Tags: obamacare | electornic medical records | mandate | reform | healthcare

Opinion: Obamacare Mandates Like Electronic Medical Records Need Reforming

Opinion: Obamacare Mandates Like Electronic Medical Records Need Reforming
(Eldar Nurkovic/Dreamstime)

By    |   Monday, 14 August 2017 12:58 PM

Although there has been significant discussion and disagreement about who will pay for your healthcare, there has not been a great deal of mention of how your healthcare will be conducted. Specifically, the debate about who gets the bill has eclipsed what happens in the exam room. As a physician forced to convert to electronic medical records and to document metrics not likely to improve the level of care that I deliver, I find it challenging to watch the debate as it currently stands.

Part of the healthcare reform imposed by President Obama was a series of mandates (with associated penalties for lack of compliance) that forced physicians to switch to electronic medical records. This was problematic from a variety of perspectives not the least of which is one is that this may be a violation of free speech (how you record your interaction with a patient should be decided by you and your patients). Instead, physicians and hospitals were forced to pay for the implementation of systems that in many cases were not ready for prime time. The companies that made this software reaped the benefits of this regulatory bonanza while healthcare providers and patients had to sort out the nuances of each interaction. Instead of focusing on the patient history, physicians were forced to focus on recording information mandated by their software. The flavor of each interaction was lost as each person became a series of boxes to check during a visit that became less and less personal.

Another component of this implementation is the wasted time spent recording information that to me (a dermatologist) is not really relevant. Is it good that someone got their flu shot or their pneumonia vaccine? The answer is probably yes. Is it important to someone that is coming to the doctor because he or she is worried about whether a lesion on his or her skin is cancer? Probably not. Yet much of the interaction between physician and patient now relies on these scripted interactions necessary to get paid. With this emphasis on checking the boxes, there may be an incentive to check more boxes and reap higher rewards since payment is now tied to this metric.

Privacy concerns should also be considered. Despite assurances from the government that health records will be secure, they don’t have a great track record in this department. Recent hacks into the IRS have exposed the social security numbers and other vital information for millions of Americans. Similar breaches have occurred at the VA.

My impression is that costs for delivering care will increase for physicians as they implement the hardware and software required to comply with the mandate. These costs may result in physicians that have to drop Medicare patients simply because they become too expensive or in trying to see more patients. Neither of these outcomes is good for patients nor are they good for physicians, many of who are already straining the limits of their schedules.

As these mandates are implemented, healthcare notes will increasingly be geared to fulfilling the information that the government requires us to collect. We are forced to collect data to satisfy requirements rather than to delve into the factors that could help us decide what is wrong with our patients. Did they travel to the Middle East or come in contact with a tick? We may not have time to ask these questions but we will document whether or not they consume alcohol socially.

Finally, the way that most software is written compels doctors to document in a manner that complies with requirements for more comprehensive visits. As this continues, what could have been a simple, relatively inexpensive visit for a problem morphs into a more comprehensive visit driven largely by the requirements to document. Instead of saving money, this seems like it will drive costs up.

My suggestion would be to allow physicians the opportunity to decide how to take notes while seeing patients. Most of us prefer to speak with our patients and try to help them rather than become technicians focused on a screen. I am not a Luddite and I recognize that in many large institutions digital records are essential for patient care. However, in medicine as in other professions, there should be some allowance for the human factors that make being a physician so rewarding.

Kenneth Beer is a board certified dermatologist in West Palm Beach, Florida. More info can be found at BeerDermatology.com.

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As a physician forced to convert to electronic medical records and to document metrics not likely to improve the level of care that I deliver, I find it challenging to watch the debate as it currently stands.
obamacare, electornic medical records, mandate, reform, healthcare
Monday, 14 August 2017 12:58 PM
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