Health care?

John Baker

Final Approach
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John Baker
My primary care physician retired back in October of last year. We, at one time simply referred to our own doctor as "my doctor". I moved over to the family practice across the court from his office.

I guess it was about a year before he retired, maybe less, that he started bringing his laptop computer into the exam room. In the good old days, he would come into the exam room with nothing but himself and his stethoscope. We would chat about this or that for perhaps five minutes or so.

Our conversations consisted of what seemed to be small talk, but mostly centered on my health and how I was feeling. My fifteen or so minutes he spent with me was usually him checking my heart and lungs, he would check my back which was usually an ongoing problem for me, and he would check whatever it was that brought me into his office. I always felt that I was the focus of all of his attention.

Then the laptop became part of my exam room time, well actually, it became the center of all of his attention, with him asking me a series of assorted questions that seemed to have been prompted by his computer. He would diligently type in each of my responses.

I visited my new doctor, er... primary health care provider, yesterday. It was the same thing. I went into the exam room, then he and his computer came in. We introduced ourselves to each other, then he set his computer on a little podium like table and we worked together on what seemed to be the patient, the computer, answering all of its assorted questions. At the appropriate time, he checked my heart and lungs, and felt the reason I was there, a lump under my arm, and then he went back to his computer.

All of this has got me to wondering how far away we are from eliminating doctors altogether. An exam could be conducted via e-mails, with a quick hop to the office to have a trained technician listen to my heart and lungs, and take other assorted vitals. Or perhaps computers could be equipped with Kromen revelators that would do all of that in your home.

I don't know the reason that a laptop computer now gets the bulk of a doctor's attention in an exam room, if it's due to insurance company demands or Obamacare demands.

I think this is actually the worst thing that has happened to our healthcare system, the self protection information gathering, or it could be more about payment gathering, I don't know.

One of the girls in the new office had worked for my old doctor. She told me he is now volunteering his time at a free clinic down in the Barrio.

I think I might wander down to Mexico and check out a few doctors down there one of these days.

-John
 
Then the laptop became part of my exam room time, well actually, it became the center of all of his attention, with him asking me a series of assorted questions that seemed to have been prompted by his computer. He would diligently type in each of my responses.

In the last year, the laptop has become a fixture with my doctor and his nurses/techs as well. I don't think the old ways will return.
 
Medicade made financial incentives to move all records to databases rather than paper files. They also demanded a move to a larger diagnostic code system. The apparent goal is to database everyone and "manage" everyone's health for them. Yes, it is part of change to mandatory health insurance.
 
I agree, the next step is a robot.

Next step, you will see less and less of the doctor and more and more of the PA's.

My followup visit after open heart surgery I didn't even get to see the surgeon. As I was doing very well I was seen by the PA only.

This trend will continue IMHO.
 
My PA referred me to a GI last year. Got to the GI office/ambulatory exam facility (~10 docs in the group) and the parking lot was practically empty. Went inside and waiting room was empty. On my previous visits parking lot was always full and waiting room packed. Girl behind the desk said their server had gone down so they had to cancel all their appts, and all the docs had gone home for the day.
 
The laptop/tablet is an ever-present tool at my doc's office, too. He doesn't carry it, but his nurse and everyone else does. They told me it's all because of the rule changes about a year ago by ACA/Obamacare to move all our records into e-format.
 
As a family doc, I miss the old days where paper was still allowed. Unfortunately this is no longer gonna be allowed. The use of EHR's only slows our production. Increases costs to run a practice and is being forced down our throats by the government.

This started long before Obama, but obamacare is going to put the nails in the coffin on any independent physicians. Afew years ago and I'm sure its worse now we spent 75k on administrative tasks/staff for every 1-2 family physician practice. Sad numbers indeed. I started my practices from the ground up and at the time of selling them I had a 1 to 1.5% margin and it was going away! The company that reviewed the purchase of my practice for the hospital congratulated me that I was only 1 of 3 practices they had reviewed that was profitable.

Sad Days for those who enjoy it for sure!
 
Electronic charts are more in use because they can be shared between facilities, and when you actually do have an emergency the folks treating you can have access to your medical records so that they don't give you the wrong stuff and you die.
 
Nurse to get your blood pressure, etc. Skype with a Doctor in India. Robotic surgery controlled by a Doctor in India.. I see a lot of Bonanzas up for sale in the future.
 
Electronic charts are more in use because they can be shared between facilities, and when you actually do have an emergency the folks treating you can have access to your medical records so that they don't give you the wrong stuff and you die.

And everyone is so good at cybersecurity, especially the medical profession. Of course they will probably spend most of their time on medicine, but we can be sure they know how to secure all the medical records. What could go wrong?
 
