The Need For Better Tools.

By Marcy Zwelling, MD

Health information technology is here to stay.  But, is it really a good thing for the medical industry? Does it really improve patient care? The government would have us believe so.

The government has put its foot forward with a huge investment in the electronic health record.  The stimulus package included billions of dollars to induce doctors to purchase an EMR by offering $40-50,000 if the doctor participates in a program that they call meaningful use.  Meaningful use requires that a doctor send data to the doctor and that he participate in E-prescribing.

The electronic health record would be a HUGE opportunity if it collected good clinical data but to date, it still remains mostly a billing opportunity.  The data extracted is financial data and actually gives us bad information. The government will be collecting that information but depending on what they do with it, it could be a step backward rather than forward.  Bad data is worse than no data.

The electronic health record would be a HUGE opportunity if it created a sequential look at our patients’ health relative to the rest of their life.  But, it remains event based and fails to deliver the right clinical data. If we could track our patient’s health using input from their daily activities, we could learn a lot about why things happen.  Health is not an event; it is about a life.  We need to build a better EMR in order to capture useful clinical data.

Finally, the electronic health record along with E-prescribing could be a wonderful opportunity to save time, improve accuracy, and save paper (and money).  But, insurers and pharmacy benefit managers have already undermined vendors by obstructing our ability to put in our drug of choice.  Some programs do not allow doctors to prescribe what the patient needs.  The keyboard actually will not enter the drug into the appropriate space.  The electronic health record and E-prescribing has (in these instances) become obstructive.

It is time the HIT industry hear doctors “better.” They need to address our patients’ needs.  A tool is only good if it helps us perform better. When it is obstructive, decreases productivity, doesn’t answer the questions we are asking, and when it gets in the way of good patient care, we need to go back to the drawing board and get it right.

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Death Panels – American Style

By Greg Scandlen

The new Medicare benefit for end-of-life counseling that was snuck in by the Obama Administration over the objections of Congress and the American people, is the fourth and final step of a process that will indeed lead to “death panels.”

Now, don’t misunderstand. You will not go before a panel of bureaucrats to plead for your life. That was Franz Kafka’s early twentieth century Bohemia. We are much more sophisticated today. In twenty-first century America, your sentence will be delivered by your friendly family doctor.

STEP ONE — We started two years ago with the appropriation of $20 billion to set up a mandatory Health Information Technology (HIT) system. This was part of the wonderful “stimulus” bill that was enacted well before ObamaCare. This law requires every physician’s office and every hospital to be wired up to a centralized database, so the government may know exactly what each doctor is doing with every single patient.

All of the research available says that HIT does not improve care or lower costs. Quite the opposite — it worsens care and raises costs. What it does do is enable the government to know with precision what a doctor is doing.

STEP TWO — The next step was also funded in the stimulus bill – the “Comparative Effectiveness Research” (CER) initiative. This will allow a panel of experts to determine what works and what doesn’t work in medical treatment. By “work,” they mean what is the best use of the available dollars. If something is quite expensive and doesn’t prolong life by many months, it will be deemed to “not work.”

That might be useful knowledge to have for a physician who is looking at treatment options. It could be one more piece of information in his understanding of what to do for a patient. But it becomes a problem only once the next step is implemented.

STEP THREE – Now we get to ObamaCare, and the presumption that the best (only?) way to finance health care is through “Accountable Care Organizations” (ACOs), that pay physicians on a “Pay-For-Performance” (P4P) basis. P4P says that doctors will get paid more when they do the “right thing,” and less when they do the “wrong thing.”

Now we’ve got something. Now we have HIT telling the government what every doctor is doing, and we’ve got CER determining what is the right and what is the wrong thing to do, AND now we have a payment system that will “incentivize” doctors to do what the government says. There is only one thing missing – how to tell the patient.

STEP FOUR – “End-of-Life Counseling.” There is no acronym for this as yet. End-of-Life  Counseling will pay physicians to deliver the bad news to the patient — “I’m afraid your breast cancer is quite advanced and there isn’t anything further we can do. How can I help you get your affairs in order?” Now, notice the physician is not explaining there IS something that can be done, but the government decided to not pay for Avastin because it costs too much. Or any of the other life-enhancing treatments that would be available if not for federal intervention. No, Medicare would not pay the doctor to deliver this information because it might upset the patient.

So, there you have it. In twenty-first century America, our Death Panel is good old kindly Dr. Marcus Welby. Don’t you feel better already?