A community of 30,000 US Transcriptionist serving Medical Transcription Industry
A letter from a doctor friend of mine to his congressman - Mom22dogs
Posted: Apr 18, 2013
The following is from a Facebook post from a physician friend of mine. This is a letter he sent to his congressman. I got permission from him to post it here. Long read, but I feel galvanized by this:
I have been dealing with 2 electronic health record (EHR) systems and it is clear that the technology is not ready for implementation. I feel they will increse cost, decrese access, and decrease quality of care in their current state. I encourage anyone reading this to contact their congressman and senator and ask them to put away the carrots and whips they are using to coerce physicians to use ...EHRs. Physicians will not need to be coerced to use EHRs once the technology is ready. A note that I sent to my congressman, Todd Rokita, follows. I apologize for the length of this posting. P
I received a follow-up email regarding my comments on EHR in which you stated that you thought that EHRs would decrease cost and improve care. I do no beleive that in their current state this is the case. I'll enumerate the reasons.
1. The current state of the software is not ready for wide spread application.
a. The systems I have worked with are being debugged and developed as they are being rolled out such that they work erratically or some functions are not available.
b. The human interface is poorly developed such that it is not intuitive and it is time consuming to work through.
c. The systems do not take advantage of melding the computers ability to process data with expert recommendations to optimize care by prompting the physician to do preventive care or make optimum decisions regarding disease management.
2. Health care providers have not been trained to incorporate the systems in their practice.
a. The work flow likely needs to change but the training received is how to use the software, not how to implement the software with best practices while providing the best care for the patient.
b. The meaningful use requirements emphasize a keeping score philosophy and not providing good and cost effective care.
The sum of the effects is that while we are looking at trying to provide care for more patients the next few years because of the increased availability of insurance and while we are trying to reduce costs, we will actually reduce access and increase costs for the following reasons:
1. The drag of the use of EHR will decrease patient volumes seen by providers. Thus their will be fewer openings for patient visit.
2. The patient visits will be less effective because fewer topics will be covered due to the overhead of the EHR so more visits are required to manage a patient's medical problems.
3. Charges per visit will increase because the complexity of the visit will seem to increase because of record keeping though in reality the complexity will decrease because fewer topics/complaints/preventive care issues will be covered.
4. Providers will opt to retire because of their frustration with the EHR's. Doctors want to provide care to patients, not type on a computer.
5. Patients will be less likely to be compliant because much of the visit will be devoted to computer data entry instead of eye to eye contact and discussion, patient examination, decision making, and care planning. They will ask themselves "Why should I return to see my doctor type data into a computer?"
6. The improved access to data will not significantly reduce cost because the data will not be readily accessed and the big ticket items are usually accounted for with the current practice methods.
7. The computer capabilities are not utilized to implement best practices for preventive care, decision making, and data tracking.
I strongly encourage you to sit down with a few doctors and get their direct feedback on Electronic Health Records.
I received a follow-up email regarding my comments on EHR in which you stated that you thought that EHRs would decrease cost and improve care. I do no beleive that in their current state this is the case. I'll enumerate the reasons.
1. The current state of the software is not ready for wide spread application.
a. The systems I have worked with are being debugged and developed as they are being rolled out such that they work erratically or some functions are not available.
b. The human interface is poorly developed such that it is not intuitive and it is time consuming to work through.
c. The systems do not take advantage of melding the computers ability to process data with expert recommendations to optimize care by prompting the physician to do preventive care or make optimum decisions regarding disease management.
2. Health care providers have not been trained to incorporate the systems in their practice.
a. The work flow likely needs to change but the training received is how to use the software, not how to implement the software with best practices while providing the best care for the patient.
b. The meaningful use requirements emphasize a keeping score philosophy and not providing good and cost effective care.
The sum of the effects is that while we are looking at trying to provide care for more patients the next few years because of the increased availability of insurance and while we are trying to reduce costs, we will actually reduce access and increase costs for the following reasons:
1. The drag of the use of EHR will decrease patient volumes seen by providers. Thus their will be fewer openings for patient visit.
2. The patient visits will be less effective because fewer topics will be covered due to the overhead of the EHR so more visits are required to manage a patient's medical problems.
3. Charges per visit will increase because the complexity of the visit will seem to increase because of record keeping though in reality the complexity will decrease because fewer topics/complaints/preventive care issues will be covered.
4. Providers will opt to retire because of their frustration with the EHR's. Doctors want to provide care to patients, not type on a computer.
