Why should doctors pay for health IT?

Why should doctors pay for health IT?

Summary: A little forgiveness would go a long way. As would linking the costs of documentation to the benefits.


An Evil Lawyer, from GlobalPOVUnderlying all the questions about health IT is the question of who should pay for it. (Evil lawyer from the blog GlobalPOV.)

Hospitals and insurers currently foot the bill. They do this for the same reason other businesses do -- to gain greater control of the operations, to cut costs.

Doctors in medical offices don't gain as many benefits, because their operations are smaller. There is a disconnect between who bears the cost of IT and who gains the benefits.

But there's another, deeper problem. Fear.

Many doctors fear automation because documentation invites lawyers. As one correspondent put it:

The Democrats love it because it will make it much easier to sue physicians.

Auditing care will find mistakes, and mistakes will lead to lawsuits. Mistakes are inevitable, however, so don't put anything down and maybe no one will be able to find out.

This same attitude exists throughout society. It's one reason President-elect Obama was told to give up his Blackberry.

Thus the real fear rears its head. Transparency. We are all afraid of transparency, assuming that others won't be willing to see the difference between honest mistakes and real malice.

The assumption is lawyers and journalists won't let us.

We should. Some medical mistakes are just mistakes. A few are ethical violations, to be dealt with through ethical means. And an even smaller number involve true venality, real criminal conduct.

How do we tell the difference in medicine so as to enable health IT reforms to go forward? If doctors truly saved time and money by supporting EHRs, many more would buy them. My personal view is punitive damages should be very tough to prove, but uninsurable, capable of driving people under.

Real damages should be accepted, ethics should determine how many are too many, and compensation should follow a regular schedule.

Why can't this happen? Cynicism and greed. Journalists assume the worst in others because it's good copy, and lawyers do because it's profitable. The response by doctors is to demand the lawyer's profit be stripped away, leaving the real baddies free to prey upon us.

Accepting honest mistakes, and understanding the vast gulf between that and truly Blagojevichian activity, would go a long way toward getting all stakeholders to accept the need for automation. A little forgiveness would go a long way.

As would linking the costs of documentation to the benefits. If doctors truly saved time and money by supporting EHRs, many more would buy them.

Topics: Software, CXO, Enterprise Software, Health, IT Employment

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  • (OT) Now sugar is the target

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    [End quote]

    Forget what science has taught about weight gain. It's the sugar blast that's the problem.

    Yes, the nation must fight back against sugar. By letting those who know better control our lives.
    Anton Philidor
  • The legal system condones it

    Unfortunately everyone is sue happy at the slightest bit of a mistake. People have blurred that line between true, honest mistakes (i mean come on people ARE fallible) and ones with intent and malice. Should honest mistakes be forgiven? Yes - in a perfect world - but multi-million dollar payouts? No. Punitive damages can and should only be assessed when there is enough evidence to suggest beyond a resonable doubt that there was malice or at least repeated failures (same mistake several times). Otherwise, only ACTUAL damages should be paid. Hell that would make health care cheaper too - the liability insurance the docs have to pay wouldnt be 100k a year :) (though i have no idea how much they pay for this insurance exactly).
    • How much does paper add to the cost of liability insurance?

      Just asking. It should cost a lot more to do discovery
      on any case involving paper than one involving
      computer records.

      This is regardless of whether the case has merit, and
      regardless of whether that was the result of malice.

      By the way, I disagree on punitive damages for
      repeated mistakes. I think that's an ethical point
      that ethics boards should deal with, not the law

      For punitive damages you should have to prove actual
      malice, IMO
  • On-Topic: Mistakes

    Medical mistakes damage people, sometimes fatally, and money damages determined by the legal system are the replacement for private infliction of bodily harm.

    Whatever the basis for determination, medical mistakes have been found by recent studies to be very prevalent. Even an honorable lawyer could make a significant amount of money compensating for (unintended) harm. And books are being published about the typical causes of mistakes.

    And it's reasonable for people to be compensated even when the mistake was not intended and when there was no malevolent intent. At least until the safety net is sufficiently strong that survivors have little need for additional cash.

