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Electronic Medical Records Don’t Reduce Costs Or Improve Patient Care… Yet

Have electronic medical records made a difference in patient care?

According to a study looking at digital medical record adoption of 3,000 hospitals, electronic records have made little difference in cost or quality of care.

That’s discouraging, considering that the government is investing billions of dollars into the technology.

Very few physicians use electronic record systems effectively. For instance, many are simply scanning paper records into a computer, which provides minimal benefit. It’s difficult to track quality improvement data doing that. The problem is further compounded by the archaic interfaces that the current generation of EMRs have, which is akin to a user interface circa Windows 95.

It’s no wonder that most doctors find electronic medical systems actually slows them down. The next generation of systems needs to focus on facilitating the doctor-patient encounter, rather than being an impediment. Taking a few lessons from Google, and improving the user interface would be a good start.

Only then can EMRs realize the potential relied upon by the government and health reformers.

*This blog post was originally published at*

Is Medicine No Longer A Calling?

As I sit here in a medical innovation conference – I find myself becoming more and more angered by one of the speakers. A man with an MBA and fancy title from PriceWaterhouseCoopers is lecturing us about how doctors are essentially money-grubbing, change-resistant, quality-care avoiding “pains in the you-know-what,” obstructing progress in healthcare reform and blocking technology adoption.

His lack of understanding of the complexity of medical care was breathtaking. And yet, he expresses a sentiment that I’ve witnessed all too many times.  Here are a few choice quotations: Read more »

Physician Pay For Performance: My 2008 Experience

It’s official. Happy has now earned his CMS physician  pay for performance PQRI Bonus for 2008, a direct deposit into Happy’s bank account. PQRI stands for Physician Quality Reporting Initiative.  How much was my PQRI Medicare pay for performance bonus for calendar year 2008? A $2,500 check written out directly to Happy by the  Medicare National Bank.  CMS gives a wonderful overview of the history of PQRI .  PQRI is the Medicare pay for performance program for physicians that was initiated by Congressional mandate in the latter half of 2007.   Doctors have an opportunity to earn back 2% of their gross Medicare collections (which the government calls a bonus but which I call legalized theft) by submitting a grotesque amount of quality performance paper work to the Medicare National Bank. It’s one giant PQRI guideline game.

PQRI reporting is currently voluntary, but legislation in future years will certainly mandate reductions in payment for not submitting data, all but making this program a punitive standard.  Many physicians failed to meet the requirements to get paid under CMS pay for performance program guidelines in the latter half of 2007, the first year for PQRI measures. Read more »

*This blog post was originally published at The Happy Hospitalist Blog*

Does Poverty Help To Explain Medical Practice Variation?

MilwaukeeIs poverty the major factor underlying geographic variation in health care? It assuredly is. There is abundant evidence that poverty is strongly associated with poor health status, greater per capita health care spending, more hospital readmissions and poorer outcomes. It is the single strongest factor in variation in health care and the single greatest contributor to “excess” health care spending. It should be the focus of health care reform but, sadly, many provisions in the current bills will worsen the problem.

Much of this is discussed elsewhere on this blog and in our recent “Report to The President and The Congress.” In this posting, I would simply like to tap into your common sense. We all know that poverty is geographic. There are wealthy neighborhoods and impoverished ones, rich states and poor ones, developed countries and developing ones.  Sometimes poverty is regional, as in Mississippi, but sometimes it’s confined to “poverty ghettos,”  as in the South Bronx. Read more »

*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*

Reducing Hospital Infections: A Stethoscope Strategy

When a patient comes in with an infection related diagnoses, efforts are often undertaken to keep that pathogen from spreading to other patient rooms.  In British hospitals they’ve banned ties and long sleeves.  At Happy’s hospital we place a dedicated stethoscope in the patient’s room which is then shared by all health care workers caring for the patient.  And that stethoscope shall remain forever in that patient’s room.

At Happy’s hospital, the dedicated stethoscopes look like they were made in a Chinese toy factory.  Read more »

*This blog post was originally published at A Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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