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Technology Is Making Doctors Feel Like Glorified Data Entry Clerks (fastcompany.com) 326

An anonymous reader writes from a report via Fast Company: The average day for a doctor consists of hours of data entry. Since the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 took effect in January of 2011, which incentivized providers to adopt electronic medical records, hospitals have spent millions, sometimes billions, on computer systems that weren't designed to help providers treat patients to begin with. The technology was supposed to reduce inefficiencies, make doctors' lives easier, and improve patient outcomes, but in fact it has done the opposite. "Frankly, the main incentive is to document exhaustively so you cover your ass and get paid," says Jay Parkinson, a New York-based pediatrician and the founder of health-tech startup Sherpa. The systems are flooding doctors with important and utterly meaningless alerts. One of the biggest problems is that the systems have made it very difficult for doctors to share information between one another, which is what the systems were intended to do all along. Why? "Because it doesn't help the bottom line of the biggest medical record vendors or the hospitals to make it easy for patients to change doctors," reports Fast Company. Since it often takes weeks, or months for data to be sent to and from facilities, that, according to Consumers Union staff attorney Dana Mendelsohn, increases the chances of doctors ordering duplicate tests. All of this reduces the time doctors have with their patients. A recent study shows that the average time doctors spend with their patients is about eight minutes and 12% of their time, down from 20% of their time in the late 1980s. "This group is 15 times more likely to burn out than professionals in any other line of work," reports Fast Company. "And much of the research on the topic concludes that 'documentation overload' is a key factor." To help alleviate this pain, medical groups are working to reduce the data-entry burden for doctors, so they can in turn spend more of their time with patients.
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Technology Is Making Doctors Feel Like Glorified Data Entry Clerks

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  • might as well "doctor to the data"
  • by dpbsmith ( 263124 ) on Tuesday July 19, 2016 @09:06PM (#52544767) Homepage

    My primary card doctor is reasonably young and when I started seeing her, she keyed in notes about treatment plans and such right into the office computer. So I know she's comfortable with computers and that's she's a fast typist.

    About two years ago, when she came into the exam room, she was followed by a young person with a laptop whom she introduced as "my scribe!" Her scribe was constantly tapping away at the laptop, taking notes and entering orders and so forth.

    I don't honestly know whether this is good, bad, or indifferent, but it certainly is evidence that the burden of data has become so overwhelming that doctors need assistants specifically to help with that.

    She works for a gigantic megapractice that is proud of being a Patient Centered Medical Home and an Accountable Care Organization and all that good stuff, so I think they are following current "best practices."

    Geezer reminiscence on. When I was a kid, the doctor's office had a big lab, where they had microscopes and hemocytometers and did their own lab work, and a small business office. Now the labs are gone--they send all the lab work out. The business offices occupy a third of the floor space, because they need room for people waiting all day long on hold to talk to insurance companies. And they have to hire scribes to help the doctor with the data entry. Maybe it's progress.

    • Good. A doctor (not a surgeon) is mostly making technical decisions. Expert systems tend to be better at that kind of thing. I don't see much value in onsite labs (immediacy, I suppose). Why not make it all standardized, auditable, and cheaper by eliminated glorified, failure-prone human symptom lookup tables?

      • More on site labs though would push through better and faster ways to get results back. What if doctor could have your blood work done while starting the next patient? That by itself would save billions of dollars.

        • My doctor does have onsite labs, and they do do exactly that. Rarer labs I assume they send out, and I have to comeback.

          You're correct that the cost savings of outsourcing labs are really partially costs externalized to patients by forcing them to come back. I imagine that there would be some way to solve for that.

      • I agree, that's why I always just google my symptoms and self-medicate.
      • by tomhath ( 637240 )

        A doctor (not a surgeon) is mostly making technical decisions. Expert systems tend to be better at that kind of thing.

        Completely wrong on both points. Every step of a surgery involves making decisions. Expert systems are useless at examining people and making sense of the symptoms.

