Why So Many Pieces?
To Fill In The Medical Record?
Riddle Me This Batman!
The Riddler
“What is the bane of my existence?”….
This is a story for readers and patients because it involves you and your personal safety. The potential for iatrogenesis and fraud is real. We have far too many cooks in your kitchen. And a solution at the end of this diatribe.
Things are upside down/topsy-turvy.
Upside Down Photo by Ehud Neuhaus on Unsplash
So… The bane of my existence as a primary care physician is fixing all the data errors in my patient’s charts. Whenever my life gets dragged down into the pit of inefficiency, I never have to look far to find out the source. Yep- another regulatory act from the Federal Government. Today’s riddle and bane is rooted in the Health Insurance Portability and Accountability Act of 1996. This gem, as many such “helpful gestures from Uncle Sam”, promised nirvana with no downside. As it rolls out, the downside is significant.
When you read the actual act (click above underlined link), this actually makes a lot of sense and should be a net positive. As I see it, the problem is that Medicare payment regulation and incentives regarding data documentation got intertwined with the EHR act, promoting a mucked-up big time. We have every health provider contact trying to recreate the wheel. This redundancy is creating serious and dangerous mischief with your health record. Let me walk you through what happens.
As intended, whenever a physician or care facility opens up its Electronic Health Record (EHR) to start or maintain your chart, a cloud data mine sweep is performed “under the hood”/behind the scenes. This mine sweep is run on a few data vendor highways. Which vendor is used is decided by each maker of an EHR software.
For nearly all prescriptions, the conduit is a company called Surescripts. Surescripts is often chosen for clinical information network clearance through their clinical direct messaging. The good thing in this scheme is that as compliance by the innumerable EHR companies improves, more providers are connecting and sharing standard data files using these network clearing houses (information highways).
Another positive outcome (from my perspective as a prescriber and primary/generalist physician), is that I can quickly see if my patient has had outside medications prescribed or filled. This helps me be aware of care a patient may forget to inform me about. The bad part as it relates to prescriptions is that the record integration results in duplicated and inaccurate active medication lists. I have to sort through the various duplicates and attempt to merge or delete the errors to provide an accurate and current chart.
Contrary to common sense, despite this integration capability, no electronic record to my knowledge has a function in the program to inform any pharmacy that a prescription was discontinued by a prescriber. The only logical reason this hasn’t been accomplished is because your corporate pharmacy chains, want desperately to fill that script and get paid again for fulfillment. This is the most glaring and frequent point of patient care error AND IT IS VERY DANGEROUS.
Consider this very common scenario. I have a patient on a blood pressure medication. The patient then lands in the hospital. The hospital doesn’t have that medication but does stock an alternative equivalent in the same drug class. Further, when the patient is brought into the hospital, no digital notice to my record or the outside pharmacy documents the med switch. Now upon discharge, the hospital doctors send the patient home on a different named but duplicated prescription. The patient takes this medication and ALSO my preadmission medication. Result? Double dosing with potential of fainting, death or organ injury from excess medication dosing.
Medication reconciliation takes work/effort which is all well and good- I am not asking for sympathy. BUT human nature being what it is, I find that most locations of care do not put in the effort to get the errors corrected. This means the opportunity for medical errors, excess and duplicated prescription filling and pill taking is compounded. Think about the phone game we played as kids. But it is getting the medication list more and more inaccurately translated as we go around the table of medical offices and hospitals. The result is one form of doctor induced illness (iatrogenesis).
Whose Job Is It Anyway?
Regarding your health record (and sharing data betwixt providers), the above question I wish to pose to Uncle Sam and specifically to the following areas of patient care:
Vaccines: Why should a hospital be vaccinating patients (exception Rabies for acute bite)?
Obesity Counseling: Again- how does an acute care facility address obesity? How many of the various specialists have to state in their record (for payment) that they see their patient suffers from excess body fat and they should discuss this with their primary care doctor.
