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Gear Grinding 9: I Need a Wine!

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  • Originally posted by dxmnkd316 View Post
    FedEx has gone from the world's best shipping and logistics company to one of the absolute worst.

    I've had delivery exceptions because they have the damn box in Minneapolis by day 2 of a 5-7-day window and they'll let it sit in the warehouse until it's due.
    There was a time when hiring someone who had earned a FedEx Five Star Award was a pretty reliable indicator of exceptional competence, especially if you hired them away from FedEx. I'm not so sure it automatically adds credibility to a resume anymore.

    Comment


    • Been awhile since I saw this thread!
      Electronic Medical records/systems grind my gears. Well the whole medical system grinds my gears.

      I just spent the morning trying to sign in for my physical and find out what to do about a specialist and my eye doc.

      All 3 places changed EMRs/systems. All 3 of them lost a bunch of data and had messed up carryover. The last 2 had refused to let me make an appt and said they would text to set up appt when I was due. Nothing.

      PCP system wanted a copy of my insurance card half way thru. No going around it. I had no way of scanning or uploading. I was so irritated I uploaded pics of an ID card. I wanted to upload something much worse! Then it wants me to sign docs and their system is messed up. I spend time doing this every year and every time almost all of what I did is not in chart.

      Call the specialist- new system. They just 'lost me' oops! So I was in the system to find but not to be connected. I didn't even tell them about the new insurance. They can find out when I get there. Annnnd the person I used to work with has joined the Practice site I go to. Let's just say if the Hospital hadn't eaten up all the independent practices and made one conglomerate I would leave.

      Call the Eye guy- new system- oops they stopped notifying people but never told anyone. They NEED my insurance card. It doesn't go thru on their system. Perfect storm- mr les uses an initial and his middle name. The system to confirm insurance company does not like initials but the card has initials. I am hyphenated. The system doesn't like that either. They decided to fix it when I am there.

      I am not in the mood.

      Comment


      • The downfall of any EHR is the data, and any time we move from one system to another - in any industry - data is lost. In healthcare, the data is "owned" by the operational groups/management and not by IT. We - IT folks - inform the operational folks of this constantly, and in the case of system migrations, what those same ops folks need to do. And they almost never dedicate sufficient resources to it.

        Data migration is hard and important, so people simply don't do it. Especially when they can simply blame this nebulous "IT" thing to patients.


        And you know what? It's still a thousand times better than paper.


        edit: that said, it's super super frustrating when you're on the short end of the stick.
        Last edited by Swansong; 09-25-2023, 01:34 PM.
        I gotta little bit of smoke and a whole lotta wine...

        Comment


        • Originally posted by Swansong View Post
          The downfall of any EHR is the data, and any time we move from one system to another - in any industry - data is lost. In healthcare, the data is "owned" by the operational groups/management and not by IT. We - IT folks - inform the operational folks of this constantly, and in the case of system migrations, what those same ops folks need to do. And they almost never dedicate sufficient resources to it.

          Data migration is hard and important, so people simply don't do it. Especially when they can simply blame this nebulous "IT" thing to patients.


          And you know what? It's still a thousand times better than paper.
          As someone who is often asked to perform data migration from, or an integration to, an old ticketing platform as part of our implementations, we almost always advise clients against it and so does the vendor. Getting the data out of the old system and into a format consumable by the new platform is often a PITA. Field mapping between two different systems is always a massive PITA (I can only imagine how much of a nightmare this must be with EMR systems). Getting the client to allocate sufficient resources to clean & normalize the old data pretty much never happens, so when we're forced to do it, it becomes garbage in/garbage out. To do it properly and as seamlessly as possible requires so much time and energy, that the juice is almost never worth the squeeze.