    • by Hadlock ( 143607 ) on Tuesday July 19, 2016 @09:29PM (#52544853) Homepage Journal

      I had to get my hand looked at after a bicycle accident about 2 years ago that could have impacted my range of movement. The doctor turned on a recorder that had a foot pedal as a sort of "push to talk/record" system. Every time he put his foot down it would start recording, and stop when he let off. This tape then got labeled with my case number and sent off to a transcriptionist/service. I don't know why you need the scribe in the room but whatever. The transcription cost gets passed along to the insurance company. No big deal.
       
      The big bonus here is that me, the patient, gets to hear exactly what is going in to the doctor's notes, not getting the sanitized version. Also the doctor doesn't have to mentally repeat themself hours after the appointment.

      • Because people keep demanding that it gets cheaper so that tape gets sent off to India where it's transcribed by someone that barely speaks english.

      • by Anonymous Coward on Wednesday July 20, 2016 @01:27AM (#52545609)

        I'm a doctor and I can tell you the transcription cost does NOT get passed along to insurance to reimburse. Same thing as a scribe. Doesn't sound like much but now I get $15/Hr taken out of my paycheck to pay for a scribe because of these EMRs. It's either that or I get to stay 3 hours late doing it myself.
        Amazing that we have iPhones with such amazing software while I'm using a MS-DOS looking EMR because my hospital requires me to use it.

    • Modern practice of medicine absolutely does make doctors into data entry clerks. Big data is telling them what works, what doesn't, improving diagnosis and treatment, the volume of data and pace of discovery are such that no human being could possibly keep up with it in the traditional med school + residency + practice & annual CE fashion. If your doctor isn't "jacked into the cloud," you're not getting the best out of modern medicine.

      This is ABSOLUTELY not to say that the best medical care comes from

    • by Flozzin ( 626330 )
      I came here to post this as an idea. If they are burdened with having to do data entry, hire someone to do it for them. It's easier to talk than to type for most people, especially when it takes mouse movements to go each of the correct textareas I'm sure they have. Or as another poster pointed out in his office visit, record the conversations and send them off to get transcribed.
    • Your PCP (as well as you) are lucky. My PCP spouse is a total burnout case because of the data entry problem and lack of organizational support. I see two factors here: (1) the doctors just suck it up and put in countless hours of unpaid overtime to feed the beast, and (2) the suits that run the place don't have the business acumen to realize that a scribe would easily pay for themselves in increased billings since the doctors could handle a larger panel.

      It kills me because it seems like the specialists h

    • by NoKaOi ( 1415755 )

      but it certainly is evidence that the burden of data has become so overwhelming that doctors need assistants specifically to help with that.

      The burden isn't on the amount of data, but rather the absolutely horrible systems that doctors have to use. Every major EMR out there is a flaming pile of crap. The thing is, they really don't care about investing in improving usability. They get selected for contracts with hospitals and clinics based off a checklist of features along with getting to tell them that so many other places use it, and the initial deliverable isn't even usable. So then they charge big, big dollars for "implementation" to ma

    • by houghi ( 78078 )

      My doctor types in what I am there fore, print outs the prescriptions (so they are readable) and papers for the insurance. If he would have a scribe, I would ask that scribe to leave.

      Once every 2 years I need to sign a paper that the other doctors in the office are allowed to access my data. If not, they will not see it.

      I do not need to wait that long as I make an appointment online. I calculate an hour when I go to the doctor. It is a doctors group that has 6 or 7 doctors. I choose that, so when the docto

  • It's not only outside of consultations that doctors can spend time entering data. I once switched doctors because he spent most of every consultation oriented towards his screen and keyboard, entering symptoms, treatments, and medication into my medical record, and little time speaking with me face-to-face.
    • Re:The mighty data (Score:4, Interesting)

      by ShanghaiBill ( 739463 ) on Tuesday July 19, 2016 @11:19PM (#52545261)

      I once switched doctors because he spent most of every consultation oriented towards his screen and keyboard, entering symptoms, treatments, and medication into my medical record, and little time speaking with me face-to-face.

      So you switched because your doctor focused on medical issues rather than providing you with emotionally comforting talk therapy?

      You are not alone. If you look at doctor review sites, by far the biggest reason for low ratings is a rude receptionist. The 2nd biggest reason is doctors that avoided chit-chat. Actual quality of treatment and medical outcomes are rarely even mentioned.

