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TURNING EVERYONE INTO DATA ENTRY CLERKS

Posted by Tim Bryce on February 12, 2012

(Click for AUDIO VERSION)

Last year you may recall me discussing the current effort by the government to create electronic medical records by physicians, hospitals, and other health care providers (see “My Dinner with the Doctor”). In a nutshell, the government is blackmailing doctors into automating all of their medical records. As a follow-up, I recently discussed this effort with my doctor friend to see how he was progressing, and a senior hospital administrator I also happen to know. Both claimed the effort was a nightmare and their time was being monopolized converting old records into an electronic format.

In theory, such an effort means a patient who travels away from home will be able to easily access his medical records which can greatly facility him/her receiving the proper treatment in the event of an emergency. Sounds good, right? Not so fast. I was horrified to discover the government never issued any standards by which data should be captured, stored, and shared in a secure manner. The only requirement was that the medical records were converted to electronic format, regardless of what that might be. As I was to learn, there are dozens, if not hundreds, of vendors selling computer software packages designed to manage patient records. Not surprising, each vendor took their own unique approach to designing their software which means there is an alarming number of incompatibilities between the different products. How one company stores patient data in a computer file is incompatible with another vendor. This means doctors and hospitals cannot share data as easily as was hoped. In other words, the government took a noble idea and botched it by failing to define any standards. Just because your primary physician has your medical records recorded one way, doesn’t mean another doctor can read it (unless, of course, the doctor happens to have the same medical records software). Despite the government’s initiative, doctors will still be dependent on faxes as opposed to a modern and secured data exchange. As an aside, my doctor friend received 18K faxes last year representing 50K pieces of paper (and that is just one doctor). The government’s new program does nothing to curtail this problem.

In order to meet government deadlines, doctors, nurses and other health care workers are swamped inputting data into their computers, a talent for which they are not necessarily suited. As a result, doctors are spending less time practicing medicine and more time as data entry clerks. Likewise, nurses are spending the lion’s share of their time inputting data and allowing their assistants to care for patients instead. As an old systems man, I asked the obvious question, “Although you are inputting a considerable amount of data, what are you getting OUT of the system in return? How is this helping you with patient care?”

Remarkably, the doctors didn’t see the system as a valuable tool, but more as a hindrance to serving their patients. This caused me to ask, “So who is going to use all of this data you are entering?” It was their guess it was intended for attorneys and government bureaucrats, certainly not for the patient or medical community. Only then did it occur to me the medical community was not alone in this regard. To illustrate, government regulations are becoming overbearing on educators who are having to spend more and more time inputting data and less time teaching. In other words, the medical and education professions are two prime examples of obnoxious government regulations having an adverse effect on the sheer nature of their work. There are likely many more examples, particularly in the law enforcement, military, and financial industries, institutions who are being greatly inhibited by obnoxious government red tape. It is one thing to insist on certain regulations, quite another to devise rational systems that enhances the volume and quality of work. My concern is we are turning our society into nothing but data entry clerks solely to feed the government’s insatiable hunger for superfluous data.

My doctor friend also happened to mention that in a few weeks his hospital will be going “paperless” with a new system that will also conform to the government electronic medical records initiative. So far, training for the new system has been abysmal, documentation is non-existent, and nobody trusts the new system. Yet, hospital officials are determined to switch to the new system all at once on a Sunday, not carefully implemented in planned stages. I asked my friend how he planned to participate in the system’s implementation. “Two things,” he said, “First, I plan on releasing all of my patients from the hospital on the day before the system is to go live.”

“And Second?” I asked.

“I plan to be on vacation that week. I don’t want to be anywhere near that hospital when it melts down.”

It kind of gives you a warm, fuzzy feeling of confidence, doesn’t it?

Keep the Faith!

Note: All trademarks both marked and unmarked belong to their respective companies.

Tim Bryce is a writer and the Managing Director of M. Bryce & Associates (MBA) of Palm Harbor, Florida and has over 30 years of experience in the management consulting field. He can be reached at timb001@phmainstreet.com

For Tim’s columns, see:
http://www.phmainstreet.com/timbryce.htm

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Copyright © 2012 by Tim Bryce. All rights reserved.

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4 Responses to “TURNING EVERYONE INTO DATA ENTRY CLERKS”

  1. Tim Bryce said

    A W.B. of Arlington, Texas wrote…

    “Excellent piece as usual, Tim…lots to chew on here. I have often asked people the question, ‘Why are you collecting data if you don’t analyze it in any way?’ Most cannot answer but have an excuse that runs along the lines that it ‘cuts down on inventory theft, etc.’ I would not be surprised to see the ‘individual’ have to enter his/her own data annually at some point…just like you file your taxes…another wonderful product of Utopia.”