5. Patients will be less likely to be compliant because much of the visit will be devoted to computer data entry instead of eye to eye contact and discussion, patient examination, decision making, and care planning. They will ask themselves "Why should I return to see my doctor type data into a computer?"
6. The improved access to data will not significantly reduce cost because the data will not be readily accessed and the big ticket items are usually accounted for with the current practice methods.
7. The computer capabilities are not utilized to implement best practices for preventive care, decision making, and data tracking.
I strongly encourage you to sit down with a few doctors and get their direct feedback on Electronic Health Records.
May or may not make a difference (probably won't), but it makes me feel good to see this in print! He said he was surprised there wasn't more of an uproar about this because of all of the complaints he has heard from other physicians. I told him maybe he should start a petition.
There ARE good systems out there, but they are mostly - quite expensive, leaving practitioners trying to
[ In Reply To ..]find something they feel is affordable to choose from literally dozens of new systems that have been rushed onto the market at lower prices. It's especially hard on those poor babies who waited until the last minute, both to educate themselves and to purchase...something.
Let's face it, if the deadlines hadn't been put in place very few would be developing or buying now.
Yet we're all of us still typing up reports every single day dictated by clinicians who have NO idea what their patients' medical histories, medications, and diagnostic tests, if any, actually are. Anybody but me disgusted and appalled at looking through reports dictated during a hospitalization and finding no 2 medication lists that are even mostly similar?
The whole thing's just not acceptable. Our providers need to suck it up and get to cleaning their act up. That they wouldn't do it on their own is beyond shameful.
Your doctor friend seems out of touch... - Laughing At The Whiners
[ In Reply To ..]Anybody with an ounce of knowledge about the EHRs--or the medical field in general--knows that doctors delegate every task possible to an underpaid, often under-trained lackey. His argument that patients do not want to sit and watch a doctor type data is just egregiously incorrect. Physicians have been shaving face-to-face time down to almost nothing for decades. Heck, you're lucky to see an M.D. at all and are often shuffled over your hours-long appointment from staff person to staff person. The doctors can complain all they want. They've made themselves replaceable in this scenario as well. Soon, we'll go to a kiosk at the supermarket for minor ailments and we have the money-grubbing clinicians and healthcare businessmen to blame.
I'm not laughing and neither should you! - Yeah Right
[ In Reply To ..]Waited in the exam room for nearly three hours. No kidding. The doctor finally showed up. She was frazzled. She was frustrated. I think I saw her trembling. She tried to balance typing on her lap top with asking me questions and attempting to make some type of eye contact. She could barely type, and I wasn't sure she was getting down everything I was telling her. I'm pretty sure she didn't. She was hours behind schedule due to attempting to fill out the apparent form fields, as well as adding typed content, while still trying to actually practice medicine. I was supposed to have my well-woman physical exam, but we never got around to it, and in witnessing her distress, I didn't push the issue either. It was absolutely crummy for me, but also for the doctor, who wasn't really able to practice medicine because she was fumbling about with her laptop. I finally left and had wasted nearly four hours of my time. That's not efficiency or quality care. She needed a scribe or to simply dictate her notes, and she wouldn't have been hours behind schedule and absolutely flustered. I saw this first hand. From a patient's perspective, as well as an MT, I'm certainly not laughing.
You've made my point about the hilarity...THANKS! - Still Laughing
[ In Reply To ..]The fact that you waited until the second to last sentence of your diatribe about your horrible--yet, standard these days--experience in your doctor's office to mention the *scribe* speaks volumes. Again...medical doctors have been delegating tasks--everything from gathering history to drawing blood to patient education...it's a loooong list--to others in their offices. There hasn't been trueness to the practice of medicine by physicians since around the time the HMOs rolled into town.
Even better is the ineptitude exhibited by someone with advanced degrees at organizing oneself while "on stage" with a patient. She couldn't handle a laptop and didn't think to place it on a Mayo stand? You waited 3 hours because she was behind schedule because she couldn't push record keeping to a manner of recollection at the end of the day when she's in a rush to get home to her family? My ophthalmologist has always done her own record keeping and does it during my visit--she learned how to use a computer somewhere.
Sure, they're feeling the squeeze, and of course patients will as well. The fact that medical records have become a huge expense in medicine and lack accountability in correctness and even accessibility (by both patients and clinicians) is ridiculous and points to the inevitability of the current situation.
