re: Anesthesiologist & Medical Assistant: vicious commentary with a sedated patient

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Saying technology doesn't make an office more efficient is kinda hard to believe, since it works for every other business on the planet.

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Efficient wise? Absolutely...

But insurance is what really matters.

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He found that he had recorded the entire examination and that the surgical team had mocked and insulted him as soon as he drifted off to sleep.

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If I were the patient in this scenario I might not want to give them my business in the future but probably wouldn't give much of a damn otherwise if they did the work correctly.

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instructing an assistant to lie to him, and then placed a false diagnosis on his chart.

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This is a completely different matter though.

I'm facebook friends with a nurse who is constantly talking shite about patients. She doesn't name names but she'll post things like "Just had to deal with the brattiest kid who came in with a broken arm. I wanted to punch him in the fricking face." She posts stuff like that all the time. No shite.

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Agreed, but all those old ladies sitting around coding, answering the phone, and being rude to the patients costs money.

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A lot cheaper than digital shite that can be proved in court, IMO

And unlike the employer in the OP, this side of Va is polar opposite in quality employees for modern technology, even in '15, but leave it to someone from Va to scam their way into a lawsuit

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I've rolled out EPIC at 3 facilities

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That's a good line to be in $$$ wise, especially if you're certified

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Saying technology doesn't make an office more efficient is kinda hard to believe, since it works for every other business on the planet.

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Believe it!! It can help in some areas, but it slows us down. I'm not averse to tech, but I am to losing money and risking the future of my business. I have yet to talk to a physician that says he is more efficient and profitable with EMR. They just say "But we have to do it". I'll just keep paying a little 3% penalty to medicare and only medicare and avoid the 30-40% hit in profit most clinics see. By the time they force me, I be able to just say "frick it" and quit or go all cash.

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Saying technology doesn't make an office more efficient is kinda hard to believe, since it works for every other business on the planet.

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Technology definitely improves the efficiency of a practice, but the problem is that...

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I'm in IT

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As are the people writing practically all commercially-available EMRs. Plenty of technology streamlines the in-office needs and makes it work more efficiently, but that's not what an EMR is designed to do. It's designed to build a big database that will allow groups, particularly from the government, to come in from the back side and mine data that they want collected, so on the front end, they force documentation of lots of things that are vital neither to patient care nor efficiency. They create a lot of work in many areas where little existed before. Most charting in EMRs is blocked/sectioned off into clickboxes with an option to write in free text. Going through a series of clickboxes can most definitely be more inefficient than many of things that could be written on paper. Some are more finicky than others, and they won't allow a patient chart to be closed out because of some checkbox that was missed or actual bugs in the software. Many times, this prevents the next chart from being opened, and, oddly enough, can force a practice into paper charting for the rest of the morning/afternoon. No one is arguing that tech could even save paper or time- if charting were allowed to be done on a templated MS Word document, I would roll through things faster than writing them, but that's not what it's like. It's not a digitization of current practices. It's series of clicks and menus and data coming from multiple places that slowly populates and adds work that wasn't previously there that isn't necessary.


Further, as pointed over by SmackoverHawg, in the next 5-10 years, I predict the majority of EMRs will be better-suited to interface with billing software (most don't or do a terrible job of it at present, leading to a separate major software purchase and training someone to be able to understand both) that will eventually point out that many, many, many doctors underbill for their services. For instance, if you'll check out this AAFP article that points out how it's currently mainly a manual process that EMRs are in the infancy of bridging the "automated" gap. And this isn't a matter of "Oh, if you do more, you get paid more, so do more" that you hear about, but really a matter of things that are done and just not documented because it's slower to document more things. And it's quite possibly writing down that you asked 7 questions rather than 5. The difference in the bill? About $33 (if the article is to be believed, and I believe it to be fairly accurate based on a number of conversations. It can be as high as about $45 or so).


ETA: hit submit before I was done.


The added cost of the EMR finding 5 underbilled patients per day? $40,000/year. That's great news for individuals and practices, but it isn't any better for healthcare. And in many ways, it's worse for it.



The point is, from the outside, it sounds like a lot of old folks resistant to change, but EMRs are typically cumbersome software that is expensive, poorly designed for their practical use that offers little advantage to the patient and slows down the physician.

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By the time they force me, I be able to just say "frick it" and quit or go all cash.

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When you open up your boutique concierge, cash practice and need a new, young guy as a partner let me know. I've always liked rural Arkansas.

I only trained end users for bedside at 2 large hospital operators here. My knowledge of EMRs is actually fairly limited. However my knowledge of hospital budgets is far less limited. No hospital is facing financial collapse due to in efficiencies in technology. The cost of EMR is overwhelming but the majority of loss comes from loweredreimbursements, uninsured, nosocomial infections/Pressure ulcers and overstaying your paid for days (DRG).

Edit-productivity numbers also play a role with budget issues...