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January 2, 2020 News 5 Comments

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Professors of nursing and medicine write in a New York Times opinion piece that the professions should overcome their traditional hostility toward each other and unite in protesting the excessive documentation required by billing and regulatory requirements that are enforced via the EHR.

The authors recommend that hospitals regularly review their EHR setup to strip away requirements that are not related to patient care.

They also observe that while doctors make more money and are often dismissive of nurses, the latter have done a better job of supporting unions.

The piece concludes by saying that doctors and nurses want the best for patients, but are prevented from delivering it because of “profiteering and gross inefficiency.”


Reader Comments

From Moon Shot: “Re: sponsors. I used Internet Wayback to compare your sponsor list three years ago to today. I’m surprised at those that have disappeared for reasons other than being acquired.” I never though of using Internet Wayback for that, but it does indeed work. The end of the Meaningful Use-fueled buying frenzy has caused quite a few companies to scale back in various ways that I assume aren’t limited to HIStalk sponsorship. Several sponsors tell us they are cutting back or don’t have any senior people remaining in marketing or other departments. I expect that trend to continue and I predict that the HIMSS conference exhibit hall will be more Spartan than in the gold rush years. We will find out if companies can downsize their way to competitive success, but in any case, I appreciate those companies that keep HIStalk running and the readers who keep coming back in numbers that haven’t diminished.

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From Corporate Brand Expert: “Re: our company name. You omitted our trademark designation – please fix.” Companies use trademark symbols in their own communications. Third parties and journalists, except for the clueless ones, do not. 

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From Robert D. Lafsky, MD: “Re: New York Times opinion piece on EHRs. How did paperless systems become ‘paperwork?’” Dr. Lafsky — the only grammarian I know who is even less forgiving than I – correctly notes that the Times article’s headline refers to performing low-value EHR activities as “paperwork.” I blame the headline writer of the “paper” (pun intended) since the authors don’t use that term in the actual article. I’m not appalled because I don’t know any word that conveys the concept better, although I am annoyed at its omission of the Oxford comma that makes the headline harder to read (no one is ever confused by its inclusion, but some are confused by its omission).   

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From Going Commando: “Re: Calvary Hospital (NY). Sacked the CIO and the analysts they hired after a successful Meditech Expanse rollout. Navin Haffty is now ruling the roost.” Unverified, although Kathleen Parker’s bio has been removed from the hospital’s web page. Either way, it’s always interesting to me how frequently CIOs are deposed by the vendors they manage.

From Please Provide a Correction: “Re: Health Catalyst share price. Up 30% from its IPO price, not down 8%.” Share performance is based on price at the market’s close. Health Catalyst shares were priced at $26 for its first day of trading on July 25, 2019, but opened for trading at $37.37 and closed at $39.17. They are now at $34.76, down nearly 12% from that first-day close in valuing the company at $1.3 billion. Their all-time high was $48.47 on August 12, while the all-time low of $26.44 occurred on October 9. HCAT shares are traded on the Nasdaq, which is up close to 10% since July 25.

From Health Tech Stocks: “Re: hospital patient survey vendor NRC Health. Shares were up 74% in 2019, valuing the company at over $1.5 billion.” Shares of NRC – headquartered in Lincoln, NE — are up nearly 400% in five years. The company was founded in 1981 by Mike Hays, who remains CEO. He holds $10 million worth after selling $300 million worth from the trust fund of his grandchildren last year.

From COBOL Been Berry Good to Me: “Re: Y2K. Thanks for that look back, which as someone involved in the remediation, made me smile.” People forget that Y2K was the ransomware of its day, a non-event only because programmers who were forced to dig into ugly, old code made it so. Anyone who thinks the issue was a made-up problem is ignorant of the facts, conveniently benefitting – as do people who refuse to be vaccinated – by the more responsible behavior of others. I think we’ll do better in fixing well in advance the Year 2038 problem, the “Unix Y2K’ in which systems that represent time as the number of seconds elapsed since January 1, 1970 will stop working when the storage variable runs out of space on January 19, 2038.

From Get Thee to Conferences: “Re: health IT conferences. I see other sites attend dozens of conferences each year. Why don’t you?” I think the lack of return is obvious given the continuingly inexpert content of those sites. Racking up exhibit hall miles is no substitute for running a hospital IT department, practicing as a clinician, performing informatics research, or all those other activities that go beneath self-important conference meet-ups and selfies. I admit that I sometimes develop useful perceptions about vendors and trends at the HIMSS conference since it covers just about everything important, but I’m not too tempted beyond that. Technology education requires cross-country flights and overpriced hotels only because that’s where the exhibit hall cash register is ringing. I always savor the irony of the American Telemedicine Association holding an-person conference in New Orleans to pitch seeing a doctor by video with the argument that those sessions are cheaper, more efficient, and more convenient.


HIStalk Announcements and Requests

Welcome to the new year, when the high deductibles and out-of-pocket maximum costs of many expensive health insurance plans reset, most likely giving providers a break as the patients who need their services can’t afford them.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Announcements and Implementations

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The World Health Organization designates 2020 as the “Year of the Nurse and the Midwife” in calling for 9 million more nurses and midwives that are needed to achieve universal health coverage by 2030.