          Comment


          • In EHRs there's typically a manual scheduling conversion "party" so that every appointment is covered. It sounds like that didn't happen for les (nor did it happen for my partner's recently scheduled and... not scheduled dermatology appointment). It's frustrating to be sure.


            edit: I'll note that I'm hearing through my EHR-world-grapevine that virtually none of the larger healthcare companies (and by that I don't mean locally large like Partners or BILH; I mean Mercy/Cleveland Clinic/United Healthcare, etc.) ever bother with conversion. They'll archive "legacy" data and make it sorta accessible to end users through the new EHR, but then will tell the clinical staff that it's on them to abstract everything manually, patient by patient.

            But then, I'll also add that for-profit healthcare is anathema to providing actual quality care anyway...
            Last edited by Swansong; 09-25-2023, 01:52 PM.
            I gotta little bit of smoke and a whole lotta wine...

            Comment


            • Originally posted by Swansong View Post
              The downfall of any EHR is the data, and any time we move from one system to another - in any industry - data is lost. In healthcare, the data is "owned" by the operational groups/management and not by IT. We - IT folks - inform the operational folks of this constantly, and in the case of system migrations, what those same ops folks need to do. And they almost never dedicate sufficient resources to it.

              Data migration is hard and important, so people simply don't do it. Especially when they can simply blame this nebulous "IT" thing to patients.


              And you know what? It's still a thousand times better than paper.


              edit: that said, it's super super frustrating when you're on the short end of the stick.
              Data that needs to be mined is transferable. If it doesn't fit into a little box then many times free text is the only way to document. Free text does not migrate.
              This was simple demographic info that didn't migrate.
              In the last few months have seen a couple of large studies showing there is no benefit to efficiency, patient outcomes, shown from using EMR vs paper or other non-EMR systems. Anyone who has used a good system pre-EMR has no surprise for this. People who have no experience before EMR have no idea how much more efficient it was to document.

              It was in my medical journal stuff. Of course I can't find it now when I went looking for the link. SYnopsis- There was no statistical improvement using EMR and in some cases older systems were more efficient and less prone to error. They looked at pt outcomes, efficiency, timeliness and ability to find information (I think those were the parameters but I can't remember)

              EMR inefficiency, ability for info to be entered in places where it could be missed, ability to create and perpetuate errors by copy/paste/ repopulate, the loss or 'corruption' of data as it was migrated from system to system were some of the things they noted. They also noted the EMR was initially created to be able to mine data for insurance companies and the structure remains focused on data mining so no matter how inefficient, confining in ways to convey information, it will not change.

              The commentary after the article was fascinating. Those of us who learned to practice real medicine (not driven by insurance) and wrote/dictated notes rich with details about the patient were on one side. Those trained to consider insurance parameters and EMR templated notes on the other. Eye eye opening to see how much knowledge has been lost and how patients were viewed more as objects when you just click a button. Some of the stories people told about how really important stuff was missed -there was no place for it in the chart or it was in there and not accessible unless you looked really hard for it.

              It isn't IT fault. There is no way in heaven I am going to be able to click a little box to tell the story about someone's suicidal ideation, family issues, past trauma, weird sign or symptom and get more than the category across. Every time I saw a patient with only EMR records I had to basically start again to get the real story.

              Still hunting for the link.
              Last edited by leswp1; 09-25-2023, 02:11 PM.

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              • I hope you take this as half tongue-in-cheek as I intend, but that just screams "I don't like change" to me.

                Being able to swiftly intersect different systems has revolutionized healthcare delivery. Video conferencing, and the integration of it directly into EHRs, will be one of the enormous positives to come out of Covid. Patient portals and release of clinical data has converted healthcare from an opaque system where people have ... ahem ... varying levels of trust in their providers to a system where patients can actually own their own health. Not to mention things like e-prescribing and its ability to reduce doctor shopping and pill milling. You may not like the Cologuard test vs. a colonoscopy (I don't mean you specifically, Les, I mean the general "you"), but I've now built two interfaces with them to drastically cut back on manual work when ordering and getting results for these tests, and the actual instances of CRC screening use has jumped specifically at both institutions I've set it up in.

                Plus, now that we have a lot of healthcare data, we're able to do observational studies across vast populations of patients and further help with clinical decision making. This part is only in its infancy.


