Enough with the hospitals, what about its providers?
I’ve gone through a lot of information detailing about hospitals and their attacks lately, but how about the providers? How are they affected by the new technologies? Also a short dive into recent politicking!
Now, I’ve discussed a plethora of information regarding EHR, Health IT, and Hospitals… but I never really touched on the other half of the industry… the people that actually work in it. Sure the hospitals and administration are greatly affected by the plethora of new policies, standards, and guidelines that they must follow… but unfortunately they’re compensated well for their work. It’s no secret that administration in any industry is often compensated well for their work, and healthcare is no different. Especially with the upcoming presidential debates, there have been talks about a single-payer system, and although that is a great idea for the people and the patients, it’s not that great for the providers themselves. More on that later on!
Source and Reddit
EHR. Costly. Time-consuming. Resource Intensive. Hospitals are able to foot the bill, maybe even larger private group practices… but EHR has been the leading cause of death… for solo practices (got you there right?) Due to these high costs, the solo practices simply cannot foot the bill and either end up selling their practice, merging together with larger private healthcare groups, or end up getting swallowed into the ever-reaching medical conglomerate known as teaching universities and their health systems. Unfortunately, it makes sense… American cannot continue to sustain the current growth of healthcare spending, and if we want to avoid drastic cost and resource rationing, there have to be policies that are widely implemented to try and contain this cancerous growth. Although there have been examples where EHR has been implemented well, that is only one aspect of a healthcare system. A commonly cited example is the VA and that despite ALL of its problems and scandals that it has gone through (cough cough fake data and waiting times cough cough)
It is still one of the more successful examples of publicly funded healthcare with a strong EHR implementation. I could write another full post regarding the VA scandal, but it’s not something that is surprising in general now. Long waiting times and the huge delay in transitioning to EHR. However it is the only comprehensive medical system primarily for the veterans, but along with it comes records of past service, medical issues, financial options, etc. In fact, in the image to the right it was found that those filing cabinets and those stacks comprised of about 0.2% of the records. There was so much and in such a small space that it actually caused structural damage to the building and was at risk for breaking through the ground. Another thing to mention about the VA problems are that it is a small infrastructure for a large population, thus long wait times… but in order to improve those depressing health outcomes, certain people decided to forge the data and hide the unsatisfactory wait times. With an ever increasing population now being eligible for the VA, from the Vietnam veterans to soldiers coming out of the Afghanistan/Iran conflicts. Aside from that, each military branch has their own set of medical records that weren’t really required to be interoperable thus they are different not only from each other but from the VA as well. Thus, in order to cut the “administrative spending” on these government institutions, many of the providers are now forced into translating medical records into VA-formatted ones. However the VA is good for a few things, and that is having loan repayment programs that can help cancel young docs’ loans as long as they commit a few years to the VA. Other organizations have such programs which isn’t too bad but in the end it’s a very rough time to be in. In fact, nearly 70% of physicians have said digitization has not been worth the cost, even after close to $30 billion in government incentives.
As someone who works in IT and has done some programming as well as project management. I can honestly say that EHR was simply poorly designed and poorly implemented. If it had more of a focus on physician/nurse/provider workflow as well as designing/coding best practices, it could have EASILY revolutionized healthcare. The ball was dropped by designers, implementers, and unfortunately the project managers who only did what they were ordered instead of thinking in the product’s as well as its users’ best interests. Providers were shafted. Not only on costs but also on workflow. They were expected to increase efficiency, but how could that happen when EHR were actually designed for billing, finances, reimbursements, and helping the government catch those exploiting Medicare/Medicaid (oh it seems all of them are money related… hmm) Not about improving patient care, but about the ability to get money back. A passive cost containment.
The train to reality has left, and all we can do is day dream about a proper EHR that is designed for patient care with provider workflow in mind. These providers are now stepping back with their faces in awestruck horror, as they struggle to restructure not only their workflow but also clinical thought processes to checkboxes, antiquated word processing functions that are logically flowed and terribly overpriced. I guess you could say it’s similar to med-tech, because of the monopoly of the market it’s able to present “brand new” innovations that when actually examined contain technologies from years past. However, the industry is able to do so, there is no other competitor and if any arise, are severely demolished. As someone who hopes to go into medicine, my background in IT emphasizes and nags on me to document everything, steps, and procedures for future reference, but there is a difference between superior and meaningful documentation and inferior hogwash that is likened to as documentation. Documentation is meant to increase and better outcomes, to produce reliable and valid results… but that’s not what it is seeming like. Providers are angry and disgruntled.