Wednesday, April 2, 2014

It's the doctors, silly

There was a lot of hand wringing this week over the delay of ICD10 by Congress. People upset that in its infinite wisdom, Congress did something it didn't fully understand - again.

Interesting was the reaction. Dozens of groups and industry organizations yelled from the rooftops how terrible of an idea it was the Congress delayed ICD10 till 2015. CIOs, consultants, policy wonks, vendors, all screaming mad at Congress.

But, there was one noticeable group that didn't seem to care: providers.
Note: I do feel bad about coders who have shelled out good money on their own to get training and will probably have to do so again, that's a load of bs.
The men and women on the front lines that I've spoken either didn't care or were happy. Now, I'll submit anecdotal evidence is a poor metric, but none of the reported stories over the anger of the delay seemed to quote any providers.

This is the problem with Health Information Technology.

Traditional HIT doesn't seem to be focusing on what can improve the lives of the people on the battle field. Adding more work to the providers day is just a consequence. Disrupting their ability to actually get work done, means little - deal with it.

This disturbs me greatly.

Many reasons why... Coming from a development and architecture perspective, it is insane that information technology should make someones life MORE difficult and have preposterous costs associated along with it.

IT should reduce costs and reduce time. Meaningful Use's impact on EHR has been to create more time wasted sitting in front of a computer for providers. ICD10 means more time for docs to be looking for the right code - all so if they choose the wrong one their payment gets denied.

But what does that all cost? It means that when a doctor is visiting a patient, they spend less time interacting with the patient and more with their computer. It means they are doing more work at the computer after a patient leaves.

All of this means a provider interacts with less patients every single day. We face a world of less doctors - why on Earth is giving them less time a benefit?

The issue here is, ICD10 has a big problem. Providers see it as nothing more than a cost center, a means for payers to deny claims, and more work.

No one has articulated (if they have they have done a terrible job) to providers why ICD10 will benefit them. Everything seems to center around "it will produce better data!" - but if your job is to triage issues in front of you, why would you care about producing better data at the point of care?

Sure, maybe a year later that data point may help solve something, but lets be honest - we humans are greedy animals. There is no immediate payoff (even long term) to the provider caring for the patient when they see them.

For some reason, no one seems to get this issue. It is lost on everyone.

Imagine if someone came along and say "We are going to take off the backspace key from your keyboard, in the end it will be great!"

Sure, there are ways to go about deleting text. Holding the Shift key + the left or right keys highlights text and you can replace it with whatever you want.

But, that is cumbersome. That takes time. There isn't a ROI nor is there a give and take.

Perhaps if we focused on what could improve the day to day activities of the provider, we could improve the "health" of our healthcare system. As it stands now, we keep adding more to the plates of providers and we don't give them anything in return.

We give them more menial tasks, that means they see less patients, and make less money. Who does that benefit?

Personally, I wouldn't be happy either without my backspace key.