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Feds Barking Up Wrong Tree On EHR Fraud?
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MedicalQuack
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MedicalQuack,
User Rank: Moderator
1/28/2014 | 12:05:38 PM
Re: What's the alternative?
Totally agree having been a former developer of an EMR in the early days, taking a production tool away iss nonsense, and you only get that kind of knowledge spending a couple years with my beta doctor working hard to create a solution for "them"..something I think many forget, you are building a tool for the doctors and not creating for your own hat...

I really had to laugh when I saw all of this come out with restricting copy and paste, it's like trying to control what you can copy and paste into a world document but that's the thinking you get when you have non tech folks trying to solve such an issue..insanity:)  I used to have some very heated session with those doctors too as they wanted the screens and functionality one way and due to privacy or just restrictions I could not do it "exactly" the way they wanted.  Too bad the internet pushes this Burger King perception out there to the public in telling them they can have it their way..it's a joke and a bit media soap opera articles that draw attention.  Reporters now are enjoying the pay for performance nutty analytics too out there if you have not take note...gotta get those hits to increase the revenue from that ad exposure.  If you read the news it's all over the place so some agencies go for your emotional jugular and get you to comment and go wild with pouring out all those emotions.


So yes, the copy and paste deal it's a big joke to any who write software and to the doctors that use EMRs...and again come off the heads of folks who have no data logic and many of them who have never spent time with doctors observing what they do and how they do it.  Had a CEO of a big firm tell me not too long ago that the folks that market the revenue accounting software just have not a clue on how difficult it is for doctors to document today and they just off in some other world when it comes to these discussion, totally out of looking at what the doctors do, just want that sale!

It falls back to a lot of quantitated justificaitons at time for things that are just not true..and thinking you can take copy and paste away, it is big joke.  Here's some information about the rise of the journobot if you want to take a look and see how this works too..Charlie has a new book in the works at NYU with a chapter devoted to the rise of the journobt, I used a clip of one of his lectures on "context is everything" here.

http://ducknetweb.blogspot.com/2013/12/quantitated-justification-for-believing.html

 

 
WKash
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WKash,
User Rank: Author
1/27/2014 | 4:39:48 PM
From a patient's point of view
It's been intereting watching two different approaches: One doctor I go to switched to EHRs and now spends more of our meeting time checking boxes and trying to type w/ a stylus on his tablet that in actually discussing my situation. The other doctor dictates a report to a transcribing service.  He's done in a third of the time, and the report probably catpures what matters most.  If I was an busy doctor, trying to balance care vs reporting, I'd say the dictation route seems faster, but not every doctor may be good at it.  I'm sympathetic to whatever improvements can be made to improve EHR productivity and patient care.  But there ought to be software that identifies possible duplication abuses and errors.
ChrisMurphy
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ChrisMurphy,
User Rank: Author
1/27/2014 | 2:10:35 PM
Re: What's the alternative?
When I met with UPMC last year, they talked about the cut-and-paste problem. Doctors did it for efficiency for in-hospital progress notes, but that turned what used to be a concise half-page "what's happening" summary into 19 page documents. A top exec called it "an ongoing patient blog" that didn't give caregivers what they needed.
David F. Carr
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David F. Carr,
User Rank: Author
1/27/2014 | 1:36:10 PM
Re: What's the alternative?
We also want a rich data trail to analyze for evidence of what care was delivered and whether it worked. We want lots of contradictory things. Balance is the big challenge.
Mr. Gigabob
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Mr. Gigabob,
User Rank: Strategist
1/27/2014 | 12:17:36 PM
Re: What's the alternative?
Terribly ironic that "regulators" who aren't doctors, don't seem to recognize the basic truth - even the most basic EHR is a highly complex array of assualting boxes options and choices, but doctors can't spend a day or more to customize each entry - there are just too many to make.  Cut and paste - then edit is a standard practice for all personnel handling any sort of regular reporting process.  I am anxiously waiting for a "Smart EHR" just like a self driving car.

 
RobPreston
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RobPreston,
User Rank: Author
1/27/2014 | 12:11:42 PM
Re: What's the alternative?
Copy and paste -- but then modify for each patient. Perhaps this is the template approach. But in the end we want doctors to focus more on patient care, less on administrative minutia. 
David F. Carr
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David F. Carr,
User Rank: Author
1/27/2014 | 11:04:15 AM
What's the alternative?
If you are going to tell physicians they are not allowed to use a technique that boosts their productivity by reducing redundant data entry, you had better have a better alternative to offer them. Template-driven systems might be it, although there's the same issue of potentially including too much boilerplate material and not correcting enough for the exceptions.

I was just speaking about this issue with Peter Basch, Medical Director, Ambulatory EHR and Health IT Policy at MedStar Health, who said he worries that tests for fraud based on multiple medical notes being too similar to each other conflict with another best practices trend in medicine - the use of checklists by physicians who are trying to make sure they provide care more consistently. Reducing variation can be one way of achieving higher quality. But if the government really goes to war over copy-and-paste medical records, it could wind up punishing consistency.

Both the productivity techniques and the scrutiny over their misuse need to be applied sensibly. Vigalance against true fraud can't be allowed to sabotage legitimate efforts to make the use of EHRs more productive.


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