How Did Our Medical Notes Become So Useless? • Hacker News Board

Re: How Did Our Medical Notes Become So Useless?

#71

Post by katbyte » Fri, Jan 04, 2019, 9:32 PM UTC

sxg wrote: post #54

limeblack wrote: post #32

Earlier quoted context omitted.

I disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even…

It absolutely 100% is at least the doctor’s job to know this. If you come back with depression again, the doctor needs to know what medications were used last time to treat you this time. They need to know if you had allergic reactions, no response, or other details regarding your medication history. The doctor may also be able to use a history of depression as a supporting factor for a new diagnosis. Your history of…

I dissagree. If I have some sensitive medical history and I go in for stitches or some other minor thing with an random doctor I might not want to share all my medical history. It’s my history and I should have the right to control who sees it.

Re: How Did Our Medical Notes Become So Useless?

#72

Post by corebit » Fri, Jan 04, 2019, 9:33 PM UTC

sxg wrote: post #40

Thriptic wrote: post #12

This EHR data problem is something I've pondered for a bit. One "simple" solution is to have departmental standardization of note format with thoughtful inclusion of what fields are typically pertinent. This doesn't solve the problem of care transitions but it might help standardize review in a hospital context. The other thing that I've been pondering is something resembling a formalized data structure and language…

Many departments do standardize their note formats. The problem is that the note is directly connected to billing, and the billing requirements are absurd. I'm a medical student, and I recently visited my PCP for a medication refill. I have no significant medical history whatsoever, and the visit took no more than 15 minutes as expected. A month later, I was given a bill for $330 stating my hospital visit was level 4…

The reason healthcare costs so much is that the feedback loop between the service recipients, providers, and payees (the largest of which is the Government which multiplies the mismanagement) is so perverse.

Re: How Did Our Medical Notes Become So Useless?

#73

Post by Scoundreller » Fri, Jan 04, 2019, 9:38 PM UTC

My favourite citation from the link:

“In fact, across this same EHR, clinical notes in the United States are nearly 4 times longer on average than those in other countries”

It seems that the EHR isn’t the root cause of the problem.

Re: How Did Our Medical Notes Become So Useless?

#74

Post by skwb » Fri, Jan 04, 2019, 9:40 PM UTC

VikingCoder wrote: post #59

1. Money 2. Legal liability (CYA) 3. We don't use outcome-based medicine

1. There's an old saying in healthcare that patient care is always first, but money is a close second.

2. Sort of yes, but I've heard it more time from managers who use it more of an excuse for not wanting change rather than it being a legitimate argument (i.e. from people with little to no legal training).

3. This is changing slowly. The Affordable Care Act and it's little known cousin MACRA have started to shift the entire system (albeit slowly) towards more outcome based measures, primarily through Medicare. Major payers are following in their steps. Not happening overnight, but any major healthcare executive sees the writing on the wall and is taking these considerations into account for their investments.

[0]. https://www.healthaffairs.org/do/10.1377/hblog20180810.48196... [1]. https://www.healthaffairs.org/do/10.1377/hblog20180810.48196...

Re: How Did Our Medical Notes Become So Useless?

#75

Post by davidw » Fri, Jan 04, 2019, 9:40 PM UTC

katbyte wrote: post #71

sxg wrote: post #54

Earlier quoted context omitted.

It absolutely 100% is at least the doctor’s job to know this. If you come back with depression again, the doctor needs to know what medications were used last time to treat you this time. They need to know if you had allergic reactions, no response, or other details regarding your medication history. The doctor may also be able to use a history of depression as a supporting factor for a new diagnosis. Your history of…

I dissagree. If I have some sensitive medical history and I go in for stitches or some other minor thing with an random doctor I might not want to share all my medical history. It’s my history and I should have the right to control who sees it.

I'd rather opt out of a few sensitive things than not have an ER doctor in another state not have easy access to critical information about me.

Re: How Did Our Medical Notes Become So Useless?

#76

Post by mikecsh » Fri, Jan 04, 2019, 9:41 PM UTC

sxg wrote: post #54

limeblack wrote: post #32

Earlier quoted context omitted.

I disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even…

It absolutely 100% is at least the doctor’s job to know this. If you come back with depression again, the doctor needs to know what medications were used last time to treat you this time. They need to know if you had allergic reactions, no response, or other details regarding your medication history. The doctor may also be able to use a history of depression as a supporting factor for a new diagnosis. Your history of…

I agree with this completely; not being able to understand a patient's medical history often makes it much harder to treat them effectively. Especially in an emergency setting.

