Physician Patient

US Health Care Needs a Major Paradigm Shift from Government-corporate Cartels to Consumer Control

Since the Minnesota Physician-Patient Alliance (MPPA) was founded in 1997 we’ve witnessed a steady and alarming flight of physicians from private, independent medical practices along with increasing government control of the US health care system. Managed care cartels of consolidating hospital-clinic- insurance organizations with all physicians as corporate employees are indeed a dire forecast.

In the meantime, most professional organizations like the MMA and AMA while also losing membership numbers have become advocates of the business interests of large health care organizations. Who supports practicing physicians and their patients today? The stalwart Association of American Physicians and Surgeons (AAPS) remains a beacon of hope for independent medical practices . And now here is a new organization called Practicing Physicians of America

A major paradigm shift from corporate-government control to consumer control is necessary. Americans could have an Amazon-like internet access to the prices of medical services, products, medications, and a variety of health care insurance policies. Yes, a real US health care marketplace will open the door to innovative medical practices and research. But to make this a real possibility for patients and physicians, individuals must take charge of owning and controlling our personal medical information. The technology permitting patients and families to do this already exists, since (almost) all of us have a smart phone or computer able to accommodate, for example, Microsoft’s HealthVault,2817,2473749,00.asp

The following article helps make the case for consumer (patient and family) control of our personal medical records and health care. When we receive (or bargain for) medical care in a clinic or hospital clinical data generated from our case can be easily transferred to our control. Then we’ll have real time medical records portability.

A truly competitive US marketplace for our health care services and insurance requires that we can shop online for health care services and insurance coverage and control the use of our clinical information.

This is the American way.


Why Your Doctor’s Computer Is So Clunky
Washington mandates Electronic Health Records but stands in the way of innovation.

By Marion Mass and Kenneth A. Fisher
March 20, 2018 6:31 p.m. ET 128 COMMENTS

The Trump administration this month announced its own effort to update the Electronic Health Record systems, which disrupt the doctor-patient relationship. The government could do even more good by deregulating EHRs, establishing a free market for user-friendly products. Perhaps Amazon, through its partnership with JP Morgan Chase and Berkshire Hathaway , could eventually do for medicine what it’s done for retail.

EHRs were forced on the health-care community by the 2009 stimulus. Congress has allocated $37 billion so far to help providers upgrade from mostly paper files. Nearly a decade later, the promised efficiencies and savings haven’t materialized.

Instead, EHRs divert doctors’ attention from patients. Physicians often rely on visual cues when taking a patient history, but now what’s visible much of the time is a computer screen. The outdated EHR technology is difficult and time consuming, contributing to doctors’ stress and burnout. The unintuitive interfaces consist of multiple drop-down menus and forms as well as countless boxes to check and pages to navigate. The screen often freezes. It takes seven clicks to order basic antibiotics, 14 clicks to order stronger ones. It’s death by a thousand clicks, and it’s killing the medical profession.

We physicians have the longest training time of any profession, yet we now spend roughly two-thirds of our workday as data-entry clerks, tending to digital paperwork and administrative burdens. A Johns Hopkins study finds that paperwork requirements have significantly reduced the amount of time new doctors spend at patients’ bedsides, limiting their clinical skills. EHRs are also contributing to doctors’ taking early retirement. According to a survey published in Medical Economics, two-thirds of doctors dislike the functionality of their EHRs. Even more say the conversion to EHRs has not been worth it.

Why Your Doctor’s Computer Is So Clunky
The clunky EHR systems distract us from the thinking necessary to make diagnoses. A Harvard-affiliated study found that 147 times in roughly 5,700 cases, EHRs contributed to “adverse events.” Half were serious and one-third fatal. The ECRI Institute, a patient-advocacy group, designated EHR hazards as the No. 1 patient-safety concern for 2014. An example from the front lines: Clonidine, a blood-pressure medication, sometimes gets prescribed instead of Klonopin, a seizure drug, because medical professionals click the wrong box.

EHRs fail to achieve one of their main selling points, interoperability—the ability to share records across providers and systems. Competing systems are generally incompatible with each other. A 2016 KLAS Research report finds only 6% of health-care providers say they can effectively access EHRs between different systems. Thus patient records still must be faxed among providers. It’s like having a computer that can’t connect to the internet.

Why are EHR systems so primitive? Partly because vendors must be certified as compliant by the Department of Health and Human Services, inhibiting better products and insulating existing ones from best-in-tech competitive pressures.

This market protection leads not only to lower quality but also higher prices. EHRs are extraordinarily expensive, with taxpayers, providers and patients footing the bill. For private hospitals, EHR conversion costs anywhere from $40 million to $353 million. Individual physicians spend an average of $32,000 a year on upkeep. All these costs are ultimately passed on to patients.

In announcing the Trump-administration initiative, White House aide Jared Kushner and Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said health-technology companies, insurers, doctors, hospitals and patient groups have been working together for six months on an initiative called MyHealthEData to modernize EHRs and achieve interoperability. But the usual suspects can only do so much. This is a market begging for competition from the likes of Amazon, whose cost-cutting and ease-of-use expertise is well established. Apple has also made a welcome entrance into the market. The administration can help by directing HHS to allow EHR competition.

Doctors and patients deserve cutting-edge technology that would offer such features as wearability, automatic audio and photo uploading to a digital chart, encrypted cloud storage for easy access, and compatibility across platforms in different locations. These features are already available at relatively low prices in consumer products.

Ultimately, EHRs must enhance the doctor-patient relationship, not impede it. Sounds like a task for the Everything Store.

Dr. Mass is a pediatrician. Dr. Fisher is a nephrologist and author of “Understanding Healthcare: A Historical Perspective.” They are, respectively, a co-founder and an advisory board member of Practicing Physicians of America.

Appeared in the March 21, 2018, print edition.

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