MD Whistleblower

A few days before writing this, I had an ‘epic’ experience upon my arrival to work.   I had 17 procedures scheduled that day and the first few of these lucky folks were arriving.  After changing into scrubs, I sat before my computer and was prepared to swipe into the electronic medical record (EMR) system with my ID card.  On prior occasions, when I have successfully performed this swiping exercise during office visits, I have joked with the patient, ‘looks like they haven’t revoked my credentials!’ But not today.   After 3 swipes I had struck out.   No entry.   And my password wasn’t accepted.   Twelve hours ago, my credentials were solid and I was a physician in good standing.    Now it seemed I had become a physician non grata.   My morning welcome from my EMR system! What happened?   Was I being terminated without notice?   Were foreign hackers at work?   Was I to expect a ransom ware demand shortly? We use the electronic medical record system called Epic.   Our first call to

Patients have many legitimate gripes about the medical profession.  Medical professionals have our own list of pesky frustrations.  Overall, the profession is operating well, but there are well known deficiencies and flaws that are correctable and yet never seem to be addressed.  This is a frustrating reality, particularly for physicians who are wired to improve and correct what can be fixed.  Yes, the system is complex.  Yes, there are competing stakeholders who are angling to protect their power and economic interests.  Yes, despite an explosion of nurse practitioners and physicians’ assistants, patients still cannot obtain timely appointments.  Yes, many medicines are too expensive even for folks who have insurance.   Yes, medical bills are simpler than they used to be, but remain downright inscrutable for many of us.  Yes, electronic medical record (EMR) systems are omnipresent, but why isn’t there a universal EMR so that allows any physician to access all of a patient’s records?

Each work day, I enter the chamber of horrors also known as the electronic medical record (EMR).  I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called Epic, is more physician-friendly than prior competitors, but it remains a formidable adversary.  And it’s not a fair fight.  You might be a great chess player, but odds are that you will not vanquish a computer adversary armed with artificial intelligence. I have a competitive advantage over many other physician contestants in the battle of Man vs Machine.   I can type well and can do so while maintaining eye contact with the patient.   You must think I am a magician or a savant.   While this may be true, the birth of my advanced digital skills started decades ago.   (As an aside, digital competence is essential for gastroenterologists.) During college, I worked as a secretary

After 30 years or so, there is still much joy for me in the practice of medicine.   Electronic medical record (EMR) systems doesn’t make the list.   Chances are that if you asked your own doctor to assemble a Frustration List, that EMR issues would be among the top five entries.   Over the past 15 or 20 years, I have struggled through several of them.   At one point, I was using 4 distinct systems: 2 different hospital EMR systems, our office practice EMR and our endoscopy center’s software.   Does this sound like fun? Think of all the passwords I kept track of!   There is a recurrent EMR event in every system that brings doctors to our knees.   Here’s the simple phrase that transforms even a stoic doctor into a sweating and trembling practitioner: The EMR system will be upgraded overnight. Let me explain.   One might think that a computer upgrade would be a desirable event. For example, Merriam-Webster’s dictionary definition of upgrade is to replace something with a more us

 Over the past 15 years or so, I have endured several electronic medical record (EMR) systems. Indeed, there is an entire category, EMR Quality , on this blog where I share with readers the good, the bad and the ugly in the EMR space.  If you are suffering from insomnia, I invite you to review these posts nightly. When EMR was creeping onto the medical landscape, physician grunts like me were salivating over the prospect that one of our thorniest and frustrating challenges was about to be solved.   EMR promised that all of our patients’ records could be accessed with a couple of keystrokes in our own offices.   This made sense as we all knew that the digital world could create linkages that would permit access to all of a patient’s medical experiences.   Regrettably, this promise that was made to medical professionals and the public remains unfulfilled. Here’s why physicians were so ripe for the EMR seduction.   Consider this typical scenario in the pre-EMR era. A patient comes t

