Tuesday, March 15, 2011

Miracles of modern technology

Dear Dr. Hitech,

I think it's great that you recently felt the need to shell out a fortune for FUBARMED, the new computerized chart system that runs your office.

Apparently FUBARMED has a feature that lets you list me, or any other doctor, as a "consultant" in a patient's chart. I assume the idea here is to improve physician communication.

It seems like an absolutely great idea. You order an MRI, or labs, and your computer automatically faxes the results to my office, too.

In theory, that sounds nice.

But FUBARMED has no fucking clue what different doctors care about.

So it faxes me EVERY DAMN THING. Mrs. Patient (who I'm seeing for migraines) gets a pap smear? I get the results. She calls you with a runny nose? The phone note shows up on my fax machine (along with your delightful response "what color is her mucus?"). She needs a refill on her cholesterol medication? FUBARMED faxes me a notification, then a copy of your approval.

As far as I can tell, this great program of yours is functioning primarily to waste my time, paper, and fax machine toner.

Hoping to see one come over soon that says "Patient doesn't like Dr. Grumpy, wants you to take him off the consultant list."

Yours truly,

Ibee Grumpy, M.D.


thatsit said...


Actual business in Alaska.

Don said...

Let me guess...the FUBARMED software version is 1.0.
Bad things happen to those that try using the whole number version of ANY software, as I know from far too many years of experience.
Most likely, the people making FUBARMED didn't spend much time, if any, testing out the units in real world settings.
Unless, of course, Dr. Hitech is one of the human guinea pigs testing this device out. If so, you might consider sending him a small "gift" of some guinea pig hay or pellets...

Anonymous said...

Maybe he should rather have invested in the BUBARMED system.

The cure for FUBARMED is to fax a solid black page to him continuously, 24/7. You could even bribe your kids to do it from home.

Not House said...

Ugh. This is what frustrates me about the EMR concept. namely that you have people who have no idea how to use EMR's out there mucking it up for the rest of you, engendering animosity to anything technologic (not you, per se Grumpy, but just in general).

Packer said...

Automation of personal service business and practices results in well a situation that is FUBAR.

Most of this stuff was put together by CPAs who think that everyone should bill 30 to 35 hours in a 24 hour day. Oh, yeah. Flat Rate Manuals for mechanics. Billable hours for lawyers, accountants, engineers and units for Dr.s Chiros and Dentist.
The quality of life for all these practioners has just leaped forward.

Anonymous said...

Wow, that sounds like some serious HIPAA violations to me. Not to mention an annoyance and a waste.

Don said...

I guess you are old fashioned Doc. Put a fax card in a PC or server. Receive the faxes electronically. Delete the crap, only print the important ones.

If you have an office server, most fax receiving software will deliver the faxes to an email box.

Its cheap to setup.

Matt said...

No, see, as a Medical IT professional, I can assure you that one of the primary benefits of electronic medical records is that it wastes less paper than old-fashioned charts! Clearly, you must be imagining things.

(when my organization went to our current EMR 'solution', one of the major changes was roughly doubling the number of printers we had. Probably more like tripling, if you count all the new label printers.)

Sparkly Jules said...

How is this not a HIPAA violation? Doesn't the patient need to give their authorization that every single effing thing that goes on with Dr. A can be faxed to Dr. B?? I know if I found out this was happening at my doctor, I'd be shopping for a new one.


Anonymous said...

1107- you are right. hipaa requires that the concept of minimum information necessary be followed

Anonymous said...

Why not use a computer fax buffer to store this crap until you can review it? That way you, or Mary, can pick out the relevant things to print for the patient files.

Don said...

From an IT standpoint, HIPPAA is probably one of the roadblocks into a good medical records systems.

For doctors to have a good picture of the history of a patient, they need access to all of the patients records. But since doctors, hospitals, nursing homes physical therapists, etc, all maintain their own databases, many records are on paper only, no central reporting, it is impossible for a doctor to review a patients entire case file.

Every office you go to makes you fill out exactly the same paperwork with the same information because there is no record storage system that would allow them to share the information.

A good records system would require everyone to store records there. Even on a regional level, all medical providers would have to share. It wouldn't have to be a monstrous billing system either. Just a good solid document management system. It only needs to do one thing and one thing only. Maintain the medical records for an individual.

20 years ago, this type of regional or national records database would be impossible. The broadband infrastructure to allow all medical providers to participate didn't exist or wasn't cost effective for most offices. Document management systems were in their infancy.

But HIPAA steps in the way. How do you prevent unauthorized access to data? Even with encryption, you can't guarantee that an unauthorized person can't access someones medical records. You can put controls in place to minimize the risk.

HIPAA has an admirable goal. Patient privacy, but it is a club. It stands in the way of meaningful changes in how we handle medical records. We need a new law that allows for central records management. I feel that instead of trying to guarantee privacy, it should instead focus on punishment for misuse of accidental disclosures.

I know, kind of long winded. I am not an expert programmer, but once upon a time, I was a document management system administrator for a major bank. These types of systems do work and can work.

Ben S said...


It is of course a good idea, but who's paying for it?

Polly said...

"For doctors to have a good picture of the history of a patient, they need access to all of the patients records."

Not necessarily, Don, and I think you're overestimating the professionalism of some medical personnel. One of my friends had a second-trimester abortion, and she has had physicians who found out about it give her a really hard time, including one who assumed that some unrelated health problems must have been hysterical symptoms since my friend is clearly an evil, crazy, baby-killing whore. So, if you're not her gynecologist, that is information she is not going to share with you, and I'm sure that she appreciates HIPAA very much.

Amy said...

A little late here... but I bet your problem would handily disappear if you sent him a bill for your time and supplies.

As for Hipaa... not a violation anyone would waste court time on. She has a relationship with both physicians, and likely has signed the standard waiver. Besides, there's no private cause of action under Hipaa, anyway. She'd have to use it to prove standard of care for a violation of privacy suit... which wouldn't likely go anywhere, as she'd have a hard time proving damages... [MHPA student]

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