       

      • by Mandrel ( 765308 )

        So you switched because your doctor focused on medical issues rather than providing you with emotionally comforting talk therapy?

        You are not alone. If you look at doctor review sites, by far the biggest reason for low ratings is a rude receptionist. The 2nd biggest reason is doctors that avoided chit-chat. Actual quality of treatment and medical outcomes are rarely even mentioned.

        It wasn't chit-chat I was missing. It was someone who could concentrate on listening to me and asking the right questions, instead of on data entry. My current doctor does this. He must update my record after I've left.

        • by Anonymous Coward

          Actually, I just don't bother to update it unless its billable. Best of luck tho!

  • I know when we go to the pediatrician for a fever, it takes 5 minutes for them to find the code for tylenol.

    • Re: (Score:3, Interesting)

      by Anonymous Coward

      Usually because of bad UI. All knowledge has been replaced with codes and it's our job to learn the codes to find anything. ...and tomorrow the codes will change, because fuck you.

      Jesus fucking christ, didn't we invent "Search" to solve these problems?

      • "Usually because of bad UI. All knowledge has been replaced with codes and it's our job to learn the codes to find anything. ...and tomorrow the codes will change, because fuck you."

        Doctors shouldn't have to think in terms of the codes that the billing system runs on. Have a Siri-like voice interface that translates a doctor's spoken summary of procedures into the current codes. It could provide feedback (through an earpiece inaudible to the patient) when the doctor's description of something is imprecise.

      • Yes. The UI's I've seen suck to high heaven. It's not hard to be five levels deep in nested dialog boxes as they have to navigate checkboxes and codes that are spread all over the place. The visual context-switching that has to be done to enter the information for a single visit is staggering. Not only is it slow as hell, but mentally taxing. A huge waste of the physician's mental bandwidth.
  • by Anonymous Coward on Tuesday July 19, 2016 @09:15PM (#52544801)

    I have stage 4 cancer and spend a few hours at the doctor's office every month. The phlebotomists spend a solid minute selecting my record, marking off all the tests, verifying id, insurance, etc. The nurses go down the list of 50 prescriptions I have, asking me if I'm still taking them, even when I say nothing has changed. They're all very polite and nice, but the whole system fails at easy things should be easy, hard things should be do-able design. You can tell that no one who designed the system ever actually performed the tasks at hand (or they were bound by absurd requirements). And all that isn't including the massive bureaucracy of insurance or scheduling that will sink days of your time pressing buttons on your phone trying to talk to an actual person.

    In my experience american health care is an inefficient, bureaucratic mess manned by very friendly medical professionals.

    • by Hans Lehmann ( 571625 ) on Tuesday July 19, 2016 @11:45PM (#52545369)
      I just went to a doctor this week, and they also asked me about my current medications. I also said "same as last time", so they printed out a form with the medications I mentioned in my last visit and just had me initial it to make sure. They don't just do this to cover their ass, they also do this to cover yours. For every ten patients that insist that "Oh, nothing's changed", they'll probably have one that eventually says "Oh wait, I stopped taking that one two months ago, I forgot to mention it". When it comes to my health, I'm glad they double check their work, and mine.
      • Patients are horrendously unreliable. The classic is hospital surgery. "Have you had anything to eat since last night." "No, just a bacon and egg McMuffin on the way in this morning." *

        *actual conversation I heard while waiting for surgery. The person didn't think don't eat meant don't eat.

        • by jittles ( 1613415 ) on Wednesday July 20, 2016 @08:55AM (#52546707)

          Patients are horrendously unreliable. The classic is hospital surgery. "Have you had anything to eat since last night." "No, just a bacon and egg McMuffin on the way in this morning." *

          *actual conversation I heard while waiting for surgery. The person didn't think don't eat meant don't eat.

          TO be fair to the patient, I would hardly call that food.

  • Is data entry really the negative stress on the "Time with Patient" stat? I'd guess it's more likely organizations pressuring Drs to treat more patients in a single day; documentation is only a part of that equation.