Doctors must have copied pilots. You now see J3 cub, taylorcraft, champ pilots discussing their iPads, etc, that they employ to go get a Burger ! In the logs of a Cessna 140 I used to own it showed it was delivered new to buffalo, ny. In the 50s The owner flew it to Miami beach four different winters for vacation. How did he ever get there and back!? My doctor arrives with the computer and within seconds has my last visit and history . It seems to save time which is what they are after, seeing more patients.
 
And everyone is so good at cybersecurity, especially the medical profession. Of course they will probably spend most of their time on medicine, but we can be sure they know how to secure all the medical records. What could go wrong?

Why, they'll do just fine because there is a law (HIPPA) requiring it.

John:rolleyes2:
 
Electronic charts are more in use because they can be shared between facilities, and when you actually do have an emergency the folks treating you can have access to your medical records so that they don't give you the wrong stuff and you die.

I hardly ever die in an emergency room. I had to go in so blood samples could be collected this morning. The young lady who drew them asked me what I thought of my new doctor, she used to work for my old one and remembered me.

I shared my thoughts about the computers and she confirmed what you said, no matter what doctor I went to, they all could access my complete, up to date medical information.

I talked to her a little about going down to Tijuana for my doctoring. She said she did not know if the level of care would be any better or worse, but it would darn sure be more personable. She said I'd have to find out about costs down there myself. She also reiterated the importance of all of this shared computer information, which they would not be participating in.

I don't know if I'll ever get around to checking it out, but maybe one day.

-John
 
Electronic charts are more in use because they can be shared between facilities, and when you actually do have an emergency the folks treating you can have access to your medical records so that they don't give you the wrong stuff and you die.


Huge misconception! Most EHR's and there are many do not communicate with each others. Only those that are so expensive are truly demonstrating this ability however even many small healthcare systems cannot afford them. This results in interfaces between 2 different systems, and even then only those affiliated with that specific system see what they want from a given facility.

Even large hospitals within a given city rarely even communicate. Several are trying but since the early days where physicians were strongly encouraged to get EHR systems there were no standards for communication between systems. Now you have a dilemma where most cannot afford to upgrade to a system that does have the ability to visit with others even though this rarely happens. Just another cost to practicing medicine that you can't recoup.

If your a patient of a large healthcare system then your info can be readily passed but if you see someone outside of that system chances are slim they are communicating. However in the big pic we will all be working for some form of a large system and it won't matter. All sounds good in theory, not completely practical at this point.
 
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Huge misconception! Most EHR's and there are many do not communicate with each others. Only those that are so expensive are truly demonstrating this ability however even many small healthcare systems cannot afford them. This results in interfaces between 2 different systems, and even then only those affiliated with that specific system see what they want from a given facility.

Even large hospitals within a given city rarely even communicate. Several are trying but since the early days where physicians were strongly encouraged to get EHR systems there were no standards for communication between systems. Now you have a dilemma where most cannot afford to upgrade to a system that does have the ability to visit with others even though this rarely happens. Just another cost to practicing medicine that you can't recoup.
Some doctors still fax each other, eventually they will all connect by computer. Research groups did this way way back, hence the computer as we know it.
 
Electronic medical records are a great idea but the implementation leaves a lot to be desired. They are used for much more than accessing patient medical records. The government will be using this to monitor and micromanage physicians. I would elaborate but I'm beat from a few rough days at work, maybe later. Here is some interesting reading:

WELL.v19-25.March10.Hayes_.DaveMalan.jpg
Dave Malan

Ever considered suicide by jellyfish? Have you ended up in the hospital after being injured during the forced landing of your spacecraft? Or been hurt when you were sucked into the engine of an airplane or when your horse-drawn carriage collided with a trolley? Chances are slim. But should any of these unfortunate injuries befall you after October 1, 2014, your doctor, courtesy of the federal government, will have a code to record it. On that date, the United States is scheduled to implement a new system for recording injuries, medical diagnoses, and inpatient procedures called ICD-10​—​the 10th version of the International Classification of Diseases propagated by the World Health Organization in Geneva, Switzerland. So these exotic injuries, codeless for so many years, will henceforth be known, respectively, as T63622A (Toxic effect of contact with other jellyfish, intentional self-harm, initial encounter), V9542XA (Forced landing of spacecraft injuring occupant, initial encounter), V9733XA (Sucked into jet engine, initial encounter), and V80731A (Occupant of animal-drawn vehicle injured in collision with streetcar, initial encounter). http://www.weeklystandard.com/articles/code-chaos_783576.html
 
As far as you personally , your records are no longer your personal domain. As the computer security company president stated, " they already know all about you if they want to."
 