Government and Politics

The VA awards Liberty IT Solutions a three-year, $95 million task order to integrate the VA’s Consolidated Patient Account Centers with its Cerner system, adding to the $434 million contract Liberty won in November to modernize the VA’s systems under Cerner. The company had previously won $700 million in VA IT contracts in a single quarter of 2019.


Other

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Hospital mergers and acquisitions haven’t improved quality and in some cases have made it worse, researchers find. While prices nearly always increase after a merger, quality rarely does. Sometimes the acquired hospital saw its quality scores dragged down by the lower ones of its acquirer.

An Australian insurer says doctors there appear to be choosing medical device implants based on their personal profit rather than medical evidence, to the point that sales reps are scrubbed in to advise surgeons during procedures (it’s exactly the same in the US, in case you haven’t worked in a hospital). The company recommends creating an independent organization that reviews prices and clinical efficacy similar to a program that reviews drugs, also noting that the federal government sets medical device payments for public hospitals but private hospitals pay a lot more. The medical device trade group says the campaign is a smokescreen for increasing health insurance premiums and that it’s not the government’s job to decide which products provide the most value.

In England, politicians call for the resignation of the Imperial College Healthcare Trust Chair Paula Vennells after the country’s Post Office – which she headed as CEO from 2012 through 2019 – agrees to pay $75 million in lawsuit damages to sub-postmasters who were blamed for accounting shortfalls that were actually caused by the Post Office’s Horizon computer system. Some of the sub-postmasters had been fired, fined, or imprisoned while the Post Office was spending millions defending Horizon, which the presiding lawsuit judge called “institutional obstinacy.”


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Currently there are "5 comments" on this Article:

  1. Re: New York Times opinion piece on EHRs. How did paperless systems become ‘paperwork?’

    Once again, EHRs are tied to the whipping post and blamed for… the “bureaucracy of a failing health care system”. Do the authors mean to imply that if there were no EHRs then “Insurance companies and hospitals would NOT demand ever more data to make decisions about payments and billing, so clinicians have to provide much more information about each patient at each interaction. Mounting regulatory requirements that get built into these records are described as insuring patient safety, but are ultimately tied to compensation, which means money. And in a system rife with legal risks, there is a strong incentive to overdocument everything. It’s convenient to point the finger at the defenseless EHR… but the EHR doesn’t make the business requirements for these activities.

    Clearly, EHRs are not the easiest software to operate. But blaming everything from clinician burnout to suicide on EHRs seems a bit of stretch. The authors prove this point rather succinctly – by pointing out that at the VA, the EHR isn’t hated. Guess what? That EHR is functionally the same as every other EHR. What’s different are the business requirements.

    I, for one, am tired of the endless EHR bashing without offering any specific recommendations. To say that doctors and nurses must revolt makes (arguably) for good headlines… but is just hot air. How about some suggestions as to what exactly should be done to address the alleged profiteering and gross inefficiency?

    • “Do the authors mean to imply that if there were no EHRs then “Insurance companies and hospitals would NOT demand ever more data to make decisions about payments and billing,”

      I actually think there is some truth to this, though not in the way the authors intended. Electronic documentation has made it easier for health systems to document the things that payors want and thus have increased the ability to get paid. But payors don’t want to increase payments so they add even more things to their requirements so they don’t have to pay out more than they want. Its almost like a regulatory arms race. EHR makes documenting a requirement easy, payor increases or changes the documentation needed for reimbursement.

      An example is the somewhat recent copied notes issue. In a pen and paper world, docs couldn’t copy notes on patients. With EHRs, its trivial to copy a previous note for the same or similar patient. However, once docs began doing this frequently, CMS released new guidelines that copied notes wouldn’t be reimbursed and patients would require fresh notes. Was this done to ensure better care? Maybe, but i’m not aware of any actual literature on copied notes affecting care. Was it done so medicare won’t have to pay out as much? Well that is certainly an effect. Does this contribute to provider frustration about the EHR requiring too much work? Absolutely.

  2. Re NY Times opinion piece

    The co-author, Stephen Bergman, is none other than Samuel Shem, of House of God fame. Those who’ve read that book will know that he is an expert in the area of doctors’ disrespecting nurses and patients.

  3. RE: CIOs being deposed and vendors having a hand it in. I for one cannot wait until the first lawsuit that names a vendor along with a former employer for such tactics. It’s the flawed software, the flawed implementation methodology, the lack of properly trained and experienced vendor staff, etc., etc., etc. Yes, CIO’s have a hand in every vendor relationship and project, but far too often are the scapegoats for vendors trying to avoid a lawsuit or a leadership team at the health system that doesn’t take the time to listen and understand what, exactly, is going on.







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Reader Comments

  • Gubbermint: I'd wager the problem exists more on the receiving end than the sending end....
  • Low-Tech Act: 10+ years after the HITECH act, countless billions of dollars being invested into EHRs, and endless hype about informati...
  • Curious?: I particularly appreciate the final comment guessing he'd have 2 years at CC, which appears to have been the case....
  • Elizabeth H. H. Holmes: Because he is usually working somewhere new. Others can speculate on the reasons why. I enjoyed this roast a few years a...
  • Curious?: Why does it seem like each time Ed is featured, he is working for a different group?...

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