Health Care Politics Paperless

Worse Than Death Panels: Cookbook Medicine

From John Goodman author of “Priceless”

The quality police demand that for any child who comes in for a physical whose body-mass index is above the 85th percentile, I must comply with certain measures — what we call box checking. I first need to check a box stating that the child is overweight. Then I must acknowledge that I entered “overweight” in his problem list. Next, I need to check a box stating that diet and exercise counseling were provided. Finally, I need to be sure that the counseling is documented in the patient note. If this patient has asthma, I need to check more boxes for an asthma action plan, use of an asthma-controller medication, and flu-shot compliance.

When a healthy child visits, I must complete these tasks while reviewing more than 300 other preventative care measures such as safe storage of a gun, domestic violence, child-proofing the home, nutrition, exercise, school performance, safe sex, bullying, smoking, drinking, drugs, behavior problems, family health issues, sleep, development and whatever else is on a patient’s or parent’s mind.

via Worse Than Death Panels: Cookbook Medicine – John C. Goodman – Page 2.

The first point Goodman makes is that protocols and best practice guidelines are usually a good start on any issue. However there is a tendency for the protocols to morph from guidelines to rigid rules that can end up stifling innovation and creativity.

However it is the next part of the article I quoted above (which is itself a quote from Dr. Virginia McIvor) on the issue of EMR which got my attention. Just read what she has to say. Her experience follows what I have heard and read from other physicians.

However well-intentioned the medical EHR based on “Meaningful Use” has resulted in an unusable mess. The check list and protocols are not based on patient needs and efficient delivery of service but are based on political considerations delivered from the command and control center. Whoever has the most effective lobby gets to be part of the protocol.

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