I’ve worked in a lot of hospitals. And I’ve worked in a lot of medical offices. And in each location, the services provided create a record. So who owns that record? That’s the question that is at stake as we move towards the integration of medical records.
Ask a hospital administrator. They’ll puff up their chests and tell you how imperative it is to continuity of care that the hospital own and preserve the record. Why it’s their lab that cultured the bacteria. And their scanner that diagnosed the tumor. It’s only logical that the hospital maintain the patient record. Why they’re the only entity that would be capable of doing so, right?
Or ask any doctor. They’ll tell you hands down that the record stays in their office. “How would I defend myself in a malpractice case without the original record?” And they would have a good point. But wait a minute. Let’s see. Who’s that other party that’s part of the health care equation? Oh yeah; the patient. How could I have forgotten the patient.
Ultimately, if there is to be one party who owns and is to be responsible for their comprehensive medical record, it’s the patient. Now don’t conjure up images of patients with lose pieces of paper and notebooks with test results in tatters. There’s so many web based alternatives for patients to use. And the one that will rise to the top? The one alternative for medical health records that will become the universal medical record? Google Health.
We’re going to spend the next few years hearing from the pontiffs of the major medical organizations about how they feel a universal medical record should be handled. But if you know anything about web 2.0, you know that simple, open source applications are what will prevail in the long run. And Google Health is just that. Google Health doesn’t want to take ownership of your individual medical record. It simply wants to act as the repository for your record. And quite honestly, I think Google has proven themselves over time to be pretty darned good at data management.
Google Health. It’s simple and eloquent. And just waiting for its’ day.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
There’s been a lot in the news as of late regarding the virtues of adding on-line Rx (prescription) capabilities to your electronic medical record. Sounds like a good idea, right? But what’s the reality adding on-line prescribing capabilities to your solo practice?
To answer that question I called my EMR vendor (Eclipsys) to get a bit more information. Granted, many of these programs are new. And there are (in theory) some advantages for both patient and doctor. For instance, if I write an Rx and submit it to the pharmacy, the Rx program at the pharmacy will cross reference the script with those approved medications on the patient’s insurance formulary. Also, the program will cross reference the medication that I am prescribing against the other medications that the patient is taking, picking up any cross reactions between medications. Sounds pretty effective, eh?
Now let’s take a step into my practice. Face to face time with patients is limited due to the need to see more patients. That’s simply a fact. As reimbursement drops, you need to see more folks/day to be able to meet the overhead. The light bill, salaries and the rent keep going up while reimbursement to providers keeps going down. So what happens if I add a new module to my daily routine?
First, when I submit a script to the pharmacy, the neat functions we just alluded to above take upwards of 60 seconds to process. The database that the script has to access is vast and just simply takes time to process. Now remember, here you’re asking the top producer in the office to sit and wait a minute. 30 patients a day with a script each? That’s a half hour a day. Is on-line Rx worth that? No can do.
Next is the cost. Eclipsys charges $495/year for the module to accomplish what we’ve described above. Now let me get this straight; I’m in solo practice aka small business. I can write a script on my EMR for free. That script is type and legible. And did I say, free? So if you were in small business, what choice would you make?
Don’t get me wrong, I’m for EMR. I’m a technophile at heart. But it’s going to be a cold day before I buy into on-line Rx.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
There’s a good article in iHealthBeat today that calls for focus on sharing of information between providers. The report from Government Health IT calls for a move away for IT development towards a focus on sharing information. The article states,
Merely creating EHRs doesn’t give doctors and other health care providers any incentive to use those records or add updated information to them, the report states. “We need to incent the use of the information,” said Kristine Anderson of Booz Allen Hamilton, one of the report’s authors. “It just won’t happen naturally. We believe public payers can lead this charge” by offering providers incentives to share information, Anderson added.
As a physician, I see a couple of issues here. First, an incentive. That’s code for we’re going to pay you less unless you conform to our new system. I’ve been down that road a number of times before.
