EMR

Wisdom from a Toddler

I could say the cliche\’ things about it seeming like yesterday, yet like it has been forever since I worked anywhere else.  I guess I just did…so there’s that.  But more to the point is the reality that I actually survived.  Many expressed confidence in me when I started doing this, while many others expressed supreme skepticism over whether or not this type of practice could actually work.  To both of those groups of people I say: keep waiting to make your final judgment.  The practice, while profitable and now growing steadily, is still not near to the point I need it to be.  It’s heading in that direction, but there are no guarantees; I still could mess this thing up.

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ICD-10 and Inflation of Codes

For those still unaware (perhaps looking through catalogs for gigantic inflatables for president\’s day), ICD-10 is the 10th iteration of the coding taxonomy used for diagnosis in our lovely health care system.  This system replaces ICD-9, which one would expect from a numerological standpoint (although the folks at Microsoft jumped from Windows 8 to Windows 10, so anything is possible).  This change should be cause for great celebration, as  ICD-9 was miserably inconsistent and idiosyncratic, having no codes describing weakness of the arms, while having several for being in a horse-drawn vehicle that was struck by a streetcar.  Really.

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The Impending Revolution

Like my practice, membership medicine is still in its early phases.  Like my practice, the future of membership medicine depends on a lot of things beyond our control.  But the excitement I hear regularly from physicians, residents, medical students, patients, business owners, and even politicians about its potential is quite remarkable.  Both of these conferences were full of something that I once thought no longer existed: doctors who were excited about medicine and cautiously optimistic about the future.

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The Pain and Inflammation of Documentation

My previous two posts lamented the incredibly bad the documentation I get from a local hospital is.  In truth, the documentation I get from everyone is terrible.  Seldom does it tell me what I actually want to know, and if there is useful information it is buried in an avalanche of yada yada.  The main reason for this is that documentation is driven by our ridiculous payment system, which requires us to follow arcane rules to generate notes that justify the obscure codes we submit for money from the payors.  This is the reason for much of the gibberish.  These rules, combined with computers\’ ability to quickly and efficiently generate drivel (see also The Entire Internet) are the hot house and Miracle Gro for meaningless words.  Sprinkle the rules on a computerized medical record and stand back!  Useless words and codes will spew out at you like milk from the mouth of an overfed baby.

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Computerized Epic Failure

Good news: my local hospital has the fanciest, newest, coolest computer system (costing major bucks, of course) and now is routinely sending me \”transition of care\” documents on my patients.

Bad news: they are horrible.

Seriously, we get several of these documents per day and often can\’t figure out what the document is about.  On the bright side, sometimes after taking 10-20 minutes of looking through the 12-14 page document, we do actually gain some useful information.

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Ask Dr. Rob: Medical Wreckords

Dr. Rob:  

Long-time reader, first time writer!  I want to know why it is that my doctor makes me pay to get my own medical records.  It seems like since they are my records, they should be free to me!  Can you explain this to me?

– Lucy in Texas

Thanks, Lucy, for asking such an astute question that is near and dear to my heart.

There is, in fact, a simple answer as to why doctors don\’t want you to lay hands on their medical records, Lucy.  It\’s the same reason you don\’t want your son\’s underwear after his first semester in college (known to have broken autoclaves):  they stink.

Why do they stink?  It\’s complicated.  The best way to see this answer is to look into the past.  Way back.

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Personal Tech

When I say we need more tech, I am not saying we need more computerization so we can produce a higher volume of medically irrelevant word garbage.  I am not saying we need to gather more points of data that can measure physicians and \”reward\” them if they input data well enough.  The tech I am referring to is like that I used regarding my father.  I want technology that does two things: connects and organizes.  I want to be able to coordinate care with specialists and to reach out to my patients.  I want my patients to be able to reach me when they need my help.  Technology can do this; it sure did for my dad.

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Madness

One of the main things driving  me back to blogging is madness.  While I can’t be sure that I am not overcome by madness, it is not my own of madness I am referring to.  Well, no, I am mad, but not mad in the way that I hear Elvis whispering in my ear or

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