I’ve discussed the first three players in the current medical system in the last three days: patient, physician and Pharma. The fourth player is, by far, the most virulent of all the players. Despite the fact that player number four is not even human, the almighty electronic medical record, EMR, has taken over the control of almost every aspect of the healthcare industry.
The EMR has grown and propagated to the extent that all players in the medical game have to bow to its lust for data and control. Much like the insurance companies slithered into our offices and hospitals, so did the serpent called EMR.
The EMR promised to improve care by making medical records more accessible, offices more efficient, billing more standardized, along with dozens of other never realized benefits. To the best of my knowledge, there has never been a study that showed that the EMR improved any outcome or care.
What the EMR has done is enslave your doctor, his/her staff and you. As you know, I’ve been seeing a lot of physicians. Before I can see any physician, I have to go online and fill in the blanks on countless forms. I’ve filled out the same forms three times over as, despite earlier promises, EMRs don’t talk to each other.
Physicians and their staffs spend a large part of every patient visit filling in computer templates. Template medicine tends to train those using it to think the way the template would like you to think. Your doctor should have an open mind, ready to explore all aspects of your health. Instead, he/she may well be closed minded, concentrating on asking the questions needed to answer the specific questions the computer requires him/her to answer.
So, how did the EMR become so powerful? It became powerful by wrapping itself around the financial heart of the medical complex: billing. WHEN THE EMR BECAME RESPONSIBLE FOR BILLING AND RECEIVING MONEY DUE FOR SERVICES RENDERED, IT SPELLED THE END OF THE PRACTICE OF MEDICINE AS I KNEW IT WHEN I FIRST OPENED MY OFFICE.
It was ingenious. It was as if my free will was kidnapped and held for ransom. Check 25 items on your practice’s EMR and you’ll get paid $37.50. Check 30 items and get paid $60. All of a sudden, your primary role as a physician has shifted from caring for your patient to checking boxes. The same goes for each of your staff members. It’s even worse in the hospital. The last newborn I attended to took 40 minutes of care in the room with the parents and their child and 60 minutes on the computer clicking all the boxes the hospital required, as well as those the insurer required.
Let me quickly mention the fifth party involved in your medical care. The number 5 bucket holds everyone else. The primary players in group five are the administrators. Their job is to turn a profit, even when they work for a not-for-profit organization. I’ll never understand how not-for-profit hospital chains get away with generating huge profits.
Back to our task at hand, redesigning our healthcare system. Just as I’ve told you that the insurers must go, the EMR must stay. However, the EMR needs to be tamed and used to improve patient care, not to bill for it.
So, we need to eliminate insurance companies and redirect the EMR. How do we do that? I’m open to all suggestions. I don’t really believe that our system is fixable. I don’t believe a better system can be designed. Tomorrow, I’ll explore universal healthcare, a single payer system.
Here’s your music for the day and a joke.
What’s the difference between a piano and a fish? You can tune a piano, but you can’t tuna fish.