A few months ago my daughter needed to see a doc, strep throat or something, she did it via skype.:rolleyes2: I can't remember if it was the campus medical center at the college or Kaiser, but it was one of them.;)
It's funny I jay went to my annual physical, oil change and tire rotation at my PCP's new office. All electronic, he seemed to spend most of his time making sure he asked me all the questions that were prompted on the screen.:dunno:
 
If you desire a personal relationship with a doctor you trust you will either; 1) have to get over that quaint notion, or 2) be willing to pay cash for the quality and soundness- of- mind you get from a personal relationship with a doctor.
 
A few months ago my daughter needed to see a doc, strep throat or something, she did it via skype.:rolleyes2: I can't remember if it was the campus medical center at the college or Kaiser, but it was one of them.;)
It's funny I jay went to my annual physical, oil change and tire rotation at my PCP's new office. All electronic, he seemed to spend most of his time making sure he asked me all the questions that were prompted on the screen.:dunno:
You are most likely correct. How providers bill is determined by specific rules established by the government (CMS) and adopted by most insurance companies. The rules are so convoluted that checkbox prompts are a way to insure compliance and avoid being charged with fraud for over-billing.
 
I don't know the reason that a laptop computer now gets the bulk of a doctor's attention in an exam room, if it's due to insurance company demands or Obamacare demands.

It is that way because the goverment wants it that way.

Initially, there was an 'incentive' to use EMR, you received a couple of $$ extra to use it. Starting this year, practices get penalized by the goverment if they remain with a paper chart.

It's 'all better' if done with electrons, dont you know ?
 
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Multiple issues, as already discussed. Another is that the EHR systems in use today have to be some of the most poorly designed, cumbersome, user-unfriendly systems in any industry.

The problem is that the systems are so expensive to purchase and implement, the vendors know full well that once a hospital or healthcare system purchases an EMR, they cannot afford to change to a competitor's product. Hence, little money seems to go toward GUI or even back-end upgrades, once the vendors have your money and know you can't jump ship. The vast majority of EHRs I've seen appear to have been designed with virtually no input from the end users. Some of them, to this day, offer little more than a DOS command line!

When my hospital chose an EMR/EHR product, it truly was a matter of selecting the best of some very bad products. Once installed and configured -- a process often requiring months -- they are so cumbersome that the provider spends virtually all of his/her time simply navigating multiple menus and pages, arranged in utterly illogical order, to enter the data. That's why the doctors of today can hardly look up from their screen.

I've been a computer user and online since the dinosaurs roamed the earth back in the Apple II days, but the mandate for electronic records/ordering has unfortunately led to little innovation, and products which lag far, far behind virtually every other industry.

If only Steve Jobs could have designed today's EMRs, we might be in a better place. :D
 
I work for a critical access hospital in NW Colorado which we are evaluating EHR systems that would integrate both our clinic and hospital. The prices are ridiculous however anything we get will be better then what we have.

I have personally purchased 2 different EHRs for my practices in the past. When it comes down to it you just choose the system that sucks the least!

This didn't start with insurance companies. The govt initially offered monies to those that implemented these costly systems which helps soften the blow initially. However for those that don't comply in the near future with adopting EHR will face a penalty with their reimbursement. So instead of crappy Medicare reimbursement you can get just downright ****ty payments.

Oops sorry Weilke, should have read more.
 
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I've been a computer user and online since the dinosaurs roamed the earth back in the Apple II days, but the mandate for electronic records/ordering has unfortunately led to little innovation, and products which lag far, far behind virtually every other industry.

The reason EMRs suck so bad is the goverment and their bizarre billing and documentation rules. Without medicare and hipaa, I could come up with a EMR that costs $200 and runs on a tablet.

For anyone who doesn't know this, but the goverment doesn't pay for what you do, they pay for what you document. The endless clicking through menus and submenus only exists to create a multi-page note full of redundant crap that has nothing to do with the reason the patient came to see you. But by creating that long note, you gather enough 'points' to be able to bill a code that ends up paying you maybe $50 for a regular visit.

I remember many years back receiving a kid as a transfer from Nairobi. The kid had been evaluated for 2 weeks for persistent fevers and they had run all the lab tests we would have done and then some. The medical record fit on something like 12 pages of which 8 were printouts of the relevant lab results from a south african lab. The clinical course was documented in a series of daily notes, each consiting of maybe 3-4 lines of very concise handwriting. After reading through the notes, you knew what they were thinking, how the kid had done throughout the stay and what relevant changes had occured to the labs they had obtained. We never figured out what the kid had btw., but we sure produced a lot more paperwork in the following week at our facility.

This morning I had 10 voice mails and text messages from our EMR vendor: OMG OMG your e-prescribing server lost connectivity OMG OMG the world will come to a screeching halt OMG. I logged in, re-started the process and all is well.

