician Burnout, Health IT Barriers.  This tiresome, laborious piece is crammed with the acronyms and foregone conclusions that make it read like the prepared hostage statement that it surely is.  Just read the first sentence: “Fully comprehending a future path to mitigating EHR clinician burnout requires a complete understanding of the intent and development of health IT regulations and why these regulations exist…”  So, you and I need a “complete understanding of the intent.”  Why is that, when our concurrence was never required?  How often do we hear in terms of criminal law that intent does not matter?  How many physicians have been assaulted by Big Insurance and Big Government audits, despite good intentions?

“Healthcare leaders expected health IT adoption to address critical deficiencies, such as poor EHR usability, unintuitive EHR design, and high clinician workload. However, that has not been the case.”  Really??  Color me shocked.  And who exactly were these “leaders”?  Certainly no one I’ve ever met – were they even clinicians?

“These goals have been met with mixed success and the clinical community is struggling with burnout directly attributed to health IT; in part caused by usability issues, nonintuitive workflows, use of structured forms that impact the ability to construct and interpret a cohesive patient narrative…” True dat.  IT experts from the Office of the National Coordinator of Health Information Technology (ONC) say we need “improved health IT system designs, enhanced system configuration decisions, and increased end user training during health IT implementation.”  But the presumption of these hammer-holders is that the rest of us are nails to be driven into our places, where we can be presumably fixed for more “end-user training.”  

(Readers will be thrilled to know that the ONC developed the SHARP, and along with the HHS funded research into UCD processes by IT developers.  Just memorize that for the MOC later.)

The preceding bozos have linked clinician burnout and patient safety, establishing a set of safety-enhanced design certification requirements for EHR usability.  One certainty is that these requirements will in no way make EHR’s more user friendly, nor improve actual patient care in any way.  It will make the IT priests and vendors scurry around, ginning up a lot of nonsense software updates, and passing the costs on to physicians who cannot then pass it on to their customers. 

Don’t believe me?  “The EHR Reporting Program mandates that EHR developers must submit data on the functions of their health IT products per provisions of the 21st Century Cures Act (Cures). The program could contribute to the establishment of new EHR certification requirements.”  None of that will have meaningful (ha!) physician input, and whatever gobbledygook results will be one more little anchor for drowning offices to hold.

“In accordance with Cures provisions, the EHR Reporting Program’s reporting criteria must address EHR security, interoperability, usability and user-centered design, conformance to certification testing, and other categories deemed appropriate to measure the performance of certified EHR technology.”  The key phrase is “user-centered,” with all the seriousness and efficiency of the now shopworn “patient-centered care.”

Bottom line, this is all garbage.  It is make-work to keep mandated layers of parasites busy gnawing on the diseased carcass of the medical profession.  The self-promotion of these is evident: “Since EHRs are foundational to many other goals of the Cures Act (are they ‘foundational to YOU?), the timely development and implementation of these programs is paramount.  [They] may not be able to implement the EHR reporting provisions from Cures if the President’s budget cut is enacted, we urge you to ensure that the agency has the resources it needs to … prioritize policies that enhance patient safety and care coordination.”  So if these redundant bureaucrats don’t get the funding they want, it will predictably threaten patient safety.  How often is patient safety threatened now, by erroneous input, ridiculous, ever-shifting quality reporting, constantly increased expenses and complexity, and plain ‘ol physician burnout, none of which will be improved by this latest flurry of activity? 

A corrupt, self-interested cabal of government bureaucrats, lobbyists, vendors, academicians, sellout physicians, and various and random do-gooders produced the now-widely accepted presumption of mandated EHR’s.  They did it a generation ago with no thought or care as to what actual physicians wanted (or did not want), and have since trained successive years of doctors that a computer screen is a normal part of the physical exam.  A great deal of primary care could be done competently, and with far more efficiency on a 4 x 6 index card.  Actual physicians who have completed a residency don’t need to document ROS, social history, and blah blah blah for every minor complaint; this benefits only Big Insurance, Big Government, and the ever-lurking lawyers.  It was easy to turn the demands of third-party payers into a complimentary industry by computerizing it all, building such mental inertia that the health IT “experts” actually have convinced themselves that they are providing patient care. 

Physicians that cannot escape to DPC, an alternate career, or retirement, will be stuck with this.  We arrived in practice already trained to use the computer on top of our necks.  Any additional requirements by non-physicians and the moronic society that empowered them are simply more eggs that we don’t want but have to eat, no matter how they’re fixed.

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427750cookie-checkYour Career on EHRs