Physicians aren’t used to sharing. And there’s a number of historical reasons why. First, other doctors may represent competition to my ability to earn a livelihood. Second, there’s an issue of competence. Do I want to share my treatment with another doctor who I feel is less capable of providing the same care to ‘my patient’?
My patient. What does that mean? It means that we take ownership of care. A good physician vests themselves in the care of their patient sharing in the successes and failures of care. From a philosophical basis, it’s going to be hard for a doctor to not take ownership of the people for whom they treat.
It may not sound like it, but I’m behind these changes. I currently use an EMR but I’m also a vocal advocate for my patients. There I go again…my patients. I might have to just get over it.
Jeff
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
One of the keys to Mr. Obama’s proposed economic stimulus plan is to push money into the economy where it can work quickly. We saw with the financial sector bailout that the money given to the financial sector was used to prop up the banking industry and never made it out into the general circulation. From an article in Politco, it seems Mr. Obama’s health care restructuring plan is to use Medicaid as a tool to accomplish a number of goals.
The first goal would be to float and estimated $700 billion into the economy through Medicaid. These payments would be made to doctors and hospitals based upon the traditional fee for service method we now have in place.
The second goal would be to aid the states who are now crippled by a Medicaid burden they can no longer sustain. An influx of federal funds into the state coffer via Medicaid would be a welcome relief to all states.
And lastly, the third goal would be to benefit the general population through improving health. The Medicaid plan may not be perfect but it’s a good place to start. Sure, we need to fix this system. But more importantly, we need to fix the economy. And heck, why not save a few lives while we’re at it.
So the big question is whether it’ll work. As a doctor, I’ve contemplated the collapse of the US health care system. You have to realize that the majority of the health care system is now dominated by publicly held companies. The share holders of those companies will only stay the course for so long if their investments in health care start to drop. If we saw a mass exodus from health care by those investors, we’d be seeing the next economic bail out. That’s right, a bail out of the health care sector.
I’m no economist. But as a doc, I like Mr. Obama’s proposal. And yes, I think it will have a positive impact on my practice.
Jeff
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
There’s a lot in the news about how IT and electronic records are going to turn health care into an effective, integrated business. Proponents of these steps say that medicine has drug its’ feet and has been reluctant in embracing IT.
What these proponents fail to realize is that the fabric of medicine is made up of solo and small groups of independent docs, clinics and practitioners. Integrating these groups isn’t as simple as connecting them with a USB cable. Integration requires business relationships. Many of these new relationships would need to be created between entities who now consider themselves competitors.
So what’s the common thread that we can weave between these differing groups? How do we find consensus in a profession that is dominated by power, ego and money? The only solution that seems to have merit is for the government to offer a voluntary program for which docs can sign on. Sure, they’ll drag their feet at first claiming autonomy and crying that socialism is overtaking free choice. But in time, we’ll all acquiesce and be part of the system. And if we don’t, I don’t see much of a bright future for the system.
Jeff
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
Any suggestions on going green in a medical office? We’ve looked around and found a few changes. We’ve gone from paper to electronic charting and that has saved reams of paper. So on the front office, we can find changes.
We’re looking into reducing our new patient forms. We’re thinking that we could use a tablet that would be given to each new patient to input HIPPA information, medications, allergies, etc. Currently we have each new patient fill in a black paper form. We scan it and shred it. In a green world, that just seems dumb.
As we move into the back office, changes are harder to find. For instance, my staff and I talked about using cloth (re-usable) towels for washing our hands but found the potential for hand-to-hand bacterial transfer out-weighed the gain made when compared to paper towels. We voted for paper towels to keep our infection rates low.
Anyone else coming up with good ideas?
Jeff
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
I’ve been in solo practice for 25 years. Sure, I’ve rotated here and there in group practices as a specialist, but never really found the comfort I have in my own solo practice. But is there a future in solo practice?
Integration seems to be at the core of cost savings. Practice integration requires an autonomous doc to join the group, have a boss and be an advocate for the mission of the group.
Is it time to circle the wagons? Time to come into the fort? Boy, I just hate to let go of my freedom.
Jeff
Jeffrey Oster, DPM
Medical Director
Myfootshop.com
