Data Whores

I hate talking about healthcare, because I do it all day and because people really don’t understand what the hell I’m talking about.

But it has to be talked about because it affects everybody’s health.

Do you want your health improved?

Well, we can begin with the healthcare medical record as conceived by the boobs who came out of Harvard University.

Jesus Christ, we can’t escape these people.

They are ubiquitous in their destruction of the world.

These losers have created an electronic healthcare record and its attendant note that is incomprehensible in every sense of the word.

There’s no easy way to begin this discussion because there’s so much that’s wrong with the medical note.

You can thank Barack Obama for that.

He put a bunch of losers in charge of constructing the standards for electronic health records back when he was President. Naturally, most of the ones in charge came from the Ivy League schools.

It has to be that way, don’t you know, because there’s always an ulterior motive when the oligarchy gets involved.

The goal is control of you via data collection.

Let’s begin with who the medical record is for.

It’s supposed to be for the patient’s well being, but it’s not. It seems to be constructed for the statistician so that he can run around town waving his sheaf of data while screaming: I have data; I have data.

It reminds me of Billy Zane playing Caledon Hockley on the deck of the Titanic: I have a child, I have a child.

So because of these data whores, the healthcare record is littered with tons and tons of irrelevant information that I need to wade through in order to find out just what the fuck happened to the patient.

I don’t need to know what time the lab was drawn down to the second. I don’t need to know who drew the lab.

In fact, I don’t even want the lab data integrated within the body of the medical note unless the doctor organically makes reference to a particular lab value in his or her narrative.

I want the lab data separate. I want it separate because I might want to give a copy to the patient. Or I might want to send a copy to a referral specialist. Or I might want to compare it to other pieces of lab data from different dates.

When it’s integrated with the body of the note, which is now 8 to 10 pages long, I have to go hunt and search for it. That takes time. I need my time. I value my time. I can’t be wasting my time hunting around for something I shouldn’t have to hunt around for.

In addition to that, when you integrate the lab data into the body of a letter, it often comes out in a format that is consistent with how you would type a letter. That’s not necessarily how the lab data should be printed out.

Instead of a simple report of a Chen-7 or a Chem 24 which should take less than a half a page to 3/4 of a page, I will sometimes receive a report that is spread out over 3 to 5 pages.

Thank you, Sylvia Matthews Burwell. Thank you Barack Obama.

The people who were responsible for constructing the standards, could only have been politically active academic types who have either never seen a patient within the last 10 years, or they are doctors and geniuses at large who see a few patients per day.

They have all the time in the world before their next cocktail party.

On the other hand, a soldier on the front lines is under time constraints. And there are bullets whizzing by his head.

A soldier on the front line doesn’t have the time to fuck around.

***

We play a game in our office. It’s called: Who is has the worst electronic medical record note?

My gosh, I can sift through some of these notes for two minutes and ask myself: What the fuck is going on with this patient? What is the diagnosis?

And who is the patient anyway?

It takes far too long to find out what I need to know. And every doctor has a different electronic medical record that is constructed in a different way

In the old days, I’d get a half page to one page note from the specialist, as to what was going on. Yes, his writing was often a little crummy, but I could generally figure out what he was trying to say.

These days I get a nicely typed out report, but the good stuff is buried within a ton of crap and irrelevant information.

Sometimes I have to struggle with just finding the name of the doctor who saw the patient.

Or even the name of the patient.

You see, it’s not always important to a software programmer to list at the top of the note in a prominent manner, the name and birthdate of the patient. Or the date of service.

You would think that the name, the birthdate, and the doctor, who saw the patient would be highlighted in big bold letters at the top of the page. But if you thought that, you would be wrong..

Software programmers don’t see patients. Software, programmers and designers are not under any time pressure when it comes to seeing patients because they don’t see patients. Consequently they do not understand that an electronic healthcare record has to be designed with the user in mind. And that includes the report that is going to be sent out to other doctors.

Communication is everything.

If the doctor has to waste valuable time because the communication is poor, patient healthcare will ultimately suffer.

Mistakes will be made.

***

In addition to this, there is stuff in the medical note that just doesn’t need to be there.

I don’t need to know if a five year old is a smoker or not. I’ll just assume that he isn’t unless you tell me specifically that he is.

(PS: I haven’t found one yet.)

Ditto for alcohol use.

I don’t need a complete list of the specialist’s diagnoses going back to the beginning of time. I need to know what’s going on now. What do you think is going on now, Mr. Doctor?

I also don’t need a list of all the medicines that have been prescribed in the past, I need to know what medicine the doctor is giving now.

And please don’t give a list of discontinued medicines.

I also don’t need a bogus review of systems, questions that were never asked. I know this from first-hand experience when I had to get my ankle repaired by my orthopedic doctor. I examined the notes from my office visit which contained a complete review of systems, questions that I know damn well the doctor never asked.

Family history? If you think something is relevant, state so. Otherwise, I don’t want to see it in your note.

Information sheets that are geared to the patient? Forget about it.

***

Do you know what I need from the specialist in his note?

On a one sheet piece of paper, and one sheet, only, I need the name of the patient, the birthdate, the name of the doctor, and the date of service printed in bold at the top of the sheet.

I need any pertinent positive or negative history and exam data including allergies.

Then I need a diagnosis.

Then I need the specialist to tell me what he or she plans to do or what he or she has done at that visit.

That’s it.

That’s enough.

***

You see, when you multiply a loss of a minute or two times 30 to 40 patients per day, you arrive at real time lost.

Now what I have told you is just from my end. Think about the time lost in entering all this data into the computer record in the first place.

I tell you, it’s a disaster.

The data whores, the mathematicians, the software designers, the data obsessed insurance companies, the control freaks, the goer-alonger politicians, and the fuckers who come out of Harvard are all responsible for this catastrophe.

Attention: Less is more.

Sincerely,

Archer Crosley

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