Healthcare EMR/EHR

Summary: The Business of Healthcare, Medicine and Insurance

After spending years learning about the software used in medical offices, hospitals and insurers, I came to the conclusion that healthcare technology is the trailer park of the computer world.

I have since realized that I was wrong in the comparison; trailer parks actually work to house their inhabitants, effectively and inexpensively, unlike most medically-related computer systems. Trailer parks of the world, I humbly apologize.


Healthcare Computers and Software

Hospitals have trouble keeping their computers working. When they fail, they often try to hide the failure, which puts patients at risk.

In contrast, other institutions let their customers know about computers failures and even apologize for the inconvenience.

The contrast between putting meals on the table and assuring that data is available for use on providers’ screens couldn’t be more stark.

Even when their computers are working, the people in charge brag about the fancy new things they’re doing instead of assuring that basic processes like patient scheduling work as intended.

There’s no doubt that hospital computer systems are a horror show that hurt patients and that managers try to hide. But there’s a far worse largely hidden problem leading to patient deaths.

Is making systems work reliably and well a wide-spread problem? Yes. Are there proven solutions? Yes. Hospitals do an outstanding job of ignoring them.


Electronic Medical Records (EMR)

The data about your health and health history are essential for guiding medical interactions of any kind.  The quality of the data is essential. All too often, the data is wrong or missing.

Most medical organizations have EMR’s and also loads of paper records, which both patient and provider fill out.

Have you ever tried to get your own medical records from the institution that has them – your records?? Nightmare.

They all say they have easy-to-use systems to enable patients to get their own records. Hah. Just try it.

Here are details of the horrible obstacles a major systems places between the patient and his “easy-to-access” data.

Most people have been to more than one institution, each with its own records about you. EMR interchange is supposed to make it easy for the place you’re visiting to get your records from other places.

EMR interchange works? Patients sometimes have to go to ridiculous lengths to get essential data from where it is to where it’s needed.

The bottom line is that medical institutions should prioritize giving patients their data. There should be an EMR app for your data just like there are money apps like Venmo and Zelle for your money.

One of the many reasons for EMR nightmares is that the software is a huge problem and “just” buying and installing it is a job of “epic” proportions.


Healthcare Business: Scheduling, Testing, Billing and Payment

Medicine is all about helping people get and stay healthy, but it’s also a business.

Scheduling, billing and payment are different for medical care than any other service we require. Here are highlights of the differences.

You need to get a simple test like an X-Ray? No problem. Bad data at the provider, the insurer and the EMR will ensure that lots of time is wasted.

Scheduling sounds simple, right? Maybe for a cat at a vet, but not for a person at a hospital.

The amount of time and effort on everyone’s part to schedule a medically-required MRI is amazing. Without patient persistence, it won’t happen.

Covid testing illustrated the widespread problems with scheduling – it was about the systems and software, not Covid.

Once you’re scheduled, you have to go to the right place, which can be its own adventure. Fortunately, you can usually rest afterwards by filling out reams of paperwork.

For costlier tests like MRI’s, the extent of useless, costly processes is mind-boggling.

MRI’s are an amazing technology. The reports from the specialists are something else again. It turns out that in spite of endless years of training, there are no standards for reading and reporting – even “simple” things like the size of a tumor.

What I’ve described aren’t one-off’s. The problems from scheduling to getting the results are business-as-usual in the world of medicine.

And then there’s billing. I went for an MRI, and got bills from different places with bad information and a broken online payment system.

The second bill was also a mess of bad data, with an offer to pay online but the bad data prevented me from paying. So I wrote a check.

When you dive into the insurance payment part, the nightmare morass of bad data and bad software is overwhelming. Business as usual.

My health insurer announced a major new service to help patients pay provider bills. Strike out.

Here is a summary of what’s wrong with medical billing and insurance payments.


Medical Costs

Medical costs are outrageous. They don’t have to be.

Hospitals could stop spending money on useless fancy innovations and concentrate on simplifying and automating the everyday nuts and bolts of the business.

Removing the regulatory straight-jacket on medical equipment would be huge.

Some of the same principles apply to drug discovery and costs.


Health insurance

Health insurance companies maintain a huge trove of your personal data. They are incapable of keeping it secure, and bungle the response when there’s a major breach they can’t cover up.

Health insurers think providing patients incentives to keep healthy is a win all around. Sadly, their incentives tend to be embarrassing failures. Here’s an example with giving a Prepaid debit card.

The marketing departments of health insurers want to communicate with patients to make good things happen. Most of them appear never to have heard of the concept of personalization.

The same marketing gurus reach out to patients for feedback and reveal that they flunked Marketing 1.01

Here’s an example of why they get terrible response rates when asking for customer feedback.

Every serious company has to have an app, right? It makes sense that the insurer would spend piles of money to build one that customers hate.


AI and fashionable algorithms in Medicine

There are many examples of AI in healthcare in this summary of AI in general.

Here are some of the AI posts relevant to healthcare. A major theme of AI in healthcare is that well-paid managers are desperate to keep up with the AI fashion, and spend lots of money and generate lots of publicity about how wonderful they are. The trouble is that there are simpler, common-sense things that are fully understood that could be done right away that would yield major improvements in patient health; these things are too often ignored or neglected.