EPtalk by Dr. Jayne 3/28/19

For your entertainment pleasure, ONC has released the public comment submissions received on the “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs” document. More than 200 comments were received, with the majority being in the areas of HIT usability and clinical documentation. My personal favorites:

• I believe that part of the reason that only 30 PERCENT of physicians practice independently and that most are now employed is the push for EMR usage and all the administrative burdens associated with it. Add the “click the button” game and more will leave. (Michael Richter MD)
• Thank you for finally throwing a life to all physicians! One of the biggest blunders made when HER’s (sic) were approved was not mandating interoperability. This single mistake is costing the Health Care System in the United States billions of dollars every month. Please act now on this blatant oversight / mistake. The time to correct it is overdue. Also, it is time to spend some money on plane tickets to visit countries like Italy, France, Germany and Japan to name just a few, and learn how they have better outcomes at half the price we pay. Being ranked 37th in the world is not good. Our infant death mortality statistics and ranking is pathetic! (Joseph S. Testa MD)
• i have not seen any reliable study that has concluded that the adoption of electronic health records in doctors’ private offices has led to improved health care or reduced costs of health care. As a frequent recipient of electronic health care records, I have found this mode of information retrieval is more often an impediment than an asset; as vital data is never highlighted and is usually either omitted or buried within a large file of irrelevant data. Within the hospital setting, I have found electronic health records to be a life threatening obstacle to patient care. When a computer monitor takes the place of a simple vital sign monitor, I’ve had to wait for as long as ten minutes for nurses to acquire the simplest of vital sign measurements. In my community, had the local hospital been motivated to spend the same money on health care that was wasted on an overly complex and inefficient computer system, our town would be enjoying the finest health care at no cost whatsoever. Instead, tens of millions of dollars leave the community to pay for a large computer service corporation. (Michael Steiner MD)
• Our staff and physicians have nicknamed our system The PDS (practice-destroying software). (Howard Green MD)
• The cost and complexity of EMR system maintenance and exponentially increasing regulatory requirements force doctors into large groups where we are relegated to data entry and coding tasks rather than the patient care we trained for. We are clearly expendable… End direct to consumer advertising for medications and durable medical equipment. (The author didn’t include his identifying information in his document, so once I downloaded it, I had no idea which submission it was.)
• EHRs have been created for effective billing tools. CMS contractors are NOT following the CPT coding guidelines agreed to by all other stakeholders creating tremendous chaos and dissatisfaction. So adding EXTRA work to a process that was already stressed expecting a different result is insane. So payments should include costs for scribes to input the data in order to reduce physician burn out as we have aging population and will need MORE physicians to care for them. AI will not do it. (Another one that became de-identified when I downloaded it.)
• The EMR was not designed with the end user in mind. It was designed with government and insurers in mind. It was never designed to help improve “quality” but rather make it easy to mine data and make insurance companies look good. I have opted not to participate in obtaining such a system because there is no compelling reason to do so. (see above) If you want physician buy in, you would have to scrap the current systems and start with the physician in mind. You would need to make the physicians job easier, not harder. You would have to be honest about the motivation to pursue an EMR. It should be made optional, and let it be bought on its own merits. If it has no merit; it won’t be bought. Remember that physicians are not stupid. Any attempt to market an EMR with hidden agendas will be discovered, and the reception lukewarm at best. Good luck. (Also de-identified on download – learn to sign your documents, folks!)
• In healthcare, focus not on cure. but care. Ailing patients need care and it can even be provided by 3rd, 4th, 5th, or even any one person outside the family. Exceptional cases are there that at times like Tom Hanks in Cast Away was being motivated by a basketball which he perceives as a man talking to but its rare and it needs a healthy young man to do so but A Patient is a Patient. (Anonymized by download.)
• However, the draft Strategy does not appear to recognize the investment that providers must make to train staff, procure and implement new systems, migrate and secure data, and respond to patient requests for assistance with healthcare data. For example, for the past several years my PCP requires an annual fee of $150 to help offset the cost of compliance with insurer and regulator IT standards. We just received a letter notifying us that his annual fee will raise to $1,800.00 per patient in 2019. My family of six cannot afford to spend $10,800 to be his patients. Neither can my elderly family members who were patients of the same PCP but who now struggle to find local providers who accept Medicare patients. HHS can begin to address these issues with a recognition of the costs and challenges faced by providers– and ultimately their patients. For example, the CMS fee schedules should be revised to reflect the costs of training, IT infrastructure maintenance, and patient educaton. The cost of annual IT Security training should included as directly attributable to the cost of care. (Martin O’Connor)

Most of the vendor submissions were lengthy, but I commend Epic for their two-page submission that calls out two key elements, one of which is the fact that “the electronic patient access timelines for Medicaid Promoting Interoperability are not aligned with Medicare Promoting Interoperability or MIPS, causing additional complexity for provider organizations and software developers, despite previous indications that the programs are intended to be aligned.” Whoops!

Healthfinch included the adorable Charlie on their submission as they championed the need for ONC to include delegation of routine tasks into strategic goals. They also ask for recommendations that state boards “address inconsistent and unclear “scope of practice” guidelines.” Can I have an amen from the congregation?

Intelligent Medical Objects (IMO) sent a very organized submission with a table of contents. The fact that they cited the original text then followed with their comments for each point they were making helped tremendously compared to other submissions. I was also interested to learn about an organization called the “Partnership to Amend 42 CFR Part 2” whose goal is to align various privacy rules to allow appropriate sharing of health information around substance use disorders.

One community hospital quality coordinator sent a submission that had at least seven fonts in it, which forced me to stop reading since it felt like a ransom note. I was surprised by the number of typos and grammar errors in some of the submissions, as if spelling and grammar checks weren’t run. It’s hard to take comments from a Top 3 EHR vendor seriously when the author hasn’t edited properly for its vs. it’s. Another submission was clearly written in Notepad, which is always entertaining for us IT folks.

The only other exciting conversation this week was around the Duke University whistleblower settlement. Lung researchers were caught faking data for inclusion in grant applications to the National Institutes of Health, resulting in a $112.5 million False Claims Act settlement. The whistleblower is a former staffer in the department. He’ll receive 30 percent of the settlement, which is a good amount since his career as a research biologist is likely to be over. The US government will receive the balance. There was a fair amount of misconduct in the involved labs, with the need for retraction of 17 scientific articles to date as lab technicians either falsified data to document a desired result or sometimes failed to even conduct experiments where data was recorded.

Would you ever risk it all to be a whistleblower? How serious would the situation have to be? Leave a comment or email me.

Email Dr. Jayne.