Respectfully disagree with you - waited 5 hours to see my oncologist
[ In Reply To ..]Last time I followed up with my oncologist I waited FIVE hours in his office before I could see him. The visit consisted mainly of a quick physical examination, asking a few questions, and the rest of the time he was typing into his computer. I was so tempted, as I sat there in the exam room and watched him hunt and peck on his laptop keyboard, to ask him to consider getting a scribe. I definitely see a problem here, not only how I feel as a patient but also the fact that this slows the doctor down, five hours is really an unacceptable to time to spend in a doctor's waiting room. It used to be that when I saw my doctor, I saw him and he saw me. Now I see him sitting in a corner typing on a computer, remote, unavailable. There is no natural flow of conversation and while I try to remember everything I need to talk to him about, I find that I forget to bring up important issues because of the distraction of the computer.
It has been my experience that the - medical office assistant or
[ In Reply To ..]tech, or nurse come in to see me first. They are usually the ones with the lap top, gathering data, history, etc. As I talk to them and express my concerns or answer their questions and give the reason for my visit, they are entering the info into the computer and then get my vital signs or vice versa.
By the time the physician comes into the room, that part of the visit is over with and he comes in to focus on me. They also use some form of an EMR or EHR.
I have an idea! - Mom22dogs
[ In Reply To ..]Maybe we should just say "Hey Doc, pass ME that laptop" and type our own visit while we are there? 
I would be very, VERY tempted to do that if I were sitting there in the exam room and the doc was "hunting and pecking" and I KNEW I could type it in a fraction of the time!
No, really, I do think most doctors DO come out of medical school knowing how to type (these days it's just as fundamental as reading and arithmetic)! That just isn't their main strength, and I am sure most of them, like my doctor friend said, would rather be concentrating on their patients than entering data in a computer
You know why you waited 5 hours? Let me tell you...(sm) - Still Laughing
[ In Reply To ..]All of the signing in and out at a doctor's office is documentation for the state insurance authority. It proves that you were physically on the premises from the clock-in time you write on the roster in your own handwriting, and the clock-out time that either you or some staffer writes documents. Because the billing for a doctor's visit is based on the number of minutes long the visit is, and dubbed "brief" or "intermediate" for example, documentation of your presence there is important. They do not care if you wait 5 hours, and care more that they can document that you were there at least as long as the office visit they plan on billing for. Even though your time with the doctor was brief, and only a few minutes long and not the 45-minute visit they are billing for, this has become standard practice. It is the tantamount reason we all wait entirely too long to be seen by the doctor.
You have missed entirely the point I was making in that doctors have been relegating all of these tasks to others. A system is doomed from the start if it does not have the cooperation of those implementing the system and by "cooperation" in this case I mean "skill set to run a laptop." This is a case of the ivory tower they felt medical school afforded them tumbling down upon them.
Flummoxed Docs. sm - Lap Topped
[ In Reply To ..]To the posters on this thread writing about 3 and 5-hour waits to see their physician/oncologist and identifying the cause of the problem being a laptop computer that they are typing into, which also seems to be causing them great duress by the description of the 2 physicians, doesn't it concern you that you are placing your life into someone's hands that is so flummoxed by a laptop and some data entry that in the one case the physician was frustrated, upset, did not know where to put the laptop and was trembling, and in the other case the highly educated and skilled oncologist, treating people with the disease of cancer, let's his practice get into such a shape as 5-hour waits because he cannot figure out what to do about a laptop and some data entry other than hunching over his laptop hunting and pecking and watching his oncology practice go to the dogs because of it?
Do you really want to go to a physician, and in the one case with a very serious health issue, who is seemingly incapable or overwhelmed by a relatively minor issue such as what to do about a laptop and some data entry, to the point of putting their practice in jeopardy, trembling, etc.?
Spot on. (nm) - Still Laughing
[ In Reply To ..]..
Similar Messages:
A Friend Of Mine Wants To Try This, Can She Make $30.00 An Hour Doing Transcription
Nov 02, 2009
A lady I have talked with wants to train in this kind of work and is planning on going to Andrews. Would she be making at least $30.00 an hour when she gets a job? Thanks. ...
A Friend Of Mine Asked About MTing Recently ....
Dec 20, 2010
I told her to give it not a second thought, it was a waste of money and time for the schooling required, and, even as an IC, she'd be LUCKY to make $.09 a line and have zero benefits. I told her she'd be MUCH better off working for McDonald's. Who is going to enter this profession of low pay and no benefits in the future? Who will stay when, even the transcriptionists who are fortunate enough to be doing straight transcription now, are gone after the switch to VR and ...
