Saturday, March 22, 2008

The Chart at the Foot of the Bed is Gone

Sorry for being absent the past several weeks. Recently I had the unexpected opportunity to catch up on technology at the bedside (in the bed) at my local community hospital which I had been on the staff 16 years ago.  I had been away in another community and only recently had returned to the area but practice in a more rural community in the same town.  Some things change, and others never change. Chest pain is chest pain and shortness of breath are the same complaints.  My arm band now had a bar code on it. The nurses all used wireless laptops for charting and reading orders.

The doctors were all still at the nursing stations either dictating or writing their chart notes. The doctors seem to be the last link in the chain of IT.  I definitely had the feeling IT was "leaking in".

At my post operative visit in the cardiologist's office he was able to retrieve summaries, op reports and demographics via a portal, although he had not yet implemented EMR in his office.

I am now the beneficiary of a cardiac stent, placed into a ten  year old coronary vein graft which had only 1% flow through it. Although ten years had passed without incident the old leg scar is still quite evident, more so than the long chest scar.

At the end of the rather prolonged angioplasty I was given a CD with a DICOM viewer and video for my own personal health record.  Pictures are worth a thousand words and in the future if I have to have any other procedures this will be instantly available.

This was a far cry from the CABG (4 vessels) that was performed on me ten years ago.  I was given a hand sketch of that procedure, which was lost many years ago and unavailable on short notice.

(not many patients are given advanced notice of acute coronary syndrome).

Just six months ago I had returned to near full time ophthalmology practice......the volume was up from 40 patients a day to over 50 patients a day. The practice had no EMR. Those are the numbers in productivity that are needed in some setting with capitation and/or heavy managed care intrustion, unless one adds cosmetic and/or refractive surgery to the mix.  Most doctors want one thing from an EMR....improved efficiency and reduced cost, and not over a pay back of more than one year. ROIs must be short because the only predictability of reimbursement is that it will decrease and bureaucracy will increase.  Common sense must intrude into the mix of the business of medicine.

Too many think tanks and doctor wannabees are draining dollars from patient care. Much of medicare's "fraud and abuse" mechanism revolve around inaccurate coding (obsolete ones), and complex schemes that require a graduate level education to understand.

My outlook is rather dismal....I used to be one of those optimistic "the glass is half full", now it is the other way around..."it is half empty".  Yes, those who can negotiate the system get excellent care.....there will be more care for fewer patients.

The economic engine for a typical practice bears no relationship to how doctors are trained, nor how they want to practice medicine.....Non practitioners have no idea of the stresses involved and why doctors burn out from a profession that initially was very gratifying and rewarding. 

I remain hopeful that IT will assist us all in patient care, and not become another misguided burden in caring for patients.

And, oh, by the way the bar coder broke and the nurse was delayed by over an hour trying to get medication for me. Imagine what it will be like when the server "crashes" (not if)

Happy Passover and Easter to all

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