I think electronic records are dangerous because healthcare workers presume they are infallible because “ technology “ when the records are only as good as the humans imputing the info. I have had incorrect info in my “ electronic record” as well as missing info that might be helpful to a doctor.
There is a cult like religious faith in technology that is inappropriate within healthcare in general.
1) According to Hippa, YOU are responsible for the accuracy of your electronic record and YOU have the right to change the inaccurate information. Therefore, get it changed.
(2) No, I can speak from experience: the healthcare workers do not believe the EMR is infallible. The vast majority don't trust it. That is why they go over the information with you. Physicians will have some confidence in the chart notes they take, as well as the lab tests, (and I know they will not trust a reading that is inconsistent with history and the other readings in the panel) but my experience is that they do not accept the notes of others without confirmation during the interview.
(3) I enter chart notes in my EMR all the time. I also keep my records, going back 70 years, up up to date and verified. I direct my physicians on issues before each visit. They have 15 minutes with you. You have to make the most of it by taking charge of your examination. Learn your EMR. There is a patient user interface to every one these days.
(4) Your health is important, more important than you think if you are younger. They say the order of priority is God, Family, Country... No, its God, Family, Health... You must take personal control of your health. That is what informed consent is all about.
(5) That we are in this Covid mess is and what is to come is because the vast majority of people don't take responsibility, but leave it to the state, in all areas of their lives.
While I was hospitalized...I was asked questions about my physical health and found that the answer for all of them was pharmacological. They had this weird obsession with my bowel movements. When was my last one? When will my next one be? If I went a day without any movement...in came the stool softeners...and other remedies. Do you know how many remedies i took for that outside the hospital? None.
Turns out, I was full of s, the reason being is there is a reason why there aren't toilets in the shape of beds and are in the sitting or squatting position. If only one nurse had said to me "Hey, listen we think your inability to poop might have something to do with the face that you're lying in bed." NSS sherlock. As soon as they brought in the bedside toilet. And I was upright instead of giving them ridiculous bedpan duty...the express was now running on time.
Second example. While in the same hospital...I was not in great pain, nonetheless...I did take a pain med when I was getting the dressing changed for my wound. Why? because the option was given to me...and I thought...why not. I reasoned that it was not good to look at, it did sting and hurt as they redressed it. They gave me a very low dose of percocet, I took it twice a week during the dressings. And after about a month...I was awakening at night restless, wide eyed, crawling out of myself, and not understanding why. Calling the nurse...also seemingly baffled...
Until you look up the side effects for percocet. Then it all snapped into focus. Same could be said for my nausea. I looked into the side effects for other meds...snapped into focus. So, I decided to stop taking these things. And yes, there were some issues in coming down even from the limited dosage I took, but the issues were far worse than the effects of detoxing. I still recall with great clarity...the only thing that calmed the restlessness of the percocet was to bathe myself and exercise repeatedly until the sensation abated.
The hospital will only do for you what you advocate for. Since I am not a squeaky wheel. I think I got into a wheelchair and rolled around the hospital twice. And I only got the necessary care they deemed to be necessary for me. The only time I went out was for an occasional test or when they changed my room (I went into three separate rooms over the course of my stay).
Because of this, I did tend to isolate myself as the nurses were tending to people who were constantly calling them and demanding attention. Because of my growing loneliness, I had them leave the door open to the hospital room so I could at least hear and sometimes see them walking by.
I said it before and I will say it again, the EMR has been the biggest detriment to the practice of medicine in my lifetime. The entire idea of chasing metrics in a pay for performance paradigm diluted patient care. The physician was forever chasing the carrot on the stick to increase his bonus which, in turn, reduced the time with the patient to actually treat the problem. The time spent in the doctor-patient encounter became skewed toward answering screening metrics as opposed to problem solving. EM coding was a contrivance to compensate for time spent with the patient, but it too has become tedious and not very helpful. Can anyone in practice really tell the difference from a 99213 visit to a 99214 or 99215 visit? In my mind the hair was so thin to split that it was impossible to see the difference. My thought process was the same when a patient with four or more diagnoses came in for a 4- or 6-month visit. I still had to review all of the meds, the problems, review previous labs and notes and address any new issues that came in. The tendency was to down code for fear of not including enough complexity to up code. This is another needless worry piled on the doctor's shoulders who already has enough to worry about. As you saw, you got audited and luckily you were able to document what you had done, and the fine was reduced. I had the same thing happen to me with Anthem years ago prior to EMR's and they wanted $1000 dollars from fees from two years prior. I was able to have it reduced to $100 but I had to spend a number of hours of providing the documentation. I had spoken to a doctor in Boston to whom I had sent the documentation and he told me that I had clearly done the work but to justify his time and his job he reduced the fine to $100. In essence, I got shaken down by the insurance industry. This is going to be happening more and more because the records are all there and AI will be looking for cut and paste notes and doctors who do this are going to get pounded. I see this as an intrusion into the doctor patient relationship which used be sacrosanct but no longer is. Woe to medicine!!!