  • by rtb61 ( 674572 ) on Tuesday July 19, 2016 @09:21PM (#52544829) Homepage

    This is the exact 'outcome' you would expect when corporate lobbyists write government policy. Instead of that policy providing the maximum service at the lowest cost, it provides the least service at the maximum cost. That cost being to the end users and not of course the lobbyists funders, for them it is as cheap as possible and hence maximises profits, 100%, 200%, 1,000% unlimited profits and unlimited power. Pretty 'sick' stuff (snark).

    Point of sale tech companies should be writing this, a range of confirmed, emphatically confirmed (use big fonts on confirmation with details to ensure readability, really big fonts, mistakes will kill, so confirmation buttons at the end of each sentence, think plane take off check lists), selection through a menu structure with additional comments and possibly a patient screen so they can see what is going on. You really want the doctor inputs to occur as they treat the patient, medium sized touch screen with a readily and cheaply replaceable cover (swap between patients, doctor touches patients, doctor touches screen) and a camera for close ups and photo record, possibly video elements of doctor patient sessions (all suspended on an adjustable arm from the ceiling) with a smaller smart phone styled extension (corder, doctor patient privacy requires a completely wired system) for greater flexibility. A smarter system would have some idea of what it is 'looking' at and recording ie it can recognise parts of the human anatomy arms, eyes, ears etc (helps guide the menu structure, don't let M$ touch this bit, they always fuck this shit right up, no Mr Paperclip fuckups).

  • by Rei ( 128717 ) on Tuesday July 19, 2016 @09:23PM (#52544833) Homepage

    Slashdot: News for Americans. Stuff that matters to Americans.

    Not everyone operates on a medical system like the weird one in the US....

    • Not everyone operates on a medical system like the weird one in the US....

      In the UK, GPs working for the National Health Service have all sorts of financial incentives, which means that when you visit your GP, 2/3 of the time will be spend on things unrelated to whatever took you to the office in the first place, but very closely related to those incentive payments that the GPs can receive.

    • Slashdot: News for Americans. Stuff that matters to Americans.

      Not everyone operates on a medical system like the weird one in the US....

      And yet despite this you can see the rise in paperwork in the western world too. It's particularly bad with old doctors who aren't touch typists. I actually changed doctors because my visits got too long while waiting for him to work his new and improved computer system.

  • Time to do taxes, I gather everything up and hand the pile to him. He spends maybe 20 minutes going through my pile, asking me questions, then gives me a pretty good estimate of where I stand. Cost? $300. Time for me? 20 minutes, plus travel time/making the pile. Time for him? Probably 22 minutes.

    I go to my doc (copay) and wait 20-30 minutes. He asks questions, I answer (10 minutes). Odds are, I get sent to a specialist (copay). I wait for the Specialist (20-30 minutes). Specialist orders test
    • Your tax professional certainly does have malpractice insurance.

    • The dirty secret is that if you have a 10% copay, you pay that 10% and then the insurance company company pays a fraction of their "90%".

      Once you hit your deductible and start paying only the copays, the doctors receive a lot less payment for their services.

      It sounds like your tax accountant is expensive. I was paying my accountant about $700, but that included rental houses overseas and a multi-page FBAR filing.

    • Now I realize my tax guy farking up is much less serious than my doc farking up. Still, the crap doctors have to keep track of/order tests for/ just to avoid a lawsuit is mind boggling.

      Next time someone in your family needs serious surgery, or has some life-threatening disease, you should just ask your tax guy to do it.

      Because why should we have regulations on the medical industry? Why should there be malpractice insurance?

      http://rationalwiki.org/wiki/1... [rationalwiki.org]

      http://listverse.com/2013/05/2... [listverse.com]

    • Does your tax guy have $250k+ of med school debt?

  • by Beeftopia ( 1846720 ) on Tuesday July 19, 2016 @09:44PM (#52544915)

    If you want to get a visceral appreciation for the complexity of medical billing today, check out the Medicare Claims Processing Manual [cms.gov].

    It almost seems like you can't merely get an administrative assistant, but you need someone with an A.A. in medical billing.