                I'm with you that healthcare-by-insurance-mandate is bad, very very bad, but things like PAMA - that require the consultation of approved (by cardiologists) decision-making tools when ordering high-tech imagining - have helped reduce costs and reduced wait times at imaging centers (and cut back on BS profiteering from companies like Shields).
                I gotta little bit of smoke and a whole lotta wine...

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                • Roommates have been taking more than they give, but have the audacity to call me selfish. But since they've refused to listen to my concerns, I applied elsewhere and was approved to move in on October 13th.
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                  • Originally posted by Swansong View Post
                    I hope you take this as half tongue-in-cheek as I intend, but that just screams "I don't like change" to me.

                    Being able to swiftly intersect different systems has revolutionized healthcare delivery. Video conferencing, and the integration of it directly into EHRs, will be one of the enormous positives to come out of Covid. Patient portals and release of clinical data has converted healthcare from an opaque system where people have ... ahem ... varying levels of trust in their providers to a system where patients can actually own their own health. Not to mention things like e-prescribing and its ability to reduce doctor shopping and pill milling. You may not like the Cologuard test vs. a colonoscopy (I don't mean you specifically, Les, I mean the general "you"), but I've now built two interfaces with them to drastically cut back on manual work when ordering and getting results for these tests, and the actual instances of CRC screening use has jumped specifically at both institutions I've set it up in.

                    Plus, now that we have a lot of healthcare data, we're able to do observational studies across vast populations of patients and further help with clinical decision making. This part is only in its infancy.


                    I'm with you that healthcare-by-insurance-mandate is bad, very very bad, but things like PAMA - that require the consultation of approved (by cardiologists) decision-making tools when ordering high-tech imagining - have helped reduce costs and reduced wait times at imaging centers (and cut back on BS profiteering from companies like Shields).
                    I don't think it is the change aspect. It is the failure of the system to do the job is is supposedly taking over. If the systems actually worked then great. If they intersect successfully then great.

                    My experience so far has been they do not or if they do it is rare. I am stuck with the abomination that is "Circle Health" They are a monopoly that has forced out all other choices locally. They spew nonsense about how everything is integrated and being in one system is great. They need a larger shovel to heave the BS. I cannot tell you a time I walked into a Provider and they had accurate information from my Specialists or from a referral. I correct/update information and it reverts to previous info so I needed to correct it again. It is pretty obvious when I need to give a synopsis of what has happened in the last yr and it is all news to them.

                    When I use the Portal to submit info prior to my visit, it doesn't capture. They manually correct it when I show up and tell me it almost never updates properly when people do it online.

                    That is not "I don't like change". That is "I have seen a system that worked so don't tell me I shouldn't expect the same functional level and detail of the new system". I know to ask to bring up the changes, make sure the information is correct. A lot of people assume the info is accurate. Decisions are made based on incomplete or incorrect info.

                    Are there some aspects that can be good? yup. They also have gaping holes where info gets lost and where people foolishly believe all info is available.

                    Example- my Aunt is changing her PCP within a hospital system. Initial visit they review her information. Much of it is incomplete, out of date or incorrect. The worst was her Immunization record- that should be straight forward. They reviewed immunizations on the Mass site and the hospital site. She is not up to date and they recommend 2 different imms. I remember her getting them so I ask they hold off until I can get info. They give me a list of what they can find. I walk upstairs to her old PCP and get a copy of the imms they have on record. Review and find she has had THREE of each of the missing vaxes. She should only have had 2. If I didn't do the homework she would have had FIVE.

