I do transcription and have a few doctors dictate such discrepancies OFTEN, several times a week. It's not just EHR. It can be extremely irritating as they are obviously paying no attention to what they say. I flag it but I don't know if the doc ever sees his/her error or someone else corrects it. How can you not realize you just said the date of service is 02/24/2017???? I'm just thankful to still have this job...for now.
The idea that computer programmers blindly code this stuff with no knowledge of medicine or medical practices is silly. The actual programmer may not have medical experience but the people guiding and advising how the program is put together do.
Some people have this idea that computer programs are slapped together like a sandwich, with the programmers deciding what goes in by thinking something sounds right or by some buzzword. The truth is that it is a lot more complicated than that, and if there were not medical people actually involved in the process none of this stuff would get used.
And, for crying out loud, there are medical professionals who code as well. I used to work with someone who not only could program but had an M.D. AND a Ph.D. in some medical research field.
"Since patient continues to lie about his health practices, I recommend installing additional surveillance cameras in patient's home and workplace. Bill to patient's insurance."
"Patient explained that he doesn't quite finish the tenth cigarette, so he actually smokes 0.49 packs a day. Since this is under 0.5, patient rounds down to zero."
"Patient feels that his relationship with tobacco is one of mutual respect and that both sides get what they want and need out of it. Patient therefore insists that he is not 'using' tobacco."
I once transcribed for a hospitalist who dictated the exact same physical examination section word for word regardless of age, gender, or HPI. I had to flag every time it did not jibe with information in the rest of the report. He also dictated anion gap for A/G ratio, so there were some more flags. Can't get that with EMR.
Loren Peschtel said...'Perhaps he denies smoking, but his wife says he smoke half a pack.' This is probably what happened. 12 years ago, my dad vomited blood. At the emergency room the doctor asked us if he was an alcoholic, I said yes and my mom said no. (He was). The doctor explained to me what esophageal varices was and said he would not live long. He died three weeks later and the Death Certificate said cause of death was cirrhosis of the liver. One wonders just how much incorrect info medical people are given by family members because they can't face the fact a relative is an addict or alcoholic.
The family medical history in my own EHR includes the fascinating info that my paternal grandfather had "paternal cancer." Well of course he did! He couldn't have had maternal cancer!
@Anonymous: "Hmmm...we obviously didn't trust doctors to give us health advice. So we turned that job over to a computer programmer." Yup, that's modern healthcare for ya! (Except at Dr. Grumps clinic)
This just goes to show that the provider has no choice on the screen.
ReplyDeleteIt answers ALL the questions, just in case you forget, then adds your text comments.
Nice guessing game.
I remember the days when the provider actually decided what to document, prescribe, administer, etc. Now computer programmers decide.
ReplyDeleteHmmm...we obviously didn't trust doctors to give us health advice. So we turned that job over to a computer programmer.
I think that a well-designed system would not allow you to enter/accept two conflicting options.
ReplyDeleteI just saw a similar entry in a record: Social History: Alcohol: Pt. admits to drinking a 12 pack of beer a day. Pt drinks socially. TCG, RN
ReplyDeleteNever believe anything until it's been officially denied.
ReplyDeleteI do transcription and have a few doctors dictate such discrepancies OFTEN, several times a week. It's not just EHR. It can be extremely irritating as they are obviously paying no attention to what they say. I flag it but I don't know if the doc ever sees his/her error or someone else corrects it. How can you not realize you just said the date of service is 02/24/2017???? I'm just thankful to still have this job...for now.
ReplyDeleteI hope the line "dictated but not read" is still being used in reports, at the very least.
ReplyDeleteI'm an independent medical transcriptionist, too. I'd have sent you an email regarding this discrepancy to give you a chance to verify it.
ReplyDeleteEHR is killing the medical transcription industry.
But I love your posts, Dr. Grumpy, and look forward to them every day!
:o)
Perhaps he denies smoking but his wife says he smokes half a pack?
ReplyDeleteThe idea that computer programmers blindly code this stuff with no knowledge of medicine or medical practices is silly. The actual programmer may not have medical experience but the people guiding and advising how the program is put together do.
ReplyDeleteSome people have this idea that computer programs are slapped together like a sandwich, with the programmers deciding what goes in by thinking something sounds right or by some buzzword. The truth is that it is a lot more complicated than that, and if there were not medical people actually involved in the process none of this stuff would get used.
And, for crying out loud, there are medical professionals who code as well. I used to work with someone who not only could program but had an M.D. AND a Ph.D. in some medical research field.
"Patient initially denied tobacco use, but eventually broke under interrogation."
ReplyDelete"Since patient continues to lie about his health practices, I recommend installing additional surveillance cameras in patient's home and workplace. Bill to patient's insurance."
ReplyDelete"Patient explained that he doesn't quite finish the tenth cigarette, so he actually smokes 0.49 packs a day. Since this is under 0.5, patient rounds down to zero."
ReplyDelete"If I check more boxes here I can bill for a higher level CPT code"
ReplyDelete"Patient feels that his relationship with tobacco is one of mutual respect and that both sides get what they want and need out of it. Patient therefore insists that he is not 'using' tobacco."
ReplyDeleteThat must be the same EHR my family dr uses. The computer claims 1) my 14yo son has never had a menstrual period 2) his first one was at age 13.
ReplyDeleteMy guess is the no tobacco and ETOH screenig questions were auto filled and the provider didn't uncheck them.
ReplyDeleteI once transcribed for a hospitalist who dictated the exact same physical examination section word for word regardless of age, gender, or HPI. I had to flag every time it did not jibe with information in the rest of the report. He also dictated anion gap for A/G ratio, so there were some more flags. Can't get that with EMR.
ReplyDeleteLoren Peschtel said...'Perhaps he denies smoking, but his wife says he smoke half a pack.'
ReplyDeleteThis is probably what happened.
12 years ago, my dad vomited blood. At the emergency room the doctor asked us if he was an alcoholic, I said yes and my mom said no. (He was). The doctor explained to me what esophageal varices was and said he would not live long. He died three weeks later and the Death Certificate said cause of death was cirrhosis of the liver. One wonders just how much incorrect info medical people are given by family members because they can't face the fact a relative is an addict or alcoholic.
The family medical history in my own EHR includes the fascinating info that my paternal grandfather had "paternal cancer." Well of course he did! He couldn't have had maternal cancer!
ReplyDelete@Anonymous:
ReplyDelete"Hmmm...we obviously didn't trust doctors to give us health advice. So we turned that job over to a computer programmer."
Yup, that's modern healthcare for ya! (Except at Dr. Grumps clinic)