The downside of electronic medical records, gender gaps in medical expenses, and more

Downside of electronic medical records

What happened to technology making us more connected? This week, three members of the Right Care Alliance published an op-ed on WBUR’s CommonHealth blog, calling attention to the negative effects of electronic medical records (EMRs) on doctor-patient communication, as well as clinician health.

The problem isn’t EMRs per se — integrated electronic records have the potential to greatly improve patient safety and give clinicians easy access to vital patient information — but in the way they have been implemented. EMRs were created not with the clinician in mind, the authors write, but as a billing tool. As such, many EMR systems require doctors and nurses to spend hours each day filling in administrative information when they should be focusing on their patients (one study estimates doctors spend twice as much time on their computers as they do with patients). “When large health care organizations spend billions of dollars on this kind of product, that’s really scandalous,” said president of the Lown Institute, Vikas Saini, MD in an audio segment on Radio Boston. To solve this problem, “we have to band together,” Saini said.

Gender gaps in medical expenses

Women’s finances tend to be more affected by large medical expenses than men’s, according to research from the JP Morgan Chase Institute. Researchers used data from hundreds of thousands of bank accounts to compare financial outcomes of accounts held by women versus men, before and after a large medical payment. They found that women were less prepared to withstand financial shocks compared to men, that medical expenses consumed a larger proportion of women’s income, and that large medical payments increased the gender gap in credit card debt considerably.

Another gender gap in health care identified by research fellows from Stanford’s Clinical Excellence Research Center: Two-thirds of unpaid elder caregivers in the US are women. Writing in JAMA Neurology, the authors predict that as the U.S. population ages and the number of adults with dementia rises, more women will face the financial and emotional consequences of time spent caring for elderly family members.

Health for the homeless 

At the Lown Institute Conference, Patty Gabow MD MACP argued that many health problems require social solutions: “The treatment for food insecurity is food.” This week, Jack Tsai and Kelly M. Doran echo Gabow’s thoughts in their Health Affairs blog on health care for the homeless. “Simply improving health care services for people who are homeless tacks Band-Aids onto a problem rather than solving it,” they write, “The single best way to improve the health of people who are homeless overall is to end homelessness.” They point out ways in which hospitals can address homelessness, such as referring patients to housing supports and even funding supportive housing programs.

Gaming the Medicare system

A whistle-blower from the insurance company UnitedHealth revealed this week how private insurance companies have been gaming the Medicare Advantage reimbursement system, to the tune of billions of dollars. Because Medicare Advantage reimburses private insurance companies based on the number and type of diagnostic codes per patient, insurance companies can make more money by fiddling with the codes, making it seem like patients are sicker than they actually are. The companies used data-mining to scrutinize patients with specific conditions and hunt for potential additional diagnoses, the whistle-blower said. This systematic “upcoding” has cost the federal government more than $10 billion a year in overpayments, according to some estimates.

Speaking up for patient safety

When trainees are afraid to speak up about unprofessional behavior, it is not only harmful for workplace culture, but can also hurt patients. A study in The BMJ this week finds connections between unprofessional behavior and patient harm. Researchers asked interns and residents how often they observe unprofessional behavior and other potential patient safety threats, and how often they speak up against them. Instances of unprofessional behavior, such as falsified documentation or failure to disclose an error, were common, but trainees were less likely to speak up against it, even when they thought a patient might be harmed. For better patient safety, trainees should be empowered to speak up, including by acknowledging unprofessional behavior that can lead to miscommunication, errors, and harm to patients.

Lown Institute co-hosting New England conference 

The Lown Institute and the Northern New England Medical Associations are co-hosting a conference, “Challenges to Professionalism in a Time of Change,” on June 17 in Portsmouth, NH. The conference features keynotes, panels, and group discussions around conflicts of interest, electronic medical records, and other issues of professionalism in medicine. View the agenda and register here.



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Cost of care

Disparities and inequalities

Doctor-patient communication

End of life



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Right Care Weekly is made possible through the generous support of the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.