    An M.B. of Clearwater, Florida wrote…

    “Same thing for small business. Before the new law forcing every sole proprietor contractor to become a corporation passed in 2003, I spent about 20 hours per year doing work for my husband’s carpentry business, not counting answering the phone, and virtually all of it was the annual tax prep. Since the 2003 law, I have an unpaid half time job, with endless paperwork that I have to do for our CPA and/or then I have to pay the state governement for the priviledge of doing it. Many long time contractors my husband knows simply opted out of the legal way of doing things at that point, and are now under-bidding him as unlicensed ‘handymen’. He is lucky to work two days a week so far this year, and I am a nervous wreck over how we are going to live. He’s already cut his pay by $10 an hour, and still lost 40% of his business in the past two years, despite our having to buy advertising for the first time in 40 years. He used to have a six month waiting list by word of mouth alone. Other small contractors like us needed an extension on the law so they could get a second or third mortgage on their homes to come up with enough money to qualify to be a corporation. My husband had just bought a new truck. It was the only new truck he had bought in 35 years, but we had to sell it from my husband to his corporation, a nice little bulls*it invented difference thought up by the state, and then pay the state the considerable sales tax on the brand new truck all over again. That was how we came up with enough money to become a corporation, and now I get to do useless paperwork, while sick as a dog, to keep highly paid government paper pushers employed with all their nice benefits, great health care, and early retirement. Better stop now before my blood pressure gets any higher.

    Good subject! Thanks for bringing it up. Our doctors type on computers the whole time they are talking to us…..it’s the only way they can keep up with the new requirements.”

    An S.G. of Illinois wrote…

    “Wait – you’re blaming the government for not forcing the free market to conform to a governmental preset standard? Are our American businesses so stupid that they can’t figure out that the sharing of medical records requires a common format? If they really are that dumb, perhaps we need more government making decisions for our businesses since they are incompetent when left to their own devices.”

    TIM’S REPLY: “It was the government who forced the issue of going electronic, but they didn’t define a standard data interchange format (which is common in other industries). The medical community is now pumping in the data which is incompatible across different lines. So, what is the purpose? It’s a good basic idea, but the government didn’t consider simple standards which will now create a mess and their objective will be missed. As an aside, software vendors are notorious for not cooperating as they want their product to become the standard, e.g., Microsoft, and just about every hardware manufacturer out there.”

    A P.M. of Palm Harbor, Florida wrote…

    “As a nurse, Tim, I find this conflicting with the HPPA laws. I guess HPPA is a sham; I always thought so. Maybe we should all refuse to give our social security numbers to our Doctors. This is another prime example of big brother intrusion.”

    A J.D. of Columbus, Ohio wrote…

    “Okay–well–I’m all for creating jobs. If we don’t work the jobs given–they will ship them overseas. I’m all for bringing those jobs back home and keeping them here. That was my first thought when I read the title of your post–but the post sort of went a different direction. It is sad that the government had to step in with the idea in the first place. I worry about things like — them having my information to share. What if I didn’t trust the first diagnosis? What if I need a doctor to look at me with a fresh set of eyes and find the real problem? This was true for my husband in the Army where his medical record followed him. Every time he got sick with severe abdominal pain–they blamed the chow hall for food poisoning. It wasn’t until he was almost a goner–that he went home to get his life insurance policies lined up–when he stopped into see the retiring town doctor. Who immediately had him ambulanced to a nearby hospital. He was full of gall stones–to the point he was jaundiced. Life flighted to Wright Patt for 6 hours of surgery and 8 weeks he had to recover. It wasn’t a simple “stone” type surgery. They removed a lot more than just a gall bladder and some stones. I guess part of his intestines had to come out too and he has that huge scar to prove it. If they start sharing info–I wonder if any doctor will look beyond the obvious first findings to get an accurate diagnosis–especially when they are busy with too many patients? Just a thought.” :)

    A J.T. of Michigan wrote…

    “Tim, this was one of your best analysis reports. It was even obvious to a few supervisors before the GM surrender. They were spending more time entering job data, and employee records, rather than addressing the engineering problems. ‘What did you do today?’ I don’t know, I was busy entering data yesterday.”

    A J.M. of Sparta, Michigan wrote…

    “There should be NO government involvement whatsoever. What happens between me and my doctor should stay between me and my doctor. NO ONE else has the right to be involved.”