That is the truth my friend!! 99213 or 214? Did the difference between 14 minutes and 16 minutes justify the 214? Enough comorbids? What if I am treating 4 separate conditions? UGH and every insurance company wants something different!! These audit shakedowns are ridiculous, and the hours that go into disputing them are man hours we could use for the ever ridiculous prior auths that pile up, thank you again to insurance companies!
Ironically, our EMR has crashed twice this week. It was down for half the day Monday and half the day Tuesday. I had to go back to paper notes and paper prescriptions. It was actually refreshing!!!! My handwriting is another story however…..😂
I agree 100% Jennifer. AI is pure trash. Stick to paper. Take it from a MIT dropout, (A-student), AI and all of scientism is pure rubbish and only subtracts from humanity. Keep systems as simple as possible. Peace.
Electronic medical records (EMR) have the appearance of convenience but I find them much less helpful than the practitioner-generated notes. Practitioners copy and paste old notes into new ones to satisfy insurers, so most electronic medical record are cluttered and incoherent because of mindless repetition of meaningless and often-outdated information included solely to assure compensation. Most fellow physicians I know agree but are shackled to their computer by health care systems, insurers and the government. And of course the worst aspect of EMR is that too many physicians pay more attention to the computer than the patient in front of them.
I have had incorrect info put on my chart 3 times in the last 3 years!! I’m a retired nurse ( 45 years) and I worry about the lack of attention to detail. HC seems as though there has been a decrease in the quality of patient care in the past 10 years! It seems that the nurses I have encountered in the hospital and offices are either very good or they just aren’t.... more so than when I retired. Rather polarized.
Well, that sucks the fun right out of the quarterly visit. I'll have to figure out what the bare minimum level of sanitized information I can give out in order to still get the medicine that gets me through the day. Big Brother is listening.
The AI doesn't just sift through the transcript, it reports it to somebody. With the Federal Social Media Censorship Scandal pointing out the incestuous relationship between Big Tech and the Government, I wonder what bureaucrat has been monitoring my therapy. Why do I hear Elvis Costello singing the Green Shirt song? "You can fool yourself but somebody's going to get it."
Ya, using AI to try and swindle money based of historic EMRs is corrupt and pure greed. Big surprise. We use AI to take unstructured EMR records, pull relevant data and update our Clinical Trial Database. All EMR records are anonymized prior to ever reaching our AI routines. As are all the participant records in the Trial database. We have very strict business logic that will not accept data that is outside the protocol. Of course the data is then reviewed by Site Monitors, Data Managers and Investigators ... all of whom must sign off on the accuracy of the record. The Site monitors sample the data in the DB with what is in the EMR. Still, inaccuracies can get through, but it is very rare. We also use AI to allow our users to ask for reports using plain old English language instead of having to write code. Both are good uses of AI that save money not artificially produce it.
I've have a PhD in AI and my work goes back 61 years. I was a pioneer in the field. I also implemented EMR for a major hospital system division as its CIO. That division included all the diagnostic tools, imaging, all modes of testing, the chem lab, and the sleep center as well as the physician practices and interface to the big regional hospital. Those are some of my credentials. I don't consider speech recognition to be "AI". It never was until the recent hype. I worked on speech recognition for 4 years in the 70s. Dragon has been commercially available for a long time. In fact, let me make a specific declaration. All the theory and mathematics, as well as implementation techniques of AI has been around since the 70s. The only thing that has changed is the processing power to make the techniques practical, and potentially dangerous. But, as with any technology, the technology is not the danger, it is the users of the technology. With respect to AI tools and results, the discipline that needs to be applied is information security. (And to repeat, as with any technology, the technology is not the answer, it is the users (and implementers) of the technology.) There is one other factor I would add: money. It is the same issue as "Quality is Free." Too many people, and almost everyone in positions of power, are naive about what it means by profit. We can make all health information safe: for a cost. That is technically a true statement. But can we make people safe? I think what you are saying is it requires people in power to be moral. I could go on.