    The thing that really left me aghast was the move from ICD 9 to ICD 10 (diagnosis codes and descriptions) [cdc.gov]. Those #$&!!?! policy geniuses completely abandoned the ICD 9 codes and instituted all new ICD 10 codes. There was a big infrastructure around ICD 9. There is plenty of overlap in the codes, so it's a recipe for mass confusion. It's stunning that there was not even any attempt to have even a scintilla of backward compatibility.

    It is almost like there are no senior database or programming architects involved in any of these decisions regarding medical IT. From what I've seen, it seems to me that it's purely non-technical policy staff driving this stuff. You have to get senior database and programming and UI architects in some of these decisions to reintroduce some sanity and control over the complexity of the solutions.

    • You have to get senior database and programming and UI architects in some of these decisions to reintroduce some sanity and control over the complexity of the solutions.

      And when I say "senior", I mean SENIOR. Like 15 to 20 years of experience working with databases with lots of tables and millions of rows. Someone who's actually been around the block and understands how things work and don't work. At a minimum, that's the database person necessary. Also having true senior programmers and UI types would be

    • It's the companies that will make billions to implement it that are driving the changes. Yet if I dont get lab work done by an affiliated lab it's shows up as a fax and never gets coded into my online records. My daughters pediatricians electronic records is just a bunch of scans of paper docs to comply on paper without doing anything useful. I've actualy watch the input methods shrink no longer taking electronic weights glucose levels etc rather requiring hand input.

      • It used to be that people got sick so that doctors could get paid.

        Now people get sick so that IT consultants can get their finger in the pie. And what a fat pie it is.

        As an IT consultant, the more confused the billing system is the better.

  • Burnt out doc here: (Score:5, Interesting)

    by Anonymous Coward on Tuesday July 19, 2016 @09:45PM (#52544931)

    So, yeah. I've come through my training early in the era of EMR's and have seen this clusterfrack evolve over nearly a decade and a half. I've worked with more than half a dozen EMR's over the past 15+ years, and have not only not seen anything more than improvements in appearance (because in large institutions and hospitals the paper-pushers that are actually going to approve an EMR can really only go by how it looks, since they rarely truly understand what doctors need from a record system), and I would go as far as to say many EMR's are becoming actively more difficult to work with, demanding more repetitive entry of questionably valuable data, more and more "billing" specific entry, and, as noted above, more and more URGENT ALERTS that only rarely are actually relevant to my patient.

    As also noted above, patient interactions have become the absolute smallest fraction of my work. I spend easily 2-3 times the amount of time I spend seeing and talking to patient in documenting those interactions, and new patients can far-to-often take an hour or more to document "adequately" in many EMRs I have had to deal with. I have colleagues that work from 7A to 6-7P, go home, and then after a few hours with their family, they resume "charting" until 10PM, 11PM, or even later. I've even had emails sent after 1AM from colleagues when I know they were in clinic that day, and have clinic the next day. And these are not periods of "unusually heavy utilization" like flu or RSV season, this is their typical clinic. Visit documentation, lab orders, lab confirmations, insurance issues, finding results in the system. It's disgusting that I spend so little time actually BEING A DOCTOR. It's even more disgusting that I'm told the problem is I'm not "using it right," or that I need to "be more efficient with my documentation," but every time I've requested assistance with "using it right" or improving efficiency (god what an infuriating phrase), I've been either blown off or had someone come by to "listen to my concerns" but never actually stayed to OBSERVE practical use, so nothing continued to change.

    The core problem is, I have YET to see an EMR designed by people who actually have gotten down-on-the-ground with medical providers. None of these programers have followed us around, have watched the nurses, have shadowed the medical assistants, and so of course none of them can really meet our needs! Can you imagine the absolute HELL that would be raised if this is how coding was done, for example, in the aerospace industry? If the guy responsible for setting up the pilot's computer never set foot in a cockpit?

    I've struggled with bad and worse EMRs (on top of other issues admittedly), and personally I've partially given up. I've left my full-time sub-specialty practice. I'm considering part-time now, though even that would be close to 40 hours a week. Frankly I'm tempted to leave medicine altogether, though I really don't want to give up patient care. As corny as it probably sounds to the /. crowd, I *love* (most of) my patients. I loved being able to help people figure out how to live with chronic issues, helping them get healthy and stay that way, talking with families about their fears and helping them come to terms with major diagnoses or deal with worse... It's an honor and a privilege to have been given this much TRUST by people, and I've done my damnedest to be worthy of that privilege. However, modern medicine has become so obsessed with documentation, and EMRs have become the worst reflection of this documentation, that medicine is becoming ever more toxic a field to work in.