    A J.S. of Arizona wrote…

    “I know there is a lot of open issues on this, and a lot of it quite confusing. Lately I’ve gotten some form about ‘opt-out’ options in the mail about records, but admit to not knowing what it really means/the impact if I do or if I don’t? I have one now I’m going to talk to the Doc about when I see him soon. My own doctor has a computer in each exam room, and has for many years, long before I read about this being a national thing in fact. I’m not sure if they were just trying to be more modern/efficient, or saw this coming way back? The nurses that take my BP, temp, weight, review my meds, etc., all enter that data into it, as does the doctor afterwards during my examinations, typing away before seeing the next patient.”

    An R.T. of Omaha, Nebraska wrote…

    “I read one of your latest regarding the EHRs being foisted on medical practitioners. Irrespective of one’s opinion of EHRs, the scale and scope of their use pales in comparison to the much more nefarious ICD 9 to ICD 10 conversions mandated by the Fed for October of 2013. The sheer complexity and volume of the new coding systems makes HER conversions look like a walk in the park. Ask you MD buddy about the ICD code conversion. Here is a snippet regarding raw count increases in codes (used to standardize procedures and diagnoses).

    ‘The two major changes in the ICD-9-CM to ICD-10-CM code sets are structure and detail. The codes will move from a numeric five-character size to an alphanumeric seven-character size. At current count, there are approximately 17,000 ICD-9-CM codes and the possibility of 155,000 ICD-10-CM/PCS codes. The codes are far more specific which will allow for greater accuracy.’ A link to the source is here: http://www.findacode.com/medical-code-sets/icd-10-codes.html

    Another question for your medical professional friend may be ‘Are you ever coming back?’ The amount of wealth being flushed down the proverbial toilet of PPACA is stunning and I’m beginning to see practitioners and other delivery and finance professionals adopt a ‘go along to get along’ posture. Anything you hear of administrative simplification relating to healthcare delivery and payment systems is bunk. Obama got his wish with PPACA and now we’re gonna pay long and deep as a nation. Repeal and replace; me thinks not. Keep up the writing. Great job.”

    A J.S. of Skidway Lake, Michigan wrote…

    “The American Health Information Management Association (AHIMA) has been fighting to protect confidentiality, and to develop secure, uniform record keeping and storage systems for decades. I am a member and can testify to these efforts. On the surface, automated record keeping sounds modern and efficient, but there are so many underlying problems. As you’ve said, the federal government has not considered these issues, nor to my knowledge, have they consulted the experts at AHIMA. This is not the first bad decision they’ve made and it’s unlikely to be the last. We have only to look back at the 80s to remember DRGs and managed care for Medicare patients which spawned a whole new branch of medical restrictions. Keep in mind that decisions like these come from the same folks who pay $2000 for toilet seats.”

    An M.L. of Mankato, Minnesota wrote…

    “They’re not turning everyone into data entry clerks; they’ve given professionals a second, clerical job. They have gotten rid of the $6-$8 data entry clerks. Clerks cost the system too much money, because their work does not produce anything. It costs something. Instead, they shifted clerical duties onto the medical personnel who are making money for the system because they produce services. It looks good to managers to get rid of all those useless clerical jobs. But this email describes that the work still has to be done, by higher-skilled employees. Everyone is suffering for it except for the hiring managers. They all got great bonuses for getting rid of workers.”

    A C.A. of Jamestown, New York wrote…

    “Our office has been going ‘paperless’ for a few years now. I love it. As a clinician I can chart my basic appointment and add comments per patient as necessary. Our sofware is extremely user friendly and allows for easy flow between front office staff and clinical staff. The software is useful for the ones willing to use it and explore it. Things are smoothing out as far as administration. My patient care hasn’t changed, if anything, I have more time to spend with my patients on education and with me, learning about they’re last vacation or their new job. I’m not writing the whole appointment. Our office is small so we haven’t had much need for transfer, though I can see how difficult it would be between offices, patients and hospitals. I wish all those doctors and facilities luck and perseverence. Like all change, it will take lots of time.”

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  2. [...] with a new system at a local hospital. You may remember me briefly discussing this earlier, “Turning Everyone Into Data Entry Clerks.” It’s been three months since then, and my doctor friend brought me up to date regarding the [...]

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  3. [...] federal government a few years ago requires doctors to digitize all of their medical records (see “Turning Everyone into Data Entry Clerks”). This means every medical institution in this country has been busy entering data about all of [...]

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