That said concerns about the sensitivity of information are absolutely valid and should be at the forefront of EMR systems.

In my experience (UK) access to records is reasonably well restricted to relevant staff. Access is audited in efforts to identify unauthorised access and this is taken extremely seriously; for example opening records for patients not under your direct care with no valid reason.

Further, for particularly sensitive information such as some psychiatric histories, or medical photography of sensitive areas, this is kept behind a secure area within the EMR systems, not generally accessible. Opening it requires signing a declaration that you have either discussed it with the patient and gained consent, or that you do not have consent and you are opening it in the patients best interests in an emergent situation as they are unable to consent (e.g. history of depression with paracetamol (acetaminophen) overdose brought in unconscious by ambulance.

Re: How Did Our Medical Notes Become So Useless?

#77

Post by ambicapter » Fri, Jan 04, 2019, 9:42 PM UTC

katbyte wrote: post #71

sxg wrote: post #54

Earlier quoted context omitted.

It absolutely 100% is at least the doctor’s job to know this. If you come back with depression again, the doctor needs to know what medications were used last time to treat you this time. They need to know if you had allergic reactions, no response, or other details regarding your medication history. The doctor may also be able to use a history of depression as a supporting factor for a new diagnosis. Your history of…

I dissagree. If I have some sensitive medical history and I go in for stitches or some other minor thing with an random doctor I might not want to share all my medical history. It’s my history and I should have the right to control who sees it.

You are not a medical professional and the list of medical procedures or remedies that interact poorly with each other is long and full of unexpected things.

Re: How Did Our Medical Notes Become So Useless?

#78

Post by Scoundreller » Fri, Jan 04, 2019, 9:45 PM UTC

sxg wrote: post #69

Scoundreller wrote: post #51

Earlier quoted context omitted.

Why did a visit to your PCP get billed as a hospital visit? And which acuity scale was this? Usually the higher the number, the less acute you are.

I meant outpatient visit. My PCP is in the main campus of the hospital, and I wasn’t being rigorous with the terminology. I’m using the CPT codes within the site I linked to. 99211–99215 are the codes that correlate to acuity, with 99215 being the most acute. I am aware of other systems like level 1 vs level 2 trauma centers. In that case, yes the level 1 is higher acuity. Maybe that’s what you were thinking of?

Got it. I perused the link but didn’t see any 1s,2s,3s,etc. I was just worried that the US started implementing a triage scale opposite from the rest of the world.

I’m more familiar with the (pre-)hospital triage scales in non-US countries: https://en.m.wikipedia.org/wiki/Triage#Canada

Re: How Did Our Medical Notes Become So Useless?

#79

Post by davvolun » Fri, Jan 04, 2019, 9:46 PM UTC

goldcd wrote: post #5

In (the UK at least) your medical notes follow you as you sign on with a new GP (General Practitioner - first point of medical contact for anything non-urgent). Now knew this theoretically happened, but was quite bemused to see it happen in practice. I rescued a rat from the silken-jaws of my pseudo-homicidal cat, and the ungrateful rodent bit through half of my finger - I thought it would be sensible to have a check…

I was told your permanent record wasn't a real thing!!

Re: How Did Our Medical Notes Become So Useless?

#80

Post by arkh » Fri, Jan 04, 2019, 9:46 PM UTC

jlamberts wrote: post #8

petermcneeley wrote: post #7

Medicine seems like a technological wasteland. They put "notes" into text boxes and call it "using computers". I wish I had both CS/SE experience and Medical experience so that I could understand what keeps this field in the 1970s. I have suspicions.

In my experience, it's a combination of a couple of things. First off, the field is heavily regulated (in the US anyway) and the penalties for violating regulations like HIPAA are incredibly high. Second, the field is currently dominated by major players such as Epic, so its pretty important to be compatible with them, but they don't really have an incentive to open up their ecosystem since they have such a strangleh…

> Finally, a lot of medical folks have been burned by technology in the past, and, in my experience, often view a lot of the tech they have to use as an insurance and government mandated evil, rather than a way to make their lives better.

Simply: those who choose the software are not those using it. So they go for recognizable names, certifications and how much money they'll get back for themselves.