My 46-Billion-Dollar Laugh For The Day

Some say there's no such thing as coincidence, and so I did a double-take today when I watched CBS Sunday Morning's story on computerizing medical records -- which 46-billion dollar project has already been signed, sealed and delivered by our generous Congress (article HERE). 

Why the double-take?  Because I had just written a few days ago HERE about my personal experience in computering eight retail lumber facilities and the toll it took on the manager of the project (me), the implementation specialist (me), the trainer/facilitator (me), and my long-suffering, faithful Brit assistant and support tech, Alana, who also quit at the end of the project.  Rumor has it her blood pressure and sanity were stable on her last day (unlike mine).

Compared to the vast reach of the Federally-funded project, which comes with its own Obama-czar, my effort was minuscule -- something like comparing the first Kitty Hawk airplane to an Apollo rocket -- but the molehill problems I encountered have much in common with the moutain facing the health care industry.

According to CBS and the above article on privacy issues, fewer than 20% of medical facilities are now computerized, relying instead on handwritten and hand-filed paper charts.  Congress' largesse will reimburse medical facilities $40-65 thousand dollars for their computerization (not paying for it up-front), and the most laughable part of this program is its deadline -- 2014.

There's no way in hell this is going to happen.  It took me four years to computerize eight facilities, and I had a basically unlimited budget and years of computer and managerial experience.

The business I have operated for the last15 years is an ancillary service related to health care -- in particular, to health care records.  Based on that experience, (and not intending to offend anyone who might not meet this profile), clerical staff positions in docs' offices, clinics, labs and hospitals are usually that of entry-level personnel, managed by people who have worked their way up without credentialed management training, and certainly without much technical training.  Any physician/owner, who I would guess to be over 45, doesn't exactly dance around on keyboard either.  Mid-sized and large offices often have a computer consultant who manages their systems -- techie guys who are not employees and therefor not on site all the time.  Add to this mix language problems, particularly in border states, because "entry level" very often means ESL workers necessary to service ESL patients, and you have a sure recipe for disaster.

My largest client converted to an electronic medical record system about ten years ago.  The actual transition took over two years, but their EMR system is not 100% effective even today.  It can "talk to" one hospital in the area but not to four others, which certainly negates the universal-access claim the proponents have touted as the answer to all medical errors. The Feds have NOT YET established standards between computer software choices so communication will be possible -- yet this is all supposed to be accomplished by 2014?

Remember the old mantra GIGO -- garbage in, garbage out?  It's a cliche because it's just too true.  Breathe deeply, count to ten and enjoy the following relaxation exercise.

Visualize a room the size of your house filled top to bottom with paper charts spanning at least 10 years' history for each patient in your doctor's practice.

One of those file folders is yours, hopefully (but not necessarily) with your correct name, Social Security number and your birthday.  Think about your current state of health, your medication allergies, all the intimate details of your medical history written in your chart, including every time you've phoned the office, had an office visit, a prescription,  lab or x-ray test or been admitted to the hospital.  Now visualize your doctor's handwriting.  Then think about all the errors in billing you've experienced, both from the doc's office and especially the hospital -- and the hassles you've had trying to resolve those errors with them AND your insurance company. 

Now picture Lolita with her two-inch fingernails and nose ring, chewing her gum, thinking about her boyfriend and her new Victoria Secret teddy while she works and chats with her coworker about last Saturday night.  She makes $8.50 per hour.  She's entering or scanning YOUR data into their new system.

Lolita has very little, if any, medical training and her English isn't so hot. She can't spell the drugs you've taken, she can't read the doc's scribble, so she skips stuff or garbles it.  Fourteen lab slips and other pieces of critical information swirl around her tatooed ankles as she tries to scan them, but the scanner jams or just doesn't record, AND she's mixed up your information with the next patient's chart.  She doesn't notice the errors and she doesn't know she's incompetent.  Her supervisor is so overwhelmed by continuing her regular daily duties to keep the practice afloat AND get these **&(%%$# records computerized that she doesn't notice Lolita's errors, either.  

Now, take that same scenario and multiply it by every medical facility in the land.  Your tax dollars at work.  YAY.  This is one of those instances where the theory sounds peachy and the reality will be one of the biggest messes we've ever experienced. 

I don't pretend to know a lot about national and international politics or Wall Street investments or world economics or many other important issues of the day.

I DO know a lot about computerizing facilities that employ uneducated, incompetent, untrained, often untrainable, workers and what the end result can look like.

These porkulus funds have already been allocated, the absolutely unrealistic and unattainable deadline has been set, and there are high hopes for its successful completion.

What are those other old cliches?  Pie in the sky?  When pigs fly?  When hell freezes over?  Or all of the above...
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