Saturday, October 24, 2015

EMR's Suck Epically!
And I'm Not The Only One Who Says So...

When something in the health-care field reaches the attention of Conservative columnists, it must be either really wonderful, or very, very bad. This time, it's the latter.

I'm a big fan of Michelle Malkin, a very articulate Conservative writer, who appears periodically on Fox News broadcasts, and the pages of In her latest column, she notes quite clearly that "Doctors Agree: Obama's Electronic Medical Records Mandate Sucks". This doctor concurs.
For the past several years, medical professionals have warned that the federal electronic medical records mandate—buried in the trillion-dollar Obama stimulus of 2009—would do more harm than good. Their diagnosis, unfortunately, is on the nose.

The Quack-in-Chief peddled his tech-centric elixir as a cost-saving miracle. “This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests,” he crowed at the time. In theory, of course, modernizing record-collection is a good idea, which many private health care providers had already adopted before the Healer of All Things took office.

But in the clumsy, power-grabbing hands of Washington bureaucrats, Obama’s one-size-fits-all EMR regulations have morphed into what one expert called “healthcare information technology’s version of cash-for-clunkers.”
Indeed. "I'm from the Government and I'm here to help you!" are some of the deadliest words in the English language. Few if any of the promises have proven to be accurate.
In 2014, RAND researchers interviewed doctors who spotlighted “important negative effects” of the EMR mandate on “their professional lives and, in some troubling ways, on patient care. They described poor EHR usability that did not match clinical workflows, time-consuming data entry, interference with face-to-face patient care, and overwhelming numbers of electronic messages and alerts.”


In Massachusetts last month, physicians decried the failure to achieve true “interoperability” between EMR systems despite a $30 billion federal investment through the Obama stimulus. Dr. Dennis Dimitri, president of the Massachusetts Medical Society, noted at a rancor-filled town hall that the mandate has “added significant time to the daily life of most physicians in their practices,” WBUR reported. “It has not necessarily lived up to expectations in terms of its ability to provide cues to physicians to make sure that necessary treatments are not being missed. It has certainly not been able to swiftly disseminate information from one clinical setting to another.”
The most ironic thing is that what was pledged was truly desirable and eminently achievable. Sadly, what has happened in the private world of medical software is magnified ten-fold when the government jumps in. I have bemoaned the sorry state of PACS software in particular for over 10 years on these very pages. The poor excuses for life-and-death patient-care software can be attributed at least in part to the fact that the end-users generally don't buy the software, and so it is written for those who do. Make the government that customer, or at least the entity that writes the RFP, and you have a recipe for disaster.

The EPIC failures of the most ubiquitous EMR tells us a lot about what really happened:
(The problems are) in no small part due to the cronyism embedded in the federal stimulus “incentives” – a massive chunk of which the White House doled out to behemoth EMR company Epic Systems, headed by Obama crony Judith Faulkner. As I’ve noted repeatedly in this column the past three years, Epic continues to be plagued by both industry and provider complaints about its creaky, closed-end system and exorbitant fee structure to enable the very kind of interoperability the Obama EMR mandate was supposed to ensure.

Now, even left-wing Mother Jones magazine reports this week that “instead of ushering in a new age of secure and easily accessible medical files, Epic has helped create a fragmented system that leaves doctors unable to trade information across practices or hospitals. That hurts patients who can’t be assured that their records—drug allergies, test results, X-rays—will be available to the doctors who need to see them. This is especially important for patients with lengthy and complicated health histories.”
Worst of all, physicians have been bribed to accept the concept of "Meaningful Use" which is simply the ability of their shiny new EMR's to transmit "anonymized data" (nudge, nudge, wink, wink) to Washington, and they are fined if they don't put the spyware in place. The American Medical Association, whose membership now comprises less than 10% of U.S. physicians, sold us out for figurative bowl of pottage, but now, too late, realizes its huge mistake:
The American Medical Association, which foolishly backed Obamacare, is now balking at top-down government intrusion into their profession. Better late than never. The group launched a campaign called “Break the Red Tape” this summer to pressure D.C. to pause the new medical-record rules as an estimated 250,000 physicians face fines totaling $200 million a year for failing to comply with “meaningful use” EMR requirements.
Malkin closes with a modest suggestion:
The Obama White House has responded by doubling down on its destructive EMR rules that punish both patients and providers. Congress must intervene. Rep. Steve King (R-Iowa) introduced a bill Thursday to repeal the draconian penalties “so that providers can get back to the business they are uniquely trained to do—utilizing their skills and knowledge to heal the sick and support the continued vitality of the healthy.”

Prescription: Butt out, Washington. Primum non nocere
Primum non nocere, by the way, is Latin for First, Do No Harm. Indeed, this is the one of the Prime Directives of medicine. Those who provide fractured software should take note. Pandering to IT and CIO's with programs that ignore the needs of the physicians who use them is tantamount to "doing harm" to patients. Abusing one's relationship to politicians in high places to sell exorbitantly-priced, crappy, dangerous spyware is even worse.

From the original Hippocratic Oath:
With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.

Nor shall any man's entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so.
Rather Epic advice, don't you think?

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