Up popped a comment on my Facebook page:

American Medical News Do you think your practice is, or will be, ready for meaningful use?

Uh, silly me. True, I’m now retired, but I though that seeing 20 plus patients a day, diagnosing their ills, ordering their treatment, and (often) listening to their woes and advising them on what to do was meaningful. Or maybe not.

You see, under Obama’s medical experts, the word “meaningful” means spending time, money, and energy to obey government dictates on electronic medical records, whether or not you want to do it, and whether or not you have time and energy left over after your 60-80 hour work week to do it.

Here is what we are talking about:

In late December 2009, CMS proposed the first of three stages of objectives that physicians and hospitals would need to meet to secure Medicare and Medicaid bonuses. At stake is an estimated $14.1 billion to $27.3 billion in net funding over 10 years made available through the most recent economic stimulus package. Medicare eventually would start penalizing physicians who did not adopt and use EMR systems.

Yes, all your medical information will be placed on an EMR, Electronic medical record, or else.

Never mind that most medical offices are small, and that means someone typing in all the information on all of one’s patients (which may run into the thousands for each physicians) on a brand new software program that one will have to learn how to use.

And never mind that the software program is not available until Autumn, or that the deadline to implement it is early next year.

Comply or lose money.

Needless to say, all those greedy docs via their medical societies are objecting. Obey, slave, just because you went to college, medical school, and then spent several years in residency training, you have to be taught a lesson: The one who decides what you do and how you do it is now a bureaucrat in Washington.

One can defend electronic medical records as useful, and the Federal Clinic I worked at was implementing them at the time I retired.

But the difference between the Federal Clinic and my private practice was the huge number of clerks needed to run the office (and I am old enough to remember when most doctor’s offices ran with a single nurse/receptionist/billing clerk, often his spouse). And it is the small offices, especially those who serve in rural areas, who will be affected the most.

“Studies of EHR adoption clearly show that it takes more time for smaller practices to adopt and implement EHRs because they have fewer resources and support,” the letter stated. “Aggressive timelines and criteria during the initial stage of the incentive program will only serve to undermine this effort.”

I also worry about privacy. In the testimony to a Congressional hearing about the wonderfulness of electronic records, a small town doc testified that access to the electronic record allowed a patient to be treated in the emergency room, because it allowed access to his record for vital information.

Huh? Yet in past years, (before the government “privacy act” law made it illegal) a simple phone call to the family doc would do the same. Nowadays, we tell our patients to put a paper with their diagnoses, medicine list, and living will into a tube and tape it to the Refrigerator.

Justifying a one-size-fits-all boondoggle because one elderly patient can’t remember his medicines is absurd. And another problem is stuff that doesn’t get on the charts (many of us don’t list drug abuse or STD’s, except by using euphemisms. There are rumors that HIV status doesn’t need to be on Electronic medical records. Yet all this is vital information if one goes to the ER with a fever).

Another question: What happens when the system crashes?

Our Federal clinic still used paper records for daily notes, but we did have computerized summaries for all our patients. Then one day, the entire system crashed due to a virus. It took us two weeks to get it back up and running.

And what happens when a solar flare or merely a local thunderstorm wipes out hard drives? Yes, we will have to back up the records periodically on discs, but that means more time and energy.

Viruses are bad enough. There are continuous stories of hackers bypassing sophisticated firewalls to inspect/download/destroy computer information, sometimes just for the fun of it.

And then, there is simple human error:

Example: when sending old information to be discarded, someone sent recent records. From Medicine and TechologyBlog, originally from the Boston Globe:

The Boston Globe is reporting that: “Computer files from South Shore Hospital that contain personal information for about 800,000 people may have been lost when they were shipped to a contractor to be destroyed, hospital officials announced yesterday…. The information was on back-up files headed for destruction because they were in a format the hospital said it no longer used…(but) the hospital said the files contained information on patients, employees, physicians, volunteers, donors, and other business partners associated with South Shore between Jan. 1, 1996, and Jan. 6 of this year.”

So the panacea of electronic medical records ignores that they are good, but not as good as some make them out to be.

Telling docs they need to use a certain type of medical record when the software is not available, and then giving them a quick three months to implement all the regulations for it’s use is simply not feasible.

The word “meaningful” to describe this harsh and unrealistic order is  Orwellian, and bodes poorly for the prognosis of a government take over of medicine in the near future.

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Nancy Reyes is a retired physician living in the rural Philippines. She blogs at HeyDoc Xanga blog.

 

 


 

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