Friend Of Mine Fell For One Of Those "BIG BUCKS (MT-ing) FROM HOME" Ads
Mar 05, 2010
So she signed up for this teach yourself transcription course, captured and enraptured by all its 'carnival barking' about the money, the prestige, and the convenience of working at home and being your own (uh-huh) boss...offering the world on a platter and stopping just shy of suggesting she could meet/marry a doctor. Flashcards in a box. Albeit medical words...but...flashcards in a box. ...
Doctor's Or Doctors In The Heading Of A Letter
Jan 07, 2010
In transcribing a letter should Doctor's be capitalized: Dear Doctor's or doctors? ...
Every Person Here Should Be Calling Their Congressman And Asking Why
Apr 09, 2013
Its one thing when private business with private equity sends jobs overseas. It is entirely another when Medicare and Medicaid is supporting job growth in India. Why are we not emassing in the halls of Congress???? This affects every American, not just MTs. ...
Wrote My Senators, Congressman, AND The President
Jun 15, 2010
Well, we will see what kind of response I get back. I'm not expecting much, but I thought it was high time i did my part in contacting my representatives and the White House about the sad state of OUR union :) ...
MS WORD HELP. Will Not Begin Sentence With First Letter In All Caps Anymore, Also The Letter "
Dec 20, 2009
A few weeks ago, for no reason that I can find, I cannot get the first letter of a sentence to be in all caps automatically, (unless I do it manually.) The same for the letter " I " by itself when typed. It was always automatic and now all of a sudden it is doing this and I cannot figure out how to change it back. Has anybody else had this problem, if so, how did you fix it? Thanks, appreciate the help ...
Let Me Be Your Refer-a-friend
Mar 26, 2013
I am in serious need of a new transcription job, straight typing. If your job offers a bonus for signing on a new employee, let me be your bonus.. if they don't and but still need help, please contact me. I'm seriously on the verge of not being able to make my house payment in the near future. Nine years transcription experience, basic 4, acute care, psychiatry.. you name it.. if I haven't done it, I can learn. Current job switched to VR and ...
Friend Wants To Know...Where To Begin?
Jun 25, 2013
I have a friend who is a nurse who wants to get into medical transcripting. Since she has a lot of background, she doesn’t think it would take her long. I had a bad experience with the company that trained me, so I was wondering what you guys would recommend for her? Do you know of any companies that train then give live work or know of a low-cost school?I let her know that most companies require 3 years experience, so do you know of anyone who hires fresh MTs?Thanks in advance! ...
Got An E-mail From MQ Friend. She Gave Her
Aug 15, 2010
Another one bites the dust. She said she didn't have anything lined up yet; just couldn't stand the stress any longer. ...
Asking For A Friend. How Many Hours Are Needed To Keep
Feb 18, 2013
x ...
Needing Advise For My Friend
Oct 25, 2013
My friend has worked at a local hospital for the past 6 years and within the last year they have gone to voice recognition. Now because of this they are running out of work on a daily basis and she has to use her vacation time when this happens (she takes at least 3 days of vacation per week). She is starting to run low on vacation time and then has to take it without pay. Did I read on here that she can apply for unemployment because of lack of work? I went to her house last night and helped h ...
Opinion Please: Friend Changing From Inhouse To MQ
Jan 08, 2012
Ok, I have a friend who has worked inhouse for a few years for a large hospital. She makes $14 an hour with shift differential. They have pretty much cut the incentive pay out. She really doesn't get that I don't think anymore. She is fustrated with her boss and is considering going to Medquist radiology transcription. Another friend who works on the radiology side of MQ said she has not ran of work before and has 5 accounts to work on, etc. She says ...
Friend Wants To Quit Inhouse Job To Work MedQuist
Jan 08, 2012
Someone who works at Medquist on the radiology side said that radiology isn't as bad as the acute care side. She said she has not ran out of work yet, and she has been there several months. I know what I see on these boards about the acute care side. Does this pertain to the radiology side too or is it different? ...
Which Verbatim Is It? Your's, Mine Or Their's?
Oct 30, 2010
Just worked on an ESL report (with unfortunately for me very, very, very little English). This is a VERBATIM account. Sent it to QA and it was "transformed" into English with little regard for that pesky word VERBATIM. Does verbatim mean different things to different people? ...
W-2 - Got Mine In The Mail
Jan 22, 2013
Just got mine in the mail. ...
Anybody Else's TW Timesheet Look Like Mine?
Jan 29, 2013
It's longer than the constitution for Pete's sake! I end up with so many entries because I get a job, one that usually takes 2 minutes to type, send it off, then NJA, wait a minute, here comes another job, type it, takes 2 minutes, and on and on. Craziness! ...
