Sunday, July 02, 2006
  Three Ideas to Fix Medicine in the US

RangelMD asked a question for Grand Rounds that I've been thinking about a lot, with having kids, with parents getting older, and self getting older.


Paperwork: take a clue from PCs and other electronic media: have standards for interfaces that are the same, no matter what is going on behind the interface. Like, the same exact form to bill any insurance company. The same form for well, whatever you need forms for to communicate between hospitals, clinics, departments, whatever. Am I right that this is a problem in medical land?


I would like a lifetime medical record that follows us wherever we go. Lots of technology ways to go about this, but really – medicine needs to join the rest of us as far as technology information goes. Imagine seeing a patient for the first time but knowing before you meet them (because on their 'chart' are high priority "things you should know about this patient" always on the 'front page' for new encounters) that they have diabetes or having your patient's visit with a specialist available to you as soon as it's occurred?

And the grand finale:

It is unethical for money to be generated off of the suffering or fear of individuals without any involvement in the alleviation of that suffering. This means it's wrong for stockholders of insurance companies to gain dividends when profit goes up because insurance companies have either increased the costs of policies, denied claims, or decreased compensation, or any other way they weasel as much out of both patients and doctors as they can. Furthermore, it is unethical to reduce the income, either by reducing compensation or failing to increase compensation at the rate of inflation or incurred costs, of those directly involved in patient care in order to increase or maintain profit.

What I would like to see happen is that health insurance companies, HMOs, hospitals, etc be regulated to become non-profit organizations, with a different merit system set in place other than increasing profitability. I do not mind a well paid CEO, but I do mind their having stock and holding a direct interest in increasing the amount of money the company involved in health care makes rather than how good it is at meeting the needs of its customers and health care workers.

Bonuses could be given to the appropriate people for such things as reductions in the rate of medical errors or hospital acquired infections, or advances in research and increased rates of cure or better maintenance of chronic conditions. To insurance workers for prompt and appropriate management of cases and accounts, and satisfaction ratings from patients needing services.
Hi granola, i found you through Dr. A.s. I just wanted to tell you that alot of places already have electronic records for patients. When I go to any of my Drs. whether it is my pcp, gi, os, or the hosp. it is all in their computer's. They know exactly what I'm being treated for, what meds I take, what surgeries I've had, etc...

I do think it's a good idea but it has some drawbacks as far as patients are concerned. First of all, I don't really like talking to my doctor's back the entire time I'm in his office.

Second, I worry about confidentiality. There really is none. Anyone who works at any of these offices, or at the hospitals can have access to your entire medical history. That has to be true, because, it is always either the nurse or receptionist that pulls it all up on the screen for the Dr.. When he enters the exam rm. it is already there for him.

I guess it most likely is a good thing. those are just some of the problems I have with it.
You have some excellent ideas ... I hope the right people see them!

About EMR's ... they can be, and should continue to be, confidential. The nurses who pull them up on the computer would also be pulling up our paper charts, and reading them when they ask us about medication changes, and write in our current vitals. Also - those who do the billing, still need to see what they're billing for - paper chart, or EMR.

Cathy's right - nothing's private. But EMR's aren't really the problem ...
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A Mormon housewife who loves truth, science, rational thought, and reasonable action.

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Location: Utah

Granola is a mix of things: grains, nuts, bits of dried fruit, maybe some coconut. There's some fat in it, and it's a good source of fiber to keep those arteries and colons clean.

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