I have written, or more accurately ranted, about electronic medical records (EMR) systems throughout this blog.   While the systems have clearly improved since their mandatory introduction into the medical universe, they have still not delivered on many of their promises. Of course, EMR has brought tremendous advantages to the medical profession and we are all grateful for the technology.   But this progress has exacted a cost.   Many of them are clumsy to utilize.   When the technology breaks down or freezes, the office become paralyzed.   The systems are vulnerable to hackers who can exploit personal medical data or demand ransomware.   Many of the computerized notes   are so filled with pre-populated fluff carried over from prior visits, that it can be challenging to identify new medical information.   I often scroll through several pages in search of the physician’s thoughts and plans.   And a physician who is staring at a computer screen during an office visit will create a

I have penned several posts on the pitfalls of the electronic medical record (EMR) system that we physicians must use.   Indeed, I challenge you to find a doctor who extols the EMR platform without qualification.   Sure, there are tremendous advantages, and the ease of use has improved substantially since it first came onto the scene.   But, keep in mind that these systems were not devised and implemented because physicians demanded them.   To the contrary, they were designed to simplify and automate billing and coding.   While this made their tasks considerably easier, it was at physicians' expense.   Features that helped billers and insurance companies didn’t help us take care of living and breathing human beings.    It made us focus on silly documentation requirements in order to be fairly reimbursed.   And, it offered very clumsy mechanisms to record a patient’s history – the story of your symptoms – which is our most valuable piece of medical data.   You simply can't cli

First there was Bitcoin, a cryptocurrency that utilizes blockchain, a decentralized system of data collection and transactions that we are told will defy hacking.   (Wasn’t the Titanic said to be unsinkable?)    We read that cryptocurrency and other blockchain functions will be a societal gamechanger, much like the internet was when Al Gore invented it some years ago. My own state of Ohio will now accept Bitcoin as payment for commercial taxes.   And, of course, there are many other cryptocurrencies mushrooming around us.   In my life, many innovations seem to be solutions in search of problems.   I don’t find my current methods of transacting business – cash and credit cards – to be so onerous that I am screaming for a new way to conduct commerce.   But, I will admit that I have security concerns about my credit card number and other highly personal data being ‘safely stored’ all over the internet.   Some years ago, I enjoyed the thrill of being a victim of identity theft,

The computerized era has introduced all of us to a genre of errors that never existed during the archaic pen and paper era.   The paper medical chart I used during most of my career never ‘crashed’.  Now, when our electronic medical records (EMR) freezes, malfunctions, or simply goes on strike, our office is paralyzed.  Although I appear to the patients as a breathing and willing medical practitioner, I might as well be a storefront mannequin who appears lifelike, but cannot function.  We cannot access the patients’ records, write a prescription or enter a new office visit.  Mannequins appear lifelife but don't function well. Of course, like any business who faces this crisis, we expect instantaneous rescue from our IT professionals, as if we are their only client and they are permanently stationed in our waiting room just waiting for us to sound the alarm. This is among one of the most frustrating aspects of EMR for medical professionals.   We simply don’t have

Electronic medical records (EMR) were supposed to rewire the medical grid.  It would increase efficiency, reduce redundancy, improve quality and reduce costs.  On  these measures I offer a grade of 0 for 4.  Ask any practicing doctor how EMR has impacted on his practice and be prepared for some remarks that differ from the government’s Kool Aid talking points.  EMR, thus far, hasn’t been ball bearings for the system.  More often, it gums up the works. The EMR Maze - Enjoy! The government spent billions of dollars with cash payments  to induce hospitals and doctors like me to jump on board the EMR express.  The Rand Corporation helped to fuel this euphoria in 2005 when it predicted exaggerated benefits of EMR.   By the way, this study was financed in part by EMR companies whom, I politely suggest, had a vested interest in the study’s conclusion.  Rand denies that they were unduly influenced by their backers, and I don’t claim that they caved on their principles.  Nevertheles

Which of the following events is most traumatic for a practicing physician? Your staff doesn’t show up because the roads are flooded, but the waiting room is full of patients. Medicare notifies you that coding discrepancies will result in an audit of 2 years of Medicare records. You receive an offer of employment by a corporate medical institution who will bury your practice if you do not sign. Your key expert witness defending you in your upcoming medical malpractice case is incarcerated. Your office electronic medical records (EMR) system suffers a cardiac arrest. Tough choices, I know. Our office lost complete access to EMR for 3 days, and it wasn’t pretty. I don’t grasp the technical (doubletalk) explanation for the temporary EMR coma, but we were reminded of how dependent we are on technology. Our IT gurus were working tirelessly, but their adversary was wily and formidable. Finally, they prevailed, but I wouldn’t regard this as a clean win for us. We were hobbling for 3 d

