Someone I know works at a non-profit organization (supported by health insurers) that is trying to simplify the administrative processes in healthcare. He’s tasked with finding ways to make data transfer between doctors’ offices and health insurance companies more uniform and straightforward. His work is such a success that it was promoted to President Obama as a clear example of health insurers’ efforts to reduce waste and simplify healthcare. There is even talk of his project becoming mandated.
So why is this simplification strategy now in jeopardy of being tabled rather than legislated? Vendors and clearinghouses who exist to transfer data from one disparate health insurance bureaucracy and medical practice to another are fighting to block this progress because their business model is at risk. If health insurers and physicians can safely and efficiently exchange data – then they become less reliant on middle men.
One person’s waste (non-uniform, inefficient data exchange) is another’s (clearing houses and vendors) job security.
And we wonder why it’s so difficult to reform healthcare?
I filter through progress notes looking for the few sentences different from the day before, only to find them sandwiching pages and pages of electronically-produced babble dutifully and automatically mass-reproduced in every note. I wonder, has anyone ever looked retrospectively at the mess created by this process developed to assure doctors were doing what they said they were doing? Ironically, I find we’re rarely reading most of what we re-create each day.
But we’re sure good at following the rules.
I now see prescription refills for each and every bottle of prescriptions ever filled by a patient, the date a patient filled it, and how many pills they received with each prescription. I’m not sure why. I sat awestruck in clinic yesterday when the list extended 94 pages, double-spaced, since January, 2009. No one, and I mean no one, filled that many prescriptions, did they? Or did they? Am I supposed to correct that list? Oh, by the way dear referring doctor, my note’s at the bottom of that listing.
I get pre-surgical notifications, even though I was the one to notify everyone else about the need for admission, just so I can click on the patient’s name again, lest it not appear I’m not doing enough, I guess.
I get EKG results forwarded for me to sign electronically, even though I’ve already read them, and signed them, by hand, on the EKG. I get notified again that the order I entered for that EKG now has a result, and I have to click on that to tell the computer, “I know.” But that, you see, is not enough. I must also log in, review, and sign off on my EKG’s on the EKG server, too. After all, I’m responsible, and it’s all about quality.
Quality three times over.
Now, multiply that same process for each and every other test I have ordered.
I see orders for things I’m not sure I ordered, just to be sure I’m responsible, and watching, literally hundreds of times per day.
I get e-mails and electronic notifications, and electronic communications, as if I know the difference.
I bypass nursing notes that are mere QA checklists and say nothing about the patient, except that a nurse was there last night.
I feel guilty entering data as I talk to my patient while serving my electronic master. Yet I find the stakes are high to assure accuracy and timeliness in clinical electronic reporting. After all, you never hear the bullet that hits you.
I go home on call, am paged, and reprimanded by a patient who wonders why I can’t look up their medication list on-line, even though I’m standing in the grocery store.
Worst of all, I find myself sending myself messages, just to make sure I do something tomorrow that I could not get done today.
Killing me softly …
… with information overload.
*This blog post was originally published at Dr. Wes*