Word: doctores
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Dates: during 2000-2009
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...surprisingly, nationwide adoption of Electronic Medical Records is being pushed hardest by those who would profit financially from it. The slightly embarrassing financial reality of EMR is that large, mechanized medical operations like hospitals, clinics and big multi-doctor practices stand to make quite a bit of money by adopting them - given our current convoluted system of paying for health care. Two clear factors make EMR a money-winner: improved billing and internal cost control...
Medical billing, for both hospitals and doctors, is accomplished via a system of codes, which is already so complicated that there are special schools for it, granting degrees not just in coding but in special branches of coding. Coding boils down to assigning specific numbers to every problem (diagnosis codes) and other numbers to every treatment (treatment codes). Though the lists, in my field of orthopedics anyway, are woefully inadequate to capture how we actually think about or treat patients, they are still ponderous and complex. From common cold to brain tumor, open heart surgery to handing over...
...diagnoses and treatments - to the billing side that pays for it all, makes billing faster and easier. Why give away that Ace bandage for free? This at least is efficient. But communication the other way, from billing to medical, will take place too. And this is more ominous. The doctor should tell the biller what he found and did. But that EMR program can easily be a very clever, covert way for the biller to tell the doctor what to say he found and did. We don't simply write whatever we want in an electronic chart: we must select...
When, for instance, does a urinary tract (bladder) infection become a pyelonephritis (infection involving kidneys and ureters)? There's no clear-cut answer. But when the computer reminds the doctor, every time he clicks on the "urinary tract infection" button, that the hospital gets many thousands more for the more serious condition, it's just as easy to click on the "pyelonephritis" button and make your administrators happy...
...doctor with a sore knee and for some reason he is examining your ears. It might be that you have a very thorough doctor who is ruling out a rare ear-knee syndrome. More likely, the EMR program he bought is reminding him that notes on the chart about just few more body parts will kick your visit up into a higher-paying code...