T
he NSA collects 200 million text messages a day.
Electronic medical records: They don’t save money and they don’t improve quality, but they do allow hospitals to bill more. HT: Jason Shafrin.
Judge rewrites ObamaCare law to allow people to get tax subsidies in the federally run exchanges. See Background posted by Michael Cannon.
ObamaCare insurance: deductible for the silver plan is $2,000; for the bronze plan it’s $5,000. (Karen Davis must be in mourning.)
The less you know, the easier it is to solve this puzzle.
Personalized medicine comes to psychiatry.
60% of Massachusetts doctors will not meet state electronic record mandate.
Denmark’s fat tax harms the economy and produces little change in behavior.
Bloomberg is reporting that states hungry for revenue and flush with the power to requisition individual medical records are moving to capitalize on the value of that information by selling the information in them to all comers. Unlike private companies, states and their agents are exempt from HIPAA requirements and therefore do not have to take data privacy especially seriously.
In an experiment, researchers were able to match several dozen people with their supposedly de-identified medical records by combining public record searchers and the information in a sample group of records purchased for $50 from Washington State. Among other things, “an executive treated for assault was found to have a painkiller addiction,” and a “retiree who crashed his motorcycle was described as arthritic and morbidly obese.”
Bloomberg reports notes that states that exclude zip codes, and admission and discharge dates are less vulnerable to records identification. But even “de-identified” data sets contain significant personal information that could be used to identify individuals, especially in rural areas with small populations.
This is from my column today in The Wall Street Journal.
The Obama administration wants something the federal government has never done before: a computer system that connects HHS, the Internal Revenue Service, the Social Security Administration, Homeland Security and perhaps other departments as well. This is a herculean task with unclear benefits. For perspective, consider that the Veterans Administration converted to electronic medical records in 1998 and the VA and the Department of Defense have been unsuccessfully trying to share records ever since. Even though they have spent millions of dollars on the effort, it now appears that the two agencies are abandoning the goal altogether.
Unsent letter to the Tech Department:
So today I’m doing anesthesia for colonoscopies and upper GI scopes. Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution. I’ll probably do 8 cases today. I will sign into a computer or electronically sign something 32 times. I have to type my username and password into 3 different systems 24 times. I’m doing essentially the same thing with each case, but each case has to have the same information entered separately. I have to do these things, but my department also pays four full-time masters-level trained nurses to enter patient information and medical histories into the computer system, sometimes transcribed from a different computer system. Ironically, I will also generate about 50 pages of paper, since the computer record has to be printed out. Twice.
No wonder almost everyone I know hates electronic medical records! I don’t know anything about computers, and I don’t know what systems other hospitals have. I may be dreaming of a world that doesn’t exist or that world is here and I haven’t heard about it.
HT: Jason Shafrin.
Email tells feds to make sequester as painful as promised.
AMA: taxpayers have no right to know how much the government pays doctors.
Medicare Trustee: the federal government is unlikely to keep its Medicaid promises.
Caesarian births range for 7 percent at one hospital to 70 percent at another.
The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.
More on the unmet expectations for electronic health records in the NYT.
Doctors used to have to fill out a checklist for every step in a physical exam. Now, they can click one button that automatically places a comprehensive normal physical exam in the record. Another click brings up a normal review of systems — the series of screening questions we ask patients about anything from nasal congestion to constipation.
Of course, you shouldn’t click those buttons unless you have done the work. And I have many compulsively honest colleagues who wouldn’t dream of doing so. But physicians are not saints.
Hospitals received $1 billion more from Medicare in 2010 than they did in 2005. They say this is largely because electronic medical records have made it easier for doctors to document and be reimbursed for the real work that they do. That’s probably true to an extent. But I bet a lot of doctors have succumbed to the temptation of the click…
And then there are the evil twins, copy and paste. I’ve seen “patient is on day two of antibiotics” appear for five days in a row on one chart. Worse, I’ve seen my own assessments of a patient’s health appear in another doctor’s notes. A 2009 study found that 90 percent of physicians reported copying and pasting when writing daily notes.
More on how electronic medical records make some things too easy.