    TLDR version; EMRs are not user friendly (they are fairly Admin and billing friendly, though), they are not getting better, and they (in my humble experience) are demanding more and more time for less and less benefit, and in many ways they have become a problem WORSE than the problem they were intended to solve. This is not a "doctors hate technology" problem, this is a "doctors are not being given

    • by level_headed_midwest ( 888889 ) on Tuesday July 19, 2016 @10:21PM (#52545081)
      Surprisingly, I haven't yet seen anybody here actually say *why* we have this morass. The government forced this on physicians with the HITECH Act and subsequent Medicare dictates because it suits THEIR objectives. The government wants to amass as much information on as many people as they can- just look at what it did (as in "is still doing") with the NSA. They want to be able to pick through that information for their own political purposes, a big one being finding "reasons" to pay physicians less, since the politicians grossly over-promised on Medicare and are unwilling to face up to this. Instead, they want to shift costs to doctors, and it's easier if they are "bad." They also want to use cherry-picked data to back up other political objectives like gun control, food control, etc. EMRs are clearly designed as auditing systems around federal mandates, anybody who has put information into one knows this in spades. Analyzing this data also requires a larger federal bureaucracy which the feds always love. The cronies also love EMRs well. The EMR business grew by several orders of magnitude when they went from optional (and rare) to being mandatory. Ditto with all of the compliance firms that deal with all of the issues that having an EMR now cause. Those firms lobby and "donate" to politicians to maintain their captive markets.
      • by dmr001 ( 103373 )

        I like a conspiracy theory as much as anyone, but I really don't think the NSA convinced Congress to pass the not thoroughly thought out HITECH Act to amass statistics about the home addresses of people with pneumonia or which patients with high blood pressure are smoking. Being able to gather anonymized statistics on public health issues may help, however, to figure out how to improve immunization rates or best help diabetics get their blood sugar under control.

        To the grandparent poster, our EMR company

    • Thank you for sharing your experiences. Where do you think we go from here? At what point does the whole system collapse? I sometimes think it it will take a prolonged macroeconomic disaster to force a total revamp.

    • EMRs aren't designed by anyone that actually uses them. I keep trying to convince my wife and all of her medical friends to just spend a bit of time picking up some Python or UI tools and the world will beat a path to your door. Imagine an EMR designed by people that use EMRs.

      And the default screen for the doctor isn't the default screen for the nurse isn't the default screen for the receptionist.

    • I've worked for the past two years as a software engineer at athenahealth. The experiences that you described are well known throughout the R&D people that I work with. I actually *have* been to clinics and followed doctors, PAs, and other staff around as they went about their day. I've seen them working with other EHR software that looks like it was built in the early 1980s. I've listened to them describe their ideal software solutions and what their biggest pain points are. AFAIK, my company is the on
    • The core problem is, I have YET to see an EMR designed by people who actually have gotten down-on-the-ground with medical providers.

      This. I've set up a few EMRs for some of my private practice doctor clients. From what I've seen, the software is written to make the programmer's life easier, not the user's. The programmer sees from the government specificiations that he has to implement a list of codes for ailments, and dutifully types them straight into a drop-down list because that's the easiest way t

  • by The-Forge ( 84105 ) on Tuesday July 19, 2016 @09:49PM (#52544945)

    They have the wrong article linked above. This is the right one: http://www.fastcompany.com/3061860/the-future-of-work/how-technology-is-making-doctors-hate-their-jobs

  • Welcome to my life. As a software engineer I must document everything and make reports and tickets for every single change. Even if a single digit code change takes only 2 seconds to make, I spend up to maybe 2 hours documenting, making TPS reports, tickets and work reports for that single change. Most likely that work will never be read again ever.

    • by sconeu ( 64226 )

      I spend up to maybe 2 hours documenting, making TPS reports, tickets and work reports for that single change.