    A system of compensation for mistakes is thus appropriate. But what effect should that have on documentation?

    I suggest documentation protects Doctors. Here's what the Doctor knew, here's how he responded. At best, that's exculpatory evidence. At worst, the right Doctor is being accused.

    These records are already being kept. What would change is the ability of that record to travel. The only additional vulnerability I can see is that the receiving Doctor would be more likely to observe the mistakes of the sending Doctor.

    That kind of embarassment is, I think, tolerable for the benefits to be gained.
    Anton Philidor
    • We get back to checklists

      The idea of a medical checklist before any procedure
      is the best possible protection against both mistakes
      and their consequences.

      I have written here of the guy who got the genius
      award for pushing that.

      It needs to become common practice. You run a
      checklist taking off in a private plane, you should
      run one before cutting into someone.
  • Note the tacit assumption here.

    The doctors must think they make more undocumented mistakes than undocumented good calls. Otherwise, they'd be screaming FOR medical IT to document how right they were.

    It's not just a matter of medical malpractice, though. It's also a matter of poor administrative practices. A medical office is an enormously complex operation, and a lot of things go awry. A lot of lost paperwork, unanswered calls, etc. are hidden in the info-fuzz.

    For example, when was the last time you heard of any fax machine beside a doctor's losing anything? Now, when was the last time your doctor's fax machine lost something? Exactly!

    That's why they have email, but never let patients use it -- too traceable, too hard to blame.
  • I think it's more a control issue

    Being a doctor and using an EMR I can say I doubt it's a matter of fear of the lawsuit that keeps MD's away from EMR. See, you're assuming MD's are as technically savvy as the people on this board so any resistance to EMR must be irrational right? The truth is many MD's, especially the older ones who are still heads of their practice, didn't grow up in front of a computer and really have very little idea how they work. They understand paper, it's cost, storage and function and security. They do not understand firewalls, antivirus software, proper use of emails (and of course how HIPAA influences the security of such).

    The HIPAA police tell us MD's, I kid you not, that sending any patient information to a non-hospital secured email address OR using a non-hospital secured email service (like gmail or yahoo) to send confidential patient information to ANYONE, even if "think" you know who is getting it, is a HIPAA violation. Of course that's because HIPAA was written by politicians and being left to interpretation by folks looking down the barrel of a potential lawsuit.

    Then comes the hospitals. Hospitals IT departments after HIPAA are all about security. Their information must be 100% secure, their emails must be secure. Hospital IT security does NOT trust the MD to know what information should be in emails (so they block all outside email access like gmail within their walls) or how to keep a PC virus free (so they lock down the PC's so the MD cannot install anything) or how to judiciously use the internet. They even do not trust other hospitals, my hospital has access to other hospitals PACS and EMR almost completely firewalled, nothing unapproved comes in. Nothing goes out without a signed HIPAA release from the patient.

    It's a very dysfunctional system as it stands now.
    • And of course he who pays for it

      We MD's allow a lot of being dictated to about usage of the hospital EMR because we don't pay for it. I know some radiologists who own their own EMR and I can assure you those radiologists call the shots, somethings hospitals have a pathological aversion to.
    • Who are these HIPAA police?

      They are lieing to you, doc. HIPAA does not say you
      can't communicate with patients. It says you have to
      audit your communications with others in health care.
  • Sue Physicians

    "The Democrats love it because it will make it much easier to sue physicians."


    Automation cuts both ways.

    **IF** You're clean... No worries...

    But, here's my take...

    If the medicasl community would push the Concept of Intentional Mal-Practice vs just making honest mistakes...

    Being sued wouldn't be the onnerous thing it is today...

    **IF** Doctors policed their own ranks and insisted that "bad" doctors could Never ever practice medicine again...

    Well, here I go dreaming again.

    I guess it's hard for gods to sue gods???

    Last thought. Do we value life so dearly that in doing so we litigate ourselves out of health care?
  • RE: Why should doctors pay for health IT?

    We should consider that the patient should pay for the IT, but remember that it will also need to be the patient who profits from the cost savings!!