Photo: Wikimedia Commons
In a NYT editorial Leora Horwitz, MD, says our switch to electronic health records is having troublesome unintended consequences.The specific problem is that in the US healthcare system, doctors are not paid “by how much time they spend with patients” or ” how well they listen or how hard they think about what could be wrong,” but by “how much they write down.”
And, thanks to electronic record keeping, it has become much easier for doctors to “write down” lots of material about patients without doing the kind of careful work we all expect out of a doctor.
There are two tricks Horwitz says bad doctors pull:
- Doctors are now able to click one button to produce a “a comprehensive normal physical exam” for a patient. Many of them now do this without actually going through such an exam.
- Too many doctors copy and paste old exams and submit them as new ones. “I’ve seen ‘patient is on day two of antibiotics’ appear for five days in a row on one chart.”
Besides rewarding doctors for doing a bad job, and thereby threatening our health, this system is also costing everyone financially. Horwitz says doctors billed Medicare $1 billion more in 2010 than they did in 2005, before the advent of ubiquitous record-keeping.
Howritz’s fix: Don’t dump electronic record-keeping. Dump paying doctors based on documentation, which is too easy to forge.
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