                    The concept is grand. If we were like most developed countries and had seamless healthcare system with compiled records then it could be grand.
                    We don't. We have a sucky medical system, sucky communication and millions of little islands where people are reinventing the wheel with things that don't interconnect and or mesh. And most of it is driven by what data needs to be mined, not by the details that make each patient different [climbs off soap box]

                    Comment


                    • I will say that Circle Health is a competitor to my company, but I also agree that their for-profit model is not good. They also use a hodgepodge of disparate EHRs, instead of one big one, and that's a major problem. It's not a huge surprise to me that they don't interact between them. I no longer work on the interfaces (current role is to manage patient portals, mobile apps, our partner provider access and telehealth), but I know my now-big company is planning on investing rather substantially in getting all owned-entities onto one instance of Epic. Private practices won't be on it but will use an affiliation system where their own private EHR has a direct connection to our main system, so your example won't happen.


                      Regarding the immunizations, that's just lazy on their part. There are two ways to get state immunization data - auto-pull (which we do and for god's sake there's no excuse not to) and manual pull. It sounds like the auto-pull doesn't happen (inexcusable, in my opinion) and either the provider doesn't know how to manually pull or they have not set it up to do so (also inexcusable).


                      But to me, this all comes down to a crappy, for-profit system not wanting to do what's right and what's necessary. EHRs - modern EHRs - can do all of this and more. Those that don't do it have chosen not to.
                      I gotta little bit of smoke and a whole lotta wine...

                      Comment


                      • Originally posted by Swansong View Post
                        I will say that Circle Health is a competitor to my company, but I also agree that their for-profit model is not good. They also use a hodgepodge of disparate EHRs, instead of one big one, and that's a major problem. It's not a huge surprise to me that they don't interact between them. I no longer work on the interfaces (current role is to manage patient portals, mobile apps, our partner provider access and telehealth), but I know my now-big company is planning on investing rather substantially in getting all owned-entities onto one instance of Epic. Private practices won't be on it but will use an affiliation system where their own private EHR has a direct connection to our main system, so your example won't happen.


                        Regarding the immunizations, that's just lazy on their part. There are two ways to get state immunization data - auto-pull (which we do and for god's sake there's no excuse not to) and manual pull. It sounds like the auto-pull doesn't happen (inexcusable, in my opinion) and either the provider doesn't know how to manually pull or they have not set it up to do so (also inexcusable).


                        But to me, this all comes down to a crappy, for-profit system not wanting to do what's right and what's necessary. EHRs - modern EHRs - can do all of this and more. Those that don't do it have chosen not to.
                        They manually pulled. It is because the old imms didn't migrate to the new system and the State system does not talk to their system. If you go to France they have one system. You swipe your card and all your information is in one place. That is efficient. My Auntie has 8 Specialists who all practice independently with no consistent, reliable communication method.

                        Been saying since they first mandated switch- the systems are not good enough to do the job. The insurance cos like it. They can mine data, claim things didn't happen because it wasn't coded or entered right. It is not structured to meet the needs of the Providers. Also, really scary to us older folks- the people entering the system now have all learned to practice and respond in direct relation to what the EMR requires or what insurance says they have to do. This results in care being compartmentalized instead of thinking in a decision tree with a holistic approach. Its like going to Burger King Drive thru. everyone is their own island

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                        • The issue on immunizations is that we have 50 states and 50 different sets of laws and thus, 50 different registries. That has nothing to do with insurance or EHRs. I'd love to have one central "master chart", but so long as the US is special and loves freedom and liberty (please read the dripping sarcasm here), it's on individual healthcare companies to configure their EHRs - that are all 100% capable of doing everything you say they should do - to do so.*

                          My company mostly does, or at least we plan to by 2025/2026 when we're done consolidating. Circle Health... ahem. Does not.


                          But to reiterate. Modern EHRs - Epic, Athena, ECW, even older ones like Meditech or Cerner, and even niche ones like Varian and Aria, can do literally everything you're saying they cannot do. If an individual instance of them does not do some function, it's because the organization chose not to.