I Do Everyone Else's Records And Mine, Too
Feb 26, 2014
Just got a call from my dr's medical records wanting to know the name of the dr she wants my records sent to (she and I looked it up on the computer during my visit and I saw her write the dr's name down) and my dr's address, which I'm sure was on her request, her name and address. One of the last times I saw her, they put someone else's vital signs on my records (height, weight, BP and BMI). Sheesh. ...
Canaries In The Mine
Nov 07, 2014
This discussion actually began on October 3, 2014. To search for it, use the little blue search function and type in You missed something and the date 2014-10-04. I think it bears repeating again for all who might insist that people griping" here about Nuance are just conspiracy theorists. I prefer to think of them as canaries in the mine, warning folks away from Nuance. It is NOT just Nuance, as someone pointed out, but they are the most insidious it seems, about monitoring this board and disco ...
How Are You Paid For PTO? Just Found Out About Mine
Dec 11, 2009
I always thought that companies paid for PTO based on an average of your last 3-6 months production. I just found out that my company pays by the hour! This means my PTO for a week will be half of what a I normally make? Have you ever heard of this? Is this the norm? ...
I Contacted A Supervisor Other Than Mine And Got
Aug 31, 2010
region when I had had my fill of NJA on the last region I was assigned to. Where I am now is certainly not perfect, has some NJA, some nasty dictation, but I do have something to type the majority of the time. If you could come up with the name of one of these supervisors with the critical backlog, fire off a request to be moved. Worked for me (about 10 months ago). ...
Is Anybody Elses Email Down (yet Again) Besides Mine? NM
May 21, 2012
xxx ...
TSM Covering While Mine Is Out Is Awesome!
Jul 16, 2014
I'm so jealous of the team who gets to have this particular TSM. Wow! She's prompt in returning emails, investigates a problem thoroughly, and is overall very pleasant on the phone. It's a breath of fresh air! So if you're in the North and SM runs your show, I want to be on your team! ...
Overheard A Doctor Telling Another Doctor...
Oct 15, 2010
20 years ago when the DRG's hit the hospitals, one was complaing to the other... "they treat doctors like a bunch of old dogs now". Well, that's how MTs are being treated now. Why on God's green earth do the MT services require all MT's to work at least one weekend day every week (Friday's and Monday's don't count). Every ad I see on the Job Seeker board requires weekends. Are they sadistic or something. Why do we put u ...
Trans-Tech W2s. Have Not Gotten Mine Yet. Who Should I Call?
Feb 03, 2011
tx ...
Better Keep Eye On Your Timecards. Mine Keeps Reverting To Blanks.
Oct 20, 2012
to fix it and put my schedule in there again. Not sure how that could affect PTO, if you are working supposedly with no schedule. But anyway, just a heads up. Especially if when you go to turn time clock on, if there is no blue indicator on the today's activity plan field. It that is empty and you are scheduled to be working, make sure the timecard is showing your scheduled hours. ...
Check Your Pay, Payroll Screwed Up On Mine
Mar 08, 2013
Was wondering why my check so little, even though I did have 8 hours of work availability. Apparently they only paid me for two 15 minute shifts instead of my benefit rate times four hours each shift. If you are in a state that pays you for half of your shift for work availability,make sure to carefully check your pay for this pay period. ...
I HAVE To Buy A Computer TODAY! Mine Just Died. Can I Get Opinions
Jul 03, 2010
and suggestions.....my budget is around 700.00. Does anyone use a laptop? Will that withstand an 8 hour day of typing? I have an Emachine now and it is horrible. If I go with a desktop I would only need the tower. I think I would like a laptop but know nothing about them. I have a shift today so I have to do this ASAP!! Thanks for any suggestions. ...
Just Had A Funny Error (mine) That I Wanted To Share Sm
Aug 03, 2010
I was typing my usual docs, hands flying across the keyboard when I typed "bilateral toe and knee replacements". I stopped and thought to myself...hmmm, they do toe replacements? wow! Then my brain kicked in and realized I should have typed....you guessed it, "bilateral total knee replacements" ARRGGHHHH, got a good laugh at my own expense out of that one! ...
Are You Getting Fiesa Audited Daily? Mine Have Picked Up.
Nov 26, 2013
I have noticed my Fiesa audits have picked up significantly. Several reports a day usually. Maybe a day or 2 in a week where there is no audits. Wondering if they are zoning in on me or if this is norm across the board. ...