The most aggravating part is that the left hand doesn't know what the right hand does. For the past two years, you were required to submit prescriptions electronically and dutifully report to the goverment goons that you have done so. Our main source of patients is a miltary base with a contractor run pharmacy in the PX. Turns out, the contractor doesn't participate in e-prescribing, presumably because it was not in their contract.... So all our military customers had to get paper written prescriptions and didn't qualify under the e-prescribing program :loco:.
 
The reason EMRs suck so bad is the goverment and their bizarre billing and documentation rules. Without medicare and hipaa, I could come up with a EMR that costs $200 and runs on a tablet.

For anyone who doesn't know this, but the goverment doesn't pay for what you do, they pay for what you document. The endless clicking through menus and submenus only exists to create a multi-page note full of redundant crap that has nothing to do with the reason the patient came to see you. But by creating that long note, you gather enough 'points' to be able to bill a code that ends up paying you maybe $50 for a regular visit.

I remember many years back receiving a kid as a transfer from Nairobi. The kid had been evaluated for 2 weeks for persistent fevers and they had run all the lab tests we would have done and then some. The medical record fit on something like 12 pages of which 8 were printouts of the relevant lab results from a south african lab. The clinical course was documented in a series of daily notes, each consiting of maybe 3-4 lines of very concise handwriting. After reading through the notes, you knew what they were thinking, how the kid had done throughout the stay and what relevant changes had occured to the labs they had obtained. We never figured out what the kid had btw., but we sure produced a lot more paperwork in the following week at our facility.

This morning I had 10 voice mails and text messages from our EMR vendor: OMG OMG your e-prescribing server lost connectivity OMG OMG the world will come to a screeching halt OMG. I logged in, re-started the process and all is well.

The most aggravating part is that the left hand doesn't know what the right hand does. For the past two years, you were required to submit prescriptions electronically and dutifully report to the goverment goons that you have done so. Our main source of patients is a miltary base with a contractor run pharmacy in the PX. Turns out, the contractor doesn't participate in e-prescribing, presumably because it was not in their contract.... So all our military customers had to get paper written prescriptions and didn't qualify under the e-prescribing program :loco:.

I remind myself frequently , IT either by design or by incompetence is the only thing that keeps Skynet from becoming self aware.
 
Anecdotally I have found out that even with computers, communication between different doctors isn't that good. I think they still use fax machines... that is if they even decide to communicate.
 
Anecdotally I have found out that even with computers, communication between different doctors isn't that good. I think they still use fax machines... that is if they even decide to communicate.

Yup, and again, that is because the goverment is stupid and didn't include provisions for inter-connectivity between different EMRs. In fact, the left hand of the goverment wrote a law that makes it very hard to exchange data with other providers (hipaa) while the right hand says we have to do it......

There is a pretty good standard for billing data interchange , but just when everyone sort of got on the same page with that, they decided to change everything with the introduction of ICD10. Now, we have never seen anyone who got injured by collision with a space-ship, but come October 1st, I'll be able to code it if one of our providers ever does :raspberry: .
 
Anybody know the correct spelling of Luddite ?
 
Anecdotally I have found out that even with computers, communication between different doctors isn't that good. I think they still use fax machines... that is if they even decide to communicate.
For sure. I recently referred a patient in the ED to the local cardiologist. Sent him a HIPAA-compliant e-mail with the particulars. Got a message back days later, "Please don't e-mail me about referrals. I rarely check my e-mail." Seeing that I work almost exclusively nights, and he only appears between 8 a.m. and 4 p.m., how's that supposed to work, exactly? Right...fax. :mad2:
 
Even large hospitals within a given city rarely even communicate.

Got that right! Even the heart practice I see (affiliated with and in that same building as the hospital) and the hostipal itself don't share records.

See the cardio one day, answer questions and fill out a metric excrementload of forms. Get refered to the hospital for a test procedure, and re-answer all those questions and re-fill out the excrementload of forms.

Brilliant! :rolleyes2:
 
"metric excrementload " -- :D :rofl:
 
If you desire a personal relationship with a doctor you trust you will either; 1) have to get over that quaint notion, or 2) be willing to pay cash for the quality and soundness- of- mind you get from a personal relationship with a doctor.
My PCP left the group he was with and went private about a year ago. Cash on the barrel head only, no insurance at all. As one with a high deductible plan I am acutely aware that his prices have dropped about 50%. Damn, I love his new place!
 
My PCP left the group he was with and went private about a year ago. Cash on the barrel head only, no insurance at all. As one with a high deductible plan I am acutely aware that his prices have dropped about 50%. Damn, I love his new place!

With the 'cash on the barrel' method, he can put his price where he believe it is right and doesn't have to play the silly insurance game. Also if he has opted out of medicare, he can set his price ever which way he pleases without worrying about medicares wrath for not giving them 'his best price'.
 
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