{"id":8053,"date":"2020-05-05T05:36:50","date_gmt":"2020-05-05T11:36:50","guid":{"rendered":"https:\/\/www.zmetro.com\/?p=8053"},"modified":"2020-05-05T05:38:25","modified_gmt":"2020-05-05T11:38:25","slug":"our-important-work-has-been-co-opted-by-billing","status":"publish","type":"post","link":"http:\/\/www.zmetro.com\/?p=8053","title":{"rendered":"\u201cOur important work has been co-opted by billing.\u201d"},"content":{"rendered":"

Siddhartha Mukherjee<\/a><\/span><\/span><\/p>\n

“The promise of bringing medical recordkeeping into the digital age was to maintain a live record of a live patient, enabling clinicians to track patient care across hospital systems and over time. Instead, we\u2019ve been saddled with systems that cut into patient care (clinicians typically spend an hour feeding documentation into a computer for every hour they spend with patients) and, often, are too fragmented to allow a patient\u2019s file to follow her from one medical center to another. The E.M.R., as a colleague of mine put it, is \u201celectronic in the same sense that your grandfather\u2019s radio is electronic.\u201d The energized, improvisatory role of medical Twitter inevitably draws attention to what our balky, billion-dollar systems should have been providing\u2014to the cost, in dollars and lives, of the rapid clinical learning that we\u2019ve forgone.<\/p>\n<\/blockquote>\n

It\u2019s hardly news that our E.M.R. systems have failed medicine, and yet an executive order from New York State, issued at the end of March by Governor <\/span>Andrew Cuomo<\/a><\/u>, amounted to a grim epitaph: \u201cHealth care providers are relieved of recordkeeping requirements to the extent necessary for health care providers to perform tasks as may be necessary to respond to the <\/span>covid<\/em>-19 outbreak. . . . Any person acting reasonably and in good faith under this provision shall be afforded absolute immunity from liability.\u201d A system designed to expedite and improve the delivery of health care was officially recognized as an obstacle.<\/p>\n<\/blockquote>\n

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\u201cWhen the tide goes out,\u201d Warren Buffett once said, \u201cyou discover who has been swimming naked.\u201d The pandemic has been merciless in what it has exposed. In many cases, the weaknesses in our medical system were ones that had already been the subject of widespread attention, such as the national scandal of health-care coverage that leaves millions of Americans uninsured. In others, they <\/span>should<\/em>have been the subject of widespread attention, because we had plenty of warning. Again and again, in the past several weeks, we\u2019ve heard of shortages\u2014shortages of protective gear, of ventilators, of pharmaceuticals. Yet, even before the crisis, medicine was dealing with troubling scarcities of needed drugs and support systems. Last summer, long before the pandemic, pulmonologists were raising concerns about a lack of oxygen supplies\u2014the result of cost-cutting measures by suppliers of durable medical equipment. Competitive-bidding programs drove margins down so low that more than forty per cent of such companies\u2014responsible for the supply of portable oxygen tanks and concentrators\u2014went out of business. Inventory diminished; delivery times increased. Patients suffered. Neeta Thakur, a pulmonologist and researcher at the University of California in San Francisco, told me about the byzantine process (involving \u201cten to fifteen disconnected steps\u201d) that was required in order for a patient to receive oxygen at home\u2014a patient who is then at the mercy of the intermittent delivery schedules of understocked venders. The problem builds into a failure cascade: if patients cannot be discharged from the hospital because they cannot have oxygen at home, the resultant logjam delays the treatment of other patients who need those beds for acute care.”<\/p>\n<\/blockquote>\n

Yet, taxpayers <\/span><\/span>have spent $38B+ (!) on back door electronic medical record subsidies<\/a><\/span><\/span> since 2011….. <\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Siddhartha Mukherjee “The promise of bringing medical recordkeeping into the digital age was to maintain a live record of a live patient, enabling clinicians to track patient care across hospital systems and over time. Instead, we\u2019ve been saddled with systems that cut into patient care (clinicians typically spend an hour feeding documentation into a computer […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"_links":{"self":[{"href":"http:\/\/www.zmetro.com\/index.php?rest_route=\/wp\/v2\/posts\/8053"}],"collection":[{"href":"http:\/\/www.zmetro.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.zmetro.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.zmetro.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/www.zmetro.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=8053"}],"version-history":[{"count":2,"href":"http:\/\/www.zmetro.com\/index.php?rest_route=\/wp\/v2\/posts\/8053\/revisions"}],"predecessor-version":[{"id":8055,"href":"http:\/\/www.zmetro.com\/index.php?rest_route=\/wp\/v2\/posts\/8053\/revisions\/8055"}],"wp:attachment":[{"href":"http:\/\/www.zmetro.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=8053"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.zmetro.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=8053"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.zmetro.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=8053"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}