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.
Can those who advocate the clusterf*** that is EHR give a good example of where they have accomplished any of their lofty goals? Even if they can come up with something, can that justify the billions we have sunk into it in actual dollars along with billions in uncompensated work by physicians?
No. No they can’t.
The ONLY goal for EMRs was to accumulate untold amounts of data that could be analyzed, sliced and diced, and then sold for unimaginable amounts of money.
Everything that was used to sell them to physicians was an out-and-out lie from the beginning.
EMRs have been successful beyond their developers’ wildest dreams. The only thing that didn’t go according to plan is that docs were far more gullible than anyone believed possible.
Nope. The EHRs function like Facebook. It’s not about improving patient outcomes, etc. They’re only there to collect patient data and sell to the highest bidder.
I was able to practice in the “paper age” for many years until eclinical works was jammed down our throats. I absolutely detest and hate president Obama to this day as he endorsed ramming this EHR garbage down our gnaw. If I ever were to meet him, I’d tell him he did a d!ckhead endorsement on this EHR garbage.
Before “full” EHR, we had modem logins to the hospital to check on patients, could get labs electronically though they were still being printed off for the paper chart too and could look up x-ray reports online if they hadn’t been placed in the paper chart record.
This modality certainly made my life easier.
Then came along turning the doctor into a secretary with full blown bulls#it EHR. Either type in your note or dictate it and sign it later. Truly sucks to no end.
With paper, I’d dictate the note and sign later. Everything was there. Later had to sign in, scroll, click, scroll, click and waste more time d!cking around looking for stuff on computer screens. On paper we had an excellent clerical staff that kept the paper charts up to date. Flip, flip and the result would be there. So much faster and if one is paid on production more efficient for one’s bottom line. My income dropped after EHR definitely. Production dropped royally.
I was so glad I was able to retire at age 64 and get out. It wasn’t fun anymore though I did have to stay up all night sometimes on call and take care of disasters it was o.k. to do that before EHR. The “paperwork” became horrendous after EHR. Worst thing that happened to primary care.
The new primary care docs coming up are I believe used to becoming sheep. I was efficiently able to do office, hospital work and took call for many years because the paper record system was optimized for that model. Now I highly doubt Family practitioners can partake in that model anymore and simply do office work only. Their experience is much less than what I acquired. I did 5 and a half years of residency back then and had confidence when I got out and went into practice.
Kurt Savegnago, M.D. (retired)
I have been using computers since 1973 and in medicine since entering medical school in 1978. I have been tech savvy. Yet it took 20 hours of training to begin to use Epic and another 20 to use Cerner, both poorly. Both systems were shoved on us because Epic was the 2008 President large campaign donor. Note her net worth went from 100 million to 5 billion.
We are in the cycle of the Microsoft monopoly, where the money from products that are terrible is used to eventually make products that are usable.
The program should open to a row of charts (without 3 logins and verifications), click on the chart, click on the tab orders etc, and either dictate ,click on standard or it configures. What we have now is a very expensive Access based program that can only go in one direction, if the pathway is not the way it wants it does not work.
My cell phone I click on icons and it saves me time, not I have to click steps.
Most importantly we were never PAID for the hours of training (not even a donut) or the extra time. Can you imagine government employees being told they need 40 hours of training AT THEIR EXPENSE! And they need to work an extra hour a day AT THEIR EXPENSE. No they are too busy putting $21,000 leave of absences in the fine print of supposed COVID relief bills.
This was a farce shoved on us by the 2008 administration. The correct way would have been for the government to give IBM, Microsoft, Google, Amazon, etc each a billion in seed money to write a prototype. The winner would have been purchased by the government for 50 billion and given out free. The requirements would have been it would need to interface and be compatible with the next winner in 10 years (the contract would be 10 years only) and not require costly conversion (now all places are hostage forever). It would need to talk to all the other medical programs and be user friendly. The cost savings would have been immense and we would have a better product for us and our patients. But then there would be no campaign donations.
Good post.
As someone who wrote his first computer programs at age eleven at the University of Virginia (i.e., not a Luddite), I am more thankful every day that our practice has stayed with paper charts. This decision has kept us happy, thriving, and profitable.
Let’s be clear on one thing. There is absolutely no mandate or requirement to use EMRs in order to practice medicine today. Every physician who is complaining about them has, at some level, volunteered for this misery. Let’s stop being victims and take responsibility for our bad decisions.
None of the benefits of EMRs accrue to either physicians or patients, and none of them ever will. This scam is entirely about using the free labor of physicians to collect data that others will sell for enormous profits.
This is the greatest case of the emperor’s new clothes in the history of American medicine.
I’m tech savvy and appreciate all the ‘data gathering’ available when using EHR. But there is no love when I’m assessing an elderly woman for a mild localised skin rash – and a 10 min visit turns into an hour due to checking all the required boxes.
On another note: so many private practices in Central Texas have shut down due to rising overhead costs, inability to implement expensive (required) EHR, poor compensation from insurance, etc.
Wish these providers could have at least tried the DPC model, but alas, many chose early retirement rather than fight this broken system.
Doug, I can no longer find the comments section in this new format. Help?