If we are going to solve the problem of eliminating the evil of the Covid processes that have been implemented, it is going to require AI analytics. If we are going to make our country secure, it is going to require AI security hardware and AI analytics. We have to deal with evil to get there. But evil is arrayed against us at every turn, so we have to design for evil. That will happen only from local to state and out. A tough task.
As you know by now, I believe we are "in the fourth turn." My age allows me to see back almost a whole cycle. Perhaps it will take old farts like me to lead the way. But I don't think we can defeat the lesson of the ages that the four turns are inevitable. At least, not in the time I have left. I just hope some small fraction of folks can take over. For now, with the help of my state I can build a secure healthcare infrastructure design, one that takes into account human evil. I think I have enough time to pass on my knowledge to make that a reality. But hurry up and make up your mind.
Great post. It always boils down to how technology is used doesn't it? Either you are moral and act morally or you are immoral and act immorally. Evil exists. That is a given. I would love to see a healthcare system that is bullet proof but this Covid response from the medical community and the regulatory agencies tells me that until this corruption is weeded out, the notion of a secure healthcare system seems the thing of dreams. My opinion.
I suggest it is the other way around. Either the good guys build it first or the bad guys will. EPIC is the largest vendor. Wouldn't you think they have already made a secret deal for a backdoor into their databases for the 3 letter Federal agencies. I know the next step will be to join databases together. They already have one system operational for something like 25 healthcare orgs. In my state I know the state healthcare agency has a cooperative setup that normal people can't access. So it is here and coming. The good people have to legislate and build it first. Or else. See my substack for some posts on what the Feds have done already. (ID.me) And the proposed legislation for the good guys to get there first. I will be discussing this in more detail as the weeks go on. Subscribe.
I think electronic records are dangerous because healthcare workers presume they are infallible because “ technology “ when the records are only as good as the humans imputing the info. I have had incorrect info in my “ electronic record” as well as missing info that might be helpful to a doctor.
There is a cult like religious faith in technology that is inappropriate within healthcare in general.
I agree. It's a cult. Peace.
1) According to Hippa, YOU are responsible for the accuracy of your electronic record and YOU have the right to change the inaccurate information. Therefore, get it changed.
(2) No, I can speak from experience: the healthcare workers do not believe the EMR is infallible. The vast majority don't trust it. That is why they go over the information with you. Physicians will have some confidence in the chart notes they take, as well as the lab tests, (and I know they will not trust a reading that is inconsistent with history and the other readings in the panel) but my experience is that they do not accept the notes of others without confirmation during the interview.
(3) I enter chart notes in my EMR all the time. I also keep my records, going back 70 years, up up to date and verified. I direct my physicians on issues before each visit. They have 15 minutes with you. You have to make the most of it by taking charge of your examination. Learn your EMR. There is a patient user interface to every one these days.
(4) Your health is important, more important than you think if you are younger. They say the order of priority is God, Family, Country... No, its God, Family, Health... You must take personal control of your health. That is what informed consent is all about.
(5) That we are in this Covid mess is and what is to come is because the vast majority of people don't take responsibility, but leave it to the state, in all areas of their lives.
That's true. A couple examples.
While I was hospitalized...I was asked questions about my physical health and found that the answer for all of them was pharmacological. They had this weird obsession with my bowel movements. When was my last one? When will my next one be? If I went a day without any movement...in came the stool softeners...and other remedies. Do you know how many remedies i took for that outside the hospital? None.
Turns out, I was full of s, the reason being is there is a reason why there aren't toilets in the shape of beds and are in the sitting or squatting position. If only one nurse had said to me "Hey, listen we think your inability to poop might have something to do with the face that you're lying in bed." NSS sherlock. As soon as they brought in the bedside toilet. And I was upright instead of giving them ridiculous bedpan duty...the express was now running on time.
Second example. While in the same hospital...I was not in great pain, nonetheless...I did take a pain med when I was getting the dressing changed for my wound. Why? because the option was given to me...and I thought...why not. I reasoned that it was not good to look at, it did sting and hurt as they redressed it. They gave me a very low dose of percocet, I took it twice a week during the dressings. And after about a month...I was awakening at night restless, wide eyed, crawling out of myself, and not understanding why. Calling the nurse...also seemingly baffled...
