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Are There Any Doctors Optimistic About Healthcare?

Posted on October 9, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I realize that that’s a kind of catch all title, but it seems to be the case the more doctors I talk to about healthcare. Don’t get me wrong. I know a bunch of optimistic doctors. They are optimistic about life. They are optimistic about their patients. They are even optimistic about the future of the care that can be provided patients. In fact, it’s hard to be a doctor today and not be a bit of an optimist.

However, amidst all of that optimism I don’t many (possibly any) doctors that are optimistic about where healthcare is headed. We write about technology and EHR most of the time here, but this goes far beyond technology. Sure, EHR is the scapegoat for complaints when many times the real complaint is about the healthcare system in general.

My post about the myth of “Too Many EHR Clicks” has drawn the ire of many doctors. While there are plenty of issues with EHR software (especially some of them), most of the complaints I hear about too many clicks are a reflection of regulation and reimbursement. It still begs the question of whether an EHR can be beautifully built with very few clicks in the current regulation and reimbursement environment.

I get the pain. This tweet is an example of doctors reactions:

I could just as easily hear about doctors leaving medicine because they were spending too much time charting and not enough time with patients. Imagine if the meaningful use requirements were around in a paper chart world. We’d have even more complaints about time spent charting than we have today with EHR.

All of this to say that I don’t see much optimism about the future of healthcare from the doctors I meet. Will we reach the point that doctors kick against all of these pains and something changes? Do you see something on the horizon that will alleviate the pains that doctors now deal with today?

I’m excited by the technologies that will come out and change healthcare. I’m not optimistic that regulations and reimbursement will get any better. In fact, a lot of signs point to it getting much worse.

An Example Where an EHR Overcharges Healthcare

Posted on September 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In response to my post “Study Says Overcharging by the Hospital Might Be Overstated“, Patrick Duffy from PDA Consulting offered these added insights into the “overcharging” that exists in healthcare.

Some are overcharging thanks to EMR upgrade coding errors. How about $720 for ONE nitro tablet. Insurance company did not catch it either. About 9 months after an EPIC implementation so how many people/Insurance were overcharged and never knew?

In the meantime a gastric band operation in the UK is $7500 average. In the US it is between $15k and $30k depending on State. Is that not overcharging?

I’d never heard of an EHR software doing this, but it’s not surprising at all. In fact, it’s probably not even happening because an organization is trying to be dishonest. When you look at the complexity of an EHR implementation, it’s not surprising at all that things like this happen.

It’s also not surprising that the insurance company hasn’t caught it…yet. Notice how I added in the yet there. We’ll see if this comes back to bite healthcare organizations. Insurance companies do get behind on a lot of things, but they do go back and plug holes and then it hurts.

There are so many issues with the way we reimburse healthcare, that I’m honestly not sure where to start in order to fix it. It’s a complex web of overhead.

In the tech world, a software program has technical debt (also known as design debt or code debt). We see it happen across the EHR and health IT software world. Over time, you accrue a debt of issues in your software that make it easier to scrape the old software that’s encumbered by technical debt and rewrite it from scratch so that you can do it the right way.

When I look at the healthcare reimbursement system it’s got a very similar problem. There’s a healthcare reimbursement design debt that’s grown so large that there are no easy fixes to the system. I guess that’s why I asked the question, “Is Healthcare So Complex That It Can’t Be Fixed with the Existing Parts?

Scribes and Problems with the Healthcare System

Posted on April 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In a recent #HITsm chat we had a pretty good discussion about scribes and their place in healthcare. I know a lot of people that are really big proponents of scribes, but I also know many people who are against them.

During the discussion, the question was asked if scribes mask the problems of the EHR software. This was my reponse:

If I were to do that tweet again, I might replace healthcare system with reimbursement system. Scribes are a mask to the fundamental problems with how we pay for healthcare. I’ve always loved to think about what an EHR would look like if it didn’t have to worry about billing. It would be a completely different system than what we have with EHRs today.

The reality is that doctors want to get paid and so EHRs have to deal with billing. Plus, now they have to deal with meaningful use regulation as well. Add those two together and you can understand why scribes are so popular with doctors.

Every single EHR would be better and easier to use if they were just worrying about providing a tool to doctors that lets them document the visit and ensure quality patient care. However, until that happens (which is never) scribes and other alternative methods to document are going to be very popular with many physicians.

How do ACOs Deal with Non-compliant Patient?

Posted on December 22, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I have been thinking more and more about ACOs coming together and the ACO movement in general lately. Everything seems to be heading straight towards the ACO reimbursement model and so I think we all better start to consider what that’s going to mean to a clinic. Plus, in my case I’m particularly interested in how EHR software will enable the ACO to work properly.

It is quite clear to me that EHR software and technology in general will be one of the core pillars to a successful ACO.

As I thought about ACOs, the question came into my head: How will an ACO deal with a non-compliant patient?

Since the ACO reimbursement is tied to the health of the patient, then patient non-compliance becomes a really important issue. Plus, patient non-compliance is an incredible challenge since the physician only has so much control over a patient once they leave their office. In fact, they only have so much control of their patient even within their office.

I certainly don’t have all the solutions to this problem, and I’m not sure how reimbursement will handle a doctor who did everything right to improve the healthcare of a patient and they chose not to comply. However, this makes me start to think of ways that technology could help a doctor to improve patient compliance.

I’ve written before about some really great mobile health applications for people with diabetes. It was amazing to see how simple text message reminders could improve compliance by patients with diabetes. There are probably dozens and maybe even hundreds of other models where mHealth could improve patient compliance.

One of the real challenges I see with this is that much of this compliance could best be served by an EHR software connected to the patients. Unfortunately, most EHR software is so busy helping the doctor do what he needs to do in the office and meeting government guidelines that EHR software doesn’t have the focus to create these types of connections with the patient which could improve patient compliance. I’m not sure they will ever have this focus.

This is why EHR vendors need to fully embrace the idea of creating an ecosystem where smart “app developers” can create these patient compliance apps that connect directly into the EHR software. This won’t be easy for EHR companies to embrace, but those that do and do it well will be wildly successful. Plus, they’ll improve healthcare in the process.

Are there other ways that ACOs will deal with non-compliance by patients? I’d love to hear what people think.