Smoking counseling: Again, what is your gynecologist, urologist, vein doctor, general surgeon going to do about your smoking? Why does Medicare make these busy specialists "discuss for billable payment” in this effort of futility?
Vaccines again: Why again does your specialist give two cents about whether you had the flu shot, pneumonia vaccine or shingles series?
Vaccines again: Should your corporate walk in clinic be pushing vaccines on you? What kind of record review did they perform or medical assessment for that matter?
Patients are getting too many shots due to having every Tom, Dick and Harry tasked with vaccination record keeping. Do we think it possible auto-immune illness can be induced from stimulating our immune system to product antibodies? Hint: We know that infections do this, why wouldn’t other forms of artificial immune stimulation not? Check out Guillain–Barré syndrome. Over vaccination is another iatrogenesis opportunity.
The above mentioned #’s 1-5 and many other tasks actually belong in the wheel house of your primary care physician. Corporations and hospitals don’t want that task to be assigned to us because then they can’t pander more services. Specialist frankly WANT us to do these jobs precisely because that is part of our job in overall primary health services and the pursuit of WELLNESS.
The Italians May Have The Right Health Record Model
I understand in Italy, your main doctor (aka primary care physician) harbors your hard copy health care file. Notes are brief and the chart is kept in the clinic. If you are referred to a specialist, the chart is given to you the patient with the referral. The specialist or referral recipient then provides their assessment and recommendations and place them in the chart. You, the patient, return the chart to your primary care doctor. The primary physician then reviews the consultant’s evaluation and recommendations. Incorporating that opinion, along with assimilating your overall medical conditions and other health priorities, the doctor DECIDES whether following that advise is in your best interest.
In this modern digital world, how can we in America rein this error prone, duplicative and over consumption health care system in?
Here is a huge leverage point that any serous SOS entrepreneur can make a literal fortune addressing:
Develop a patient health record card with magnetic strip or chip on ID card. This strip can assimilate all the patient’s demographic data, insurance data and all payment data fields.
Add a record reconciliation/update function that is linked to the providers EHR. Swiping on intake updates THE MOST RECENT health record data.
Sell a magnetic strip/chip reader that all interested providers pay for at their point of care.
Using that interface, patient consent for care are confirmed. Using this same data source, those providers that are agreeable can automatically have services confirmed and filed for and receive payment at the point of service and in real time.
Program the patient’s health card as the most recent and updated health record and reference point.
Have the latest care point record update upload to the patient’s chip. The patient has the most current record on file on their person for the next health care interaction.
Make the vendors the slave to the patients health card/chip. The patient owns the record.
Back it up in the cloud - the vault can be accessed if the card is unavailable (program protocol authorized by the patient at a point of care).
Result?
Patients actually have a current and accurate health record that is under their control.
Demographic and payment data field errors are eliminate- no more payment disputes. Billing overhead presently is over a quarter trillion dollars a year folks!
Hospitals and the CVS’s of the world can’t vaccine inject you out of “ignorance”.
The government can stop wasting everyone’s time, resources and data file resources replicating the same histories OVER AND OVER AND OVER AND OVER AND OVER again.
Anyone interested in this solution, I will be happy to start requesting some crowd funding on Substack- let’s GetRDone and create some destructive capitalism in the process.
If you can’t GetRDone, you can’t stay
Wow Dr. Kordonowy, that’s a brilliant idea and one I would invest my few pennies in for the next generation. 😊
My primary complains that the specialists he sends me to don't ever report back. All I can do is ask, dutifully ignored because its all in EPIC which my private doctor must access. He maintains my paper (!) chart(s). I prefer him despite our ages (80+) and my fear that he will retire. He says never despite terrible reimbursements. He notes his military retirement pay is adequate.
So far, I am the keeper of my med list. If a new script I check Google and quiz my pharmacy. I am always asked to verify EPIC and aside from a real inability to edit the record myself just live with the errors. The techs that do the check rarely ever fix them.