                          *In fact, Epic has a "Care Everywhere" network that allows most data to transfer between implementations, and they have a growing connectivity network called "Happy Together" (Epic loves these idiot mnemonics) where we map individual note types and tests and whatnot to a central database, and once that Care Everywhere link has been established, it just pulls all that in natively. Meaning if you go see a Lahey PCP but your cardiologist works for Brigham, on two different Epic installs, they can link charts and all your data flows back and forth seamlessly. When I transferred PCPs from a UMASS-based provider to an independent provider who uses the Mount Auburn system, I gave approval, my new PCP clicked 3 buttons and all my years of UMASS data was in the MAH system.
                          Last edited by Swansong; 09-26-2023, 04:51 PM.
                          I gotta little bit of smoke and a whole lotta wine...

                          Comment


                          • Originally posted by Swansong View Post
                            The issue on immunizations is that we have 50 states and 50 different sets of laws and thus, 50 different registries. That has nothing to do with insurance or EHRs. I'd love to have one central "master chart", but so long as the US is special and loves freedom and liberty (please read the dripping sarcasm here), it's on individual healthcare companies to configure their EHRs - that are all 100% capable of doing everything you say they should do - to do so.*

                            My company mostly does, or at least we plan to by 2025/2026 when we're done consolidating. Circle Health... ahem. Does not.


                            But to reiterate. Modern EHRs - Epic, Athena, ECW, even older ones like Meditech or Cerner, and even niche ones like Varian and Aria, can do literally everything you're saying they cannot do. If an individual instance of them does not do some function, it's because the organization chose not to.




                            *In fact, Epic has a "Care Everywhere" network that allows most data to transfer between implementations, and they have a growing connectivity network called "Happy Together" (Epic loves these idiot mnemonics) where we map individual note types and tests and whatnot to a central database, and once that Care Everywhere link has been established, it just pulls all that in natively. Meaning if you go see a Lahey PCP but your cardiologist works for Brigham, on two different Epic installs, they can link charts and all your data flows back and forth seamlessly. When I transferred PCPs from a UMASS-based provider to an independent provider who uses the Mount Auburn system, I gave approval, my new PCP clicked 3 buttons and all my years of UMASS data was in the MAH system.
                            Yes. Yes. Yes. and this is why we have horrid healthcare. https://yourlocalepidemiologist.subs...m_medium=email
                            She is a great person to follow re info. Very clear about just how much we suck with links to sources.

                            Hot under the collar right now about all of this. Dealing with multiple old people, all of whom are audio-visual aides for just how embarrassingly bad our system is- even with my knowledge base and advocacy. The number of errors, lack of communication, misinformation, roadblocks to care- telephone trees, hr long waits on hold, "that's not my job! So and so should be managing X" is overwhelming. Trying to deal with correcting info whole trying to explain to disbelieving olds (of course they have the right information!!!) I can't even....

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                            • A Philly cop won't even have to go to trial for killing a driver that was sitting in his car.

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                              • Originally posted by leswp1 View Post

                                Yes. Yes. Yes. and this is why we have horrid healthcare. https://yourlocalepidemiologist.subs...m_medium=email
                                She is a great person to follow re info. Very clear about just how much we suck with links to sources.

                                Hot under the collar right now about all of this. Dealing with multiple old people, all of whom are audio-visual aides for just how embarrassingly bad our system is- even with my knowledge base and advocacy. The number of errors, lack of communication, misinformation, roadblocks to care- telephone trees, hr long waits on hold, "that's not my job! So and so should be managing X" is overwhelming. Trying to deal with correcting info whole trying to explain to disbelieving olds (of course they have the right information!!!) I can't even....
                                Beyond all of our back and forth here, I sympathize very much with you on this. I'm sorry you - and everyone else for that matter - have to deal with this. I admit, I was vocally opposed to any concept of single payer or nationalized system... until I started working in healthcare. It shouldn't have taken that, but whatever, it did. I'm a slow learner :-)

                                If you decide you and your family need a change and want to come to the other big company that isn't MGB (we're not for profit and have a 4-letter acronym), let me know and I may be able to assist. Changing doctors and a known network is incredibly difficult, but all the same, the invite stands.
                                I gotta little bit of smoke and a whole lotta wine...

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