Until you look up the side effects for percocet. Then it all snapped into focus. Same could be said for my nausea. I looked into the side effects for other meds...snapped into focus. So, I decided to stop taking these things. And yes, there were some issues in coming down even from the limited dosage I took, but the issues were far worse than the effects of detoxing. I still recall with great clarity...the only thing that calmed the restlessness of the percocet was to bathe myself and exercise repeatedly until the sensation abated.
The hospital will only do for you what you advocate for. Since I am not a squeaky wheel. I think I got into a wheelchair and rolled around the hospital twice. And I only got the necessary care they deemed to be necessary for me. The only time I went out was for an occasional test or when they changed my room (I went into three separate rooms over the course of my stay).
Because of this, I did tend to isolate myself as the nurses were tending to people who were constantly calling them and demanding attention. Because of my growing loneliness, I had them leave the door open to the hospital room so I could at least hear and sometimes see them walking by.
Wow. The AI nightmare has begun.
I said it before and I will say it again, the EMR has been the biggest detriment to the practice of medicine in my lifetime. The entire idea of chasing metrics in a pay for performance paradigm diluted patient care. The physician was forever chasing the carrot on the stick to increase his bonus which, in turn, reduced the time with the patient to actually treat the problem. The time spent in the doctor-patient encounter became skewed toward answering screening metrics as opposed to problem solving. EM coding was a contrivance to compensate for time spent with the patient, but it too has become tedious and not very helpful. Can anyone in practice really tell the difference from a 99213 visit to a 99214 or 99215 visit? In my mind the hair was so thin to split that it was impossible to see the difference. My thought process was the same when a patient with four or more diagnoses came in for a 4- or 6-month visit. I still had to review all of the meds, the problems, review previous labs and notes and address any new issues that came in. The tendency was to down code for fear of not including enough complexity to up code. This is another needless worry piled on the doctor's shoulders who already has enough to worry about. As you saw, you got audited and luckily you were able to document what you had done, and the fine was reduced. I had the same thing happen to me with Anthem years ago prior to EMR's and they wanted $1000 dollars from fees from two years prior. I was able to have it reduced to $100 but I had to spend a number of hours of providing the documentation. I had spoken to a doctor in Boston to whom I had sent the documentation and he told me that I had clearly done the work but to justify his time and his job he reduced the fine to $100. In essence, I got shaken down by the insurance industry. This is going to be happening more and more because the records are all there and AI will be looking for cut and paste notes and doctors who do this are going to get pounded. I see this as an intrusion into the doctor patient relationship which used be sacrosanct but no longer is. Woe to medicine!!!
That is the truth my friend!! 99213 or 214? Did the difference between 14 minutes and 16 minutes justify the 214? Enough comorbids? What if I am treating 4 separate conditions? UGH and every insurance company wants something different!! These audit shakedowns are ridiculous, and the hours that go into disputing them are man hours we could use for the ever ridiculous prior auths that pile up, thank you again to insurance companies!
Ironically, our EMR has crashed twice this week. It was down for half the day Monday and half the day Tuesday. I had to go back to paper notes and paper prescriptions. It was actually refreshing!!!! My handwriting is another story however…..😂
I agree 100% Jennifer. AI is pure trash. Stick to paper. Take it from a MIT dropout, (A-student), AI and all of scientism is pure rubbish and only subtracts from humanity. Keep systems as simple as possible. Peace.
I'm extremely glad you wrote about this today. I am starting with a new doctor next month at a new practice. I'll be on guard more than normal now.
The 800 pound gorilla.
Takes what it wants and makes you pay for it.
Electronic medical records (EMR) have the appearance of convenience but I find them much less helpful than the practitioner-generated notes. Practitioners copy and paste old notes into new ones to satisfy insurers, so most electronic medical record are cluttered and incoherent because of mindless repetition of meaningless and often-outdated information included solely to assure compensation. Most fellow physicians I know agree but are shackled to their computer by health care systems, insurers and the government. And of course the worst aspect of EMR is that too many physicians pay more attention to the computer than the patient in front of them.
I agree!!! My mom had a bunch of stuff in her latest well check note that was old, outdated, and just autopopulated from a note 1-3 years ago!