      You forgot the new cover sheet for the TPS report. So if you could remember it next time, that would be great...

  • by rsilvergun ( 571051 ) on Tuesday July 19, 2016 @11:06PM (#52545229)
    the constant battles on the part of doctors to get paid by insurance companies who's single goal is to not pay. In no other part of my life are my goals (getting care) and the service provider's goals (not paying for that care) so diametrically opposed. I've got family members with nasty health complications from easily treatable problems that were let go because the doctor didn't want to order tests in case they came back negative. If a test comes back negative the doctors never get paid.

    Come to think of it I see this in one other place. B2B transactions. In so many of them business A won't pay the invoice for business B until A needs B's services again. I read somewhere Don Trump is famous for that, but having worked for small businesses it's so common he could just be going with the flow.
  • by ytene ( 4376651 ) on Tuesday July 19, 2016 @11:18PM (#52545255)
    But how much of this analysis looked at the fact that if a doctor mis-diagnoses something, or misses something, they are immediately subject to massive lawsuits?

    The litigation culture that pervades the medical profession, particularly in the US, makes it increasingly difficult for doctor to do their job properly, because if they deviate even slightly from "accepted practice" they end up served with a malpractice suit.

    It is going to be fear of litigation, not poor IT, that drives the change in behaviour. That and the fact that a patient who can be sold care of some kind is considered a revenue-generator to be held on to. In other words, the healthcare system is no longer about the health of or care given to the patient, it's all about the relative profitability of the condition they bring.

    This is what happens when you operate a health service on a financial model. Why are we surprised by this?
  • This is one of my favourite EconTalk episodes of all time.

    The guest talks about the "ethical drift" resulting from the imposition of an impossible burden. (My favourite EconTalk episodes are usually the ones where Russ is surprised to discover that the world works as well as it does. In this one, he's shocked by the military's willingness to engage in self-criticism.)

    Leonard Wong on Honesty and Ethics in the Military [econtalk.org]

    This one is not unbearably polemic for a general audience, and it's tremendously apropos.

    • by epine ( 68316 )

      I should have included the blurb in my post above.

      Based on a recent co-authored paper, Wong argues that the paperwork and training burden on U.S. military officers requires dishonesty—it is simply impossible to comply with all the requirements. This creates a tension for an institution that prides itself on honesty, trust, and integrity. The conversation closes with suggestions for how the military might reform the compliance and requirement process.

      What I recall from the episode is that by the end th

  • My internist, who's many years younger me so he's not just some cranky old Luddite, tried the using iPads, etc., for about a year before he threw it all out and went back to a manila folder with the patient's name on it, with all the medical records inside. I feel more comfortable with him than with his associate who seems to look everything up on their phone before making a decision. Just my data point.
  • I used to get work done. Then a whole bunch of middle managers with no UI training discovered the entire ITIL framework.

    I work more for the system than it works for me.

  • by Tablizer ( 95088 ) on Wednesday July 20, 2016 @01:56AM (#52545677) Journal

    My doc asked me about family history of a condition. I told her my mom had surgery for the condition roughly a year ago. She started typing in the date, and paused:

    "It requires an exact date. I can't enter an approximation. Can you by chance remember your mom's exact surgery date? They don't like dates that are off in case they want to research it.", she asked. (My mom is under the same provider.)

    After pondering a bit, I suggested she see if there is a "notes" fields to indicate it's only an approximation.

    "Hmm, let me see...", she replied.

    After about 5 minutes of digging between screens, she said, "Okay, here's the doggon note section."

  • by Gunfighter ( 1944 ) on Wednesday July 20, 2016 @01:10PM (#52548043) Homepage

    I've encountered medical scribes twice now:

    1. During a trip to my ophthalmologist, the doctor did the examining and talked the entire time (not to me) while the scribe took the notes.

    2. During my most recent trip to the ER (for a relative, not for myself), the doctor came in with a medical scribe. The scribe wheeled in a cart with a laptop and stood quietly in the corner. The scribe's job was to do nothing but take notes for the doctor while he examined the patient.

    In both settings, the setup seemed to work very well. Perhaps this is the answer to the "over-data" problem described in the OP.

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