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Curbside Consult with Dr. Jayne 6/11/12

June 11, 2012 Dr. Jayne 5 Comments

As a physician, I sometimes have to make the last note in the patient chart, officially “pronouncing” the patient to be dead. Regardless of how many times I’ve done it, I don’t think it is something I ever will get used to. Depending on my relationship with the patient, I sometimes receive the death certificate to sign a few days later, formally documenting the cause of death. It’s a very concrete reminder that the sacred trust given by our patients is real and enduring.

No matter how heart-wrenching, it’s good to have these reminders from time to time. Many of us in healthcare are so beaten down by the absolute enormity of what we are trying to do and how fast we are supposed to do it that we forget why we went into this business in the first place.

In many departments at my hospital, people seem to be increasingly pressured to check boxes, complete projects on time, and adhere to the almighty budget. This is particularly acute in the IT department of late.

Because physicians planned poorly for Meaningful Use and are now demanding that the hospital purchase their practices, we’re doing a massive fire drill to try to install them, train them, and help them attest before the end of the year. Our hospital has never been known to say no to a physician acquisition regardless of the circumstance. As long as you can be credentialed by payers, you’re in.

Our teams are being driven in a way they’ve never been driven before. Leadership keeps voicing how high the stakes are and how we must continue to deliver the impossible – again and again. Resources are being diverted away from the practices that have been moving towards actually using an EHR meaningfully (rather than achieving Meaningful Use.) For example, rather than building new reports for our long-adopted practices who want to tackle new quality challenges, the data analysts are spending their scarce time obsessively running MU reports for the latecomers.

We’re continually reminded how much money is at stake with MU. I don’t disagree that it’s millions of dollars for our health system, but really, it’s a small amount for the individual providers. Divide $44,000 by five years and we’re reminded that it’s $8,800 per year. (Yes, I know it’s an offset against future penalties, etc. and as a CMIO, I get it and don’t need the lecture.) But as a physician, it seems like too small a price for which to sell the heart and soul of medicine.

For the extra time that most of my physicians spend clicking boxes and delivering interventions that are largely irrelevant to good patient care, they could have seen two more patients a day. That’s a revenue boost, but what’s more important is that volume boost equates to almost five hundred patients per provider per year that could have been served in our community. These are patients who need care and still have long waits to receive it, even in a major metropolitan area.

Physicians are constantly distracted – by pseudo-quality initiatives, MU, and demands by marketing teams that they have an online presence and know how to use the media for promotion. We’re doing more paperwork than ever (even in the electronic world) and spending less time with patients. The essence of medicine is being lost.

We’re forgetting why we went into this business in the first place. For many of us, it was not to receive Most Wired awards, Top Hospital trophies, or write-ups in US News. It was to help people, cure disease, and reduce suffering.

I’d like to challenge those who are leading the initiatives and formulating the rules of this new game. For each new measure you add to Meaningful Use (and for the existing measures too), I’d like to see concrete evidence that jumping through the hoops you’re holding in front of us will actually help patients in a truly meaningful way.

When the FDA is considering a new drug, proof is demanded and studies are performed. When payers decide to cover a preventive service, they determine how many patients have to screened vs. treated in order to make it cost effective. However, when we upend the healthcare delivery system, our interventions are not held to the same standard.

Are you in favor of evidence-based Meaningful Use? E-mail me.

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Currently there are "5 comments" on this Article:

  1. Thank you. You have said what many want to and don’t have the courage to. From my perspective it simply makes me sad that many are forced to focus on the dollars instead of the actual outcomes. Use the EMR “meaningfully”? what a concept…

  2. Superbly written

    “…rather than building new reports for our long-adopted practices who want to tackle new quality challenges, the data analysts are spending their scarce time obsessively running MU reports for the latecomers.”

    no facility left behind… an unfortunate outcome to consolidation that I hadn’t considered before.

  3. this write-up deserves national attention in my opinion. hopefully enough people will tweet, post, etc. to get it there. i’ll do my part.

  4. I think you are missing the point. As a Manager for Physician Offices, those reports actually have the physicians back. Let me give you an real-life example. We recently attested for MU and in the process received all those “reports”. One of the reports was to track LDL’s in diabetic patients. So at the end of the week when I ran the report and met with my lab staff to see what was (physician standing-order) missed. We had a diabetic patient that never had an LDL in our clinic. I opened his chart, he weighed over 280 lbs. I was horrified at what his lipids might look like…… Missed opportunities like that are an injustice to patients. Thank you meaningful use for the opportunity to do Better Medicine.







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