I have had incorrect info put on my chart 3 times in the last 3 years!! I’m a retired nurse ( 45 years) and I worry about the lack of attention to detail. HC seems as though there has been a decrease in the quality of patient care in the past 10 years! It seems that the nurses I have encountered in the hospital and offices are either very good or they just aren’t.... more so than when I retired. Rather polarized.
Well, that sucks the fun right out of the quarterly visit. I'll have to figure out what the bare minimum level of sanitized information I can give out in order to still get the medicine that gets me through the day. Big Brother is listening.
The AI doesn't just sift through the transcript, it reports it to somebody. With the Federal Social Media Censorship Scandal pointing out the incestuous relationship between Big Tech and the Government, I wonder what bureaucrat has been monitoring my therapy. Why do I hear Elvis Costello singing the Green Shirt song? "You can fool yourself but somebody's going to get it."
Ya, using AI to try and swindle money based of historic EMRs is corrupt and pure greed. Big surprise. We use AI to take unstructured EMR records, pull relevant data and update our Clinical Trial Database. All EMR records are anonymized prior to ever reaching our AI routines. As are all the participant records in the Trial database. We have very strict business logic that will not accept data that is outside the protocol. Of course the data is then reviewed by Site Monitors, Data Managers and Investigators ... all of whom must sign off on the accuracy of the record. The Site monitors sample the data in the DB with what is in the EMR. Still, inaccuracies can get through, but it is very rare. We also use AI to allow our users to ask for reports using plain old English language instead of having to write code. Both are good uses of AI that save money not artificially produce it.
I've have a PhD in AI and my work goes back 61 years. I was a pioneer in the field. I also implemented EMR for a major hospital system division as its CIO. That division included all the diagnostic tools, imaging, all modes of testing, the chem lab, and the sleep center as well as the physician practices and interface to the big regional hospital. Those are some of my credentials. I don't consider speech recognition to be "AI". It never was until the recent hype. I worked on speech recognition for 4 years in the 70s. Dragon has been commercially available for a long time. In fact, let me make a specific declaration. All the theory and mathematics, as well as implementation techniques of AI has been around since the 70s. The only thing that has changed is the processing power to make the techniques practical, and potentially dangerous. But, as with any technology, the technology is not the danger, it is the users of the technology. With respect to AI tools and results, the discipline that needs to be applied is information security. (And to repeat, as with any technology, the technology is not the answer, it is the users (and implementers) of the technology.) There is one other factor I would add: money. It is the same issue as "Quality is Free." Too many people, and almost everyone in positions of power, are naive about what it means by profit. We can make all health information safe: for a cost. That is technically a true statement. But can we make people safe? I think what you are saying is it requires people in power to be moral. I could go on.
If we are going to solve the problem of eliminating the evil of the Covid processes that have been implemented, it is going to require AI analytics. If we are going to make our country secure, it is going to require AI security hardware and AI analytics. We have to deal with evil to get there. But evil is arrayed against us at every turn, so we have to design for evil. That will happen only from local to state and out. A tough task.
As you know by now, I believe we are "in the fourth turn." My age allows me to see back almost a whole cycle. Perhaps it will take old farts like me to lead the way. But I don't think we can defeat the lesson of the ages that the four turns are inevitable. At least, not in the time I have left. I just hope some small fraction of folks can take over. For now, with the help of my state I can build a secure healthcare infrastructure design, one that takes into account human evil. I think I have enough time to pass on my knowledge to make that a reality. But hurry up and make up your mind.
Great post. It always boils down to how technology is used doesn't it? Either you are moral and act morally or you are immoral and act immorally. Evil exists. That is a given. I would love to see a healthcare system that is bullet proof but this Covid response from the medical community and the regulatory agencies tells me that until this corruption is weeded out, the notion of a secure healthcare system seems the thing of dreams. My opinion.
I suggest it is the other way around. Either the good guys build it first or the bad guys will. EPIC is the largest vendor. Wouldn't you think they have already made a secret deal for a backdoor into their databases for the 3 letter Federal agencies. I know the next step will be to join databases together. They already have one system operational for something like 25 healthcare orgs. In my state I know the state healthcare agency has a cooperative setup that normal people can't access. So it is here and coming. The good people have to legislate and build it first. Or else. See my substack for some posts on what the Feds have done already. (ID.me) And the proposed legislation for the good guys to get there first. I will be discussing this in more detail as the weeks go on. Subscribe.
Thanks for your response. I will definitely go to your substack and learn.