Tuesday, January 8, 2013

Good Question...

Fresh thoughts, frozen ends and warm wishes. What’s there not to love about the New Year?
So let me kick start this one on my favorite topic: clinical documentation. Complex topic, yes, but simplifying complexity is our brain’s favorite activity, right? Makes us feel intelligent and stuff. And now that computers got almost as intelligent as their walking fathers, it seems we’re all geared to solve the biggest mystery ever besides “where the hell is Atlantis?”: why are medical errors still the third-leading cause of death in the country, behind heart disease and cancer, and showing no sign of decreasing? Good question.
Studysays: “the equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors.” How much of this stems from poor clinical documentation, we don’t know. And trust me, we don’t want to know. And the fact that we don’t want to know means that we know. You know? Oh, shut up, Doctor-Nado-knows-better.
OK, I’ll pack it in. Next year. In the meantime, there’s another figure I’d like us to sharpen our teeth upon: transcription costs. $7 billion a year, and showing no sign of decreasing either – despite the flourishing rise of technologies that all claim in unison they lower those very costs. Isn’t there something wrong with the equation? At least that's what I would think after reading Economics for Dummies.
$7 billion a year. That’s 10$ a report. No, that’s not expensive. That’s bang-your-head-against-the-hospital-wall expensive. Let’s compare this to an industry with similar reporting needs: Legal. I don’t think any right-minded attorney out there would smile at a 10$ cut to his billable hours, would he? Good question.
But what this figure really tells us is that dictation and back-end voice recognition are still the main routes from consult to report because it’s the fastest one, from a physician’s perspective - a detail EMR vendors tend to disregard. So anyone claiming that they have a better solution that dictation and backend voice rec is a Mickey Mouth - or has been so far. Time remains physicians’ most precious tool and I'm afraid it might be so for a while. Until you vendors figure this out, we’ll stick to our speech mikes.
So here we are, surrounded by miracle software that have nothing to do with the fact that Joe Blow died because Nurse T couldn’t find the right dosage in time among the medical record mess. And if it costs another 10 bucks to issue the report describing the poor guy’s agony, it’s nobody's fault either. Welcome to Twenty Thirteen.
OK. All this is fine but cynicism won’t help answer the one and only meaningful question at stake here: why? Why, despite all the computers around, are we failing to issue quality, reliable and timely clinical documentation at reasonable costs? Good question.
Because we’re trapped in marketing Lalaland, people. And we’re guilty as charged. We were told “that simply installing EHRs will transform healthcare, improve quality, save money, solve the national debt crisis, and bring about world peace. We are shocked to discover it hasn’t happened – and it won’t in the current healthcare system.” I’m quoting an MD called Ashish Jha here, and guess what?
He’s damn right. The more we let vendors tell us what time it is, the fewer questions we ask about the weather. And whatever is left to ask will be the wrong questions, which “always produce an irrelevant answer, no matter how well-crafted that answer might be” - still according to Jha, who goes on to conclude: “unfortunately the debate on health information technology seems to be increasingly focused on the wrong question.”
And where are the wrong questions typically asked? In the right documents: RFPs. Hence the damage.
So here’s my good resolution for 2013: craft one hell of a killer RFP that raises the middle finger to “political” pressures, asks the right questions in readable English and has built-in radars for bullshit answers - already working on it. Those who feel like stepping in this little creative train will see a bunch of threads inviting them onboard over the next few weeks.

Happy New Year, dear vendors. In 2013, only the fittest shall survive. I've read it somewhere. Ah, yeah, it was in Evolution for Dummies.

* Source: HealthGrades

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