Electronic Medical Records:The Potemkin Village of Healthcare

I truly believe that the 12 page boilerplate notes generated by a hospital EMR system for a problem that would have been a paragraph or two in a paper chart actually will be proven to be dangerous.

Because the information is not concise, it is hard for clinicians to sift through all the prefabricated chaff to find the few grains of pertinent information. Also, once erroneous information is entered into a system’s EMR, it is there for eternity. In a paper chart, you put a line through it and initial it. Problem solved.

EMRs are a boon for tech companies, consultants, and hackers. Not so much for doctors, and more importantly for their patients.

Just say no! The next time you go to your doctors office, tell him/her that you don’t want your private info in the cloud and you want to opt out of the electronic record that they never asked your permission to put you in. Watch what they do!

Please read the article below written by Dr. Gianoli, whom I had the pleasure of meeting a few weeks ago in Orlando.  He expands on this theme extremely well.

Michael A. Ciampi, M.D.


 

Electronic Medical Records:The Potemkin Village of Healthcare

By Gerard J. Gianoli, M.D. http://EarAndBalance.net

Legend has it that in 1787 Grigory Potemkin erected a fake portable settlement along the banks of the Dnieper River in order to fool Empress Catherine II during her visit to the Crimea. At night it was then moved down river for their next stop the following morning. The end result was an impression of greater wealth and stability in the area than reality. From this, the term “Potemkin Village” entered the lexicon, defined as: “A pretentiously showy or imposing façade intended to mask or divert attention from an embarrassing or shabby fact or condition.”

The electronic medical record (EMR) is the Potemkin Village of Healthcare, disguising the declining quality of American medicine.

When I started medical school in 1982, I visited my pediatrician, Dr. Johnson, who was still my primary care physician at the time. He pulled out my chart dating back to shortly after my birth in 1961. For nearly 20 years of visits, there were only four pages of notes. I did not find this notable. Why would I care about how extensive my medical record was as long as I got good care? It is only in retrospect that this is surprising. Today’s medical records will have 4 or 5 pages for a single office visit.

Are office visits that more extensive and comprehensive than in 1982? Not by a long shot.

During medical school in the 1980s, we were taught to do a very extensive history and physical examination. This included Chief Complaint (why are you here?), History of Present Illness (what happened?), Past Medical History (what are your prior medical problems?), Family History (major medical problems that run in the family), Social History (occupation, hobbies, habits, alcohol, tobacco and drug use), Medications and Allergies, Review of Systems (detailed questions about other systems of the body, seemingly unrelated to the current problem), and then a thorough Physical Exam. After this we developed a differential diagnosis—a list of probable causes for the patient’s chief complaint. Only then did we order tests to confirm or exclude these possible diagnoses. Then we treated the patient. This is radically different from the medical mills where American doctors practice today.

Today medical practice has contracted to: Chief Complaint, Test, Treat. My patients tell me of 5 minute visits, and I have witnessed them for family members. Currently the average doctor visit is 15 minutes or less. But that is really 8 minutes, plus 7 minutes of documentation in the computerized medical record. The traditional approach requires at least half an hour. There is no way around it. You can’t do it right in 8 minutes.

The EMR for your doctor’s office includes all of the elements of the traditional history and physical exam described above. But most of the history and physical is not done by the doctor but by the auto-populate method. The doctor presses one key, and it fills out the entire form saying that everything is normal, except what he overrides as abnormal.

One internist, in evaluating one of my patients who was having surgery to treat intractable vertigo, documented that the patient denied having any vertigo. His EMR was impressively neat, well-organized, and extensive—but filled with nonsense.

Why would a well-respected physician document nonsense? Survival. Physicians have been commanded by Medicare to produce these extensive notes via the EMR in order to get paid. The bureaucratic rules and regulations forced upon physicians in the last 8 years have driven the overhead of private practices to the breaking point. From 2008 to 2014, half of physicians in private practice left to become employees of large corporations, almost solely because government mandates made it impossible for them to make a living in an independent practice.

Becoming an employee, however, doesn’t allow the doctor to escape the EMR or other inane mandates. It just spreads the cost over a large corporate structure. The damage to quality in medical care has been institutionalized. Instead of a patient-physician relationship, we have the Potemkin Village façade of the high-tech EMR.

Dr. Johnson’s notes were sparse, but he gave excellent care. His patients paid him for care. Now government and third parties pay for the appearance of healthcare, a virtual reality of digitized make-believe.


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