From: usenet@only.tnx   
      
   On Sat, 16 Jan 2021 16:08:45 -0500, Boron Elgar    
   wrote:   
   >On Sat, 16 Jan 2021 19:11:32 +0000 (UTC), Howard    
   >wrote:   
   >>Boron Elgar  wrote   
   >>   
   >>> The system just had   
   >>> to figure out how to properly monetize it all.   
   >>   
   >>It seems possible that's a big driver.   
   >>   
   >>I was really bothered to find out that probably the biggest reason   
   >>behind problems with shifting the medical system to electronic record   
   >>keeping and data sharing was the insurance side of it. Having doctors   
   >>record their diagnoses, collect test results, issue prescriptions, and   
   >>all of that wasn't a huge challenge. For the hardcore anti-tech   
   >>oldtimers, that stuff can generally be handled by handing notes and   
   >>recordings off to third parties.   
   >   
   >It can be problematic even for younger, computer savvy docs, my own   
   >and her partner as prime examples. When the Feds first mandated the   
   >changeover to computerized record keeping, they immediately contracted   
   >with a recommended company specializing in it. It cost them a lot of   
   >money, and even with the small rebates, the training for their own   
   >plus staff use was impressive. Then the company got bought out by   
   >another med record company and that required a lot of upgrading and   
   >re-training. And then a third company ate that one- this is not   
   >unusual in a new and evolving industry- but the 3rd company decided   
   >not to support the previous software and bang, the docs were out more   
   >money and back to square one.   
      
   That's such a sad story.   
      
      
   >The docs gave up. It got to the point that they sold their practice to   
   >one of the large hospital corporations that provided all of the   
   >computerized patient and billing and lab work properties. They still   
   >practice, but as part of a corporation now.   
   >   
   >The computerized requirements are so time consuming, that many   
   >practices use what are known as scribes to sit in on examinations to   
   >do all the recording while the doc just interacts with the patient. In   
   >fact, all but one of my docs has that sort of thing in place now.   
      
   There was an interesting article in the New Yorker (okay, that's redundant)   
   about three years ago about this very issue.  It mentioned scribes and   
   discussed   
   the problems of doctors dividing their attention between the patient and the   
   distraction of data entry.  The article also covered many of the problems that   
   occur when one starts collecting data on anything, as they apply to medical   
   issues.   
      
   When one starts collecting data on subjects, one is by necessity creating a   
   model of them.  Most human experience manifests on a continuum (or is even more   
   complex), not easily quantified by a scale from one to ten.  Yet that is often   
   required for computerized systems, since that is what they can process most   
   easily.  The nuance added by notes in the comments section is not likely to be   
   recognized by algorithms.  Soon it is tempting to believe that these numbers   
   Mean Something (tm) and eventually a decision is made to do one thing and not   
   another because a certain value is a seven and not eight -- when it might as   
   well be six except for the times when it's nine.   
      
   There are also all the usual problems that occur with any data regime -- update   
   consistency, maintaining concurrent databases, format differences between   
   entities (medical professionals, government, insurance companies) that exchange   
   data, etc.  Electronic medical records are supposed to improve patient care by   
   making it easier to save and share information, and to some extent it does do   
   that.  It also adds another layer of technical responsibilities on top of the   
   usual tasks needed to provided health care, one that does not directly   
   contribute to the well-being of patients.  It's more overhead.  Sometimes   
   it's worth it, and sometimes it creates more problems.  Boron's example above   
   is   
   a striking example of the latter.   
      
      
   >>It wasn't even the privacy issues -- it was the fact that the   
   >>documentation had to conform to billing specs in order to justify   
   >>decisions that needed insurance reimbursement.   
   >>   
   >>Digitizing the patient-provider and provider-provider sides were   
   >>challenging but manageable, but the patient-insurer and especially the   
   >>provider-insurer parts were (and still are) a nightmare.   
   >   
   >And they are not going to emerge from it easily or quickly. Lots of   
   >patient burden, too. The practices and labs now have patient portals   
   >and more of those larger groups do not share patient data across   
   >companies. I have my doc's hospital group and two other hospital   
   >groups and a two separate lab and diagnostic companies that have   
   >separate portals. Lots of record keeping for me, too.   
      
   No doubt under the guise of increased transparency or more access or a better   
   patient "experience."  We see this in industries across the board.  Do your own   
   account management, do your own customer service, etc.  All promoted as being   
   more convenient for the consumer.   
      
   --   
   Late afternoon is a time to dream, I like to listen to Coltrane's A Love   
   Supreme   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)