Whistleblower readers know of my criticisms of the electronic medical record (EMR) juggernaut that is oozing over the medical landscape. Ultimately, this technology will make medical care better and easier to practice. All systems will be integrated, so that a physician will have instant access to his patients’ medical data from other physicians’ offices, emergency rooms and hospitals. In addition, data input in the physician’s office will use reliable voice activated technology, so that some antiquated physician behaviors, such as eye contact, can still occur. Clearly, EMR is in transition. I place it on the 40 yard line, a long way from a touch down or field goal position. A colleague related a distressing meeting he had at the community hospital he works at. This hospital, like nearly every hospital in Cleveland, is owned by one of the two towering medical behemoths. I’m not a businessman, but I have learned that when something owns you, it’s generally better for the owner than t

Several posts on this blog have been devoted to tort reform . More than any other subject, this topic generates more heat than light. Indeed, I describe these debates and commnets on this blog and elsewhere as duels, not discussions.  Many folks on various sides of this issue earnestly believe that they have the better argument. Other viewpoints are not purely held and are clearly contaminated by self-interest. I have written repeatedly that I believe that the current system is unfair and does not serve the public well. The public understands the issues and the controversies. In general, I don’t think most Americans believe that we have too few lawyers or lawsuits in this country. It is astonishing that people can defend a medical liability system that           Misses the vast majority of patients injured by medical negligence           Ensnares many more innocent physicians than negligent ones. Shouldn’t these two inarguable facts be sufficient to demand at least an examinat

Painting of Paul's Damascus Road Conversion Electronic Medical Records (EMR) promises to be the holy grail of modern medicine.    It aims to deliver us from the Smith Corona era into the digital age.    I’m a gastroenterologist who has already been practicing digitally for two decades.   I guess I am way ahead of my time Is EMR progress?      Consider these two hypothetical   patient assessments.   The assessment is a critical section of the medical record where the physician shares his thinking on the patient’s condition.    The assessment answers the question, “What do you think is going on here and why?”   The Old Fashioned, Archaic, Fossilized and Sclerotic Assessment The quality and timing of the patient’s abdominal pain is strongly suggestive of mesenteric ischemia (lack of blood supply to the guts), as the pain consistently develops   45 minutes after meals.   The patient has numerous risk factors for this condition.    Peptic ulcer disease is unlikely as the patient ha

Two weeks ago, I did what had to be done. Months of procrastination had to end. Fears had to be put aside. Anxiety and misgivings had to be overcome. Second opinions always confirmed the need to proceed. So, when the excuses ran out, I jumped. What decision did I make? Did I… (a) Finally have rotator cuff surgery? (b) Begin electronic medical records (EMR) in the office? (c) Retire from medicine to be a full time ‘Whistleblower’? (d) Agree to a family vacation when we will hike up and down the Grand Canyon sans mules? (e) Agree to become an expert witness for a medical malpractice plaintiff’s attorney? (f) Apply an Obama 2012 bumper sticker on my car? Two weeks ago, our office entered the paperless universe. The era of ink on paper was over. The manner that I had seen office patients for 20 years suddenly evaporated. And, I wasn’t happy about it. For our small group of gastroenterologists, even though we are aware of the potential advantages of computerized charts, we adopted EMR be

Physicians and patients are under more strain than ever before. Electronic medical records (EMR) won’t be a force of healing, but will threaten to divide the parties further apart. We physicians are already under more stress than ever before. We are working harder and earning less. Insurance companies dictate how much (or how little) we are paid and what medicines we may prescribe. We are crushed by an avalanche of absurd paperwork. We worry about being sued even if we haven’t done anything wrong. Patients are more dissatisfied today also. They often feel rushed through appointments without having adequate time to express their medical concerns. They want more communication and softer bedside manners from their doctors. They want more conversation and fewer medical tests. They complain that medicine has become more of a business than a profession. They admire Dr. House’s diagnostic acumen, but they still want Marcus Welby as their own doctor. All of these issues strain the docto