One of my anesthesia partners helps out at a “not show a profit” hospital every now and then when their surgical case load cannot be accommodated by the hospital anesthesia group.  While I receive regular feedback from surgeons about the goings on at the big hospitals, I receive only occasional glimpses into big hospital patient care from the perspective of an anesthesia colleague.  

Two of the patients he had recently anesthetized were large individuals with significant obstructive sleep apnea issues.  These patients require a higher level of vigilance following an anesthetic as they are more likely to develop an airway obstruction after receiving the drugs that we administer.  He brought the first patient in to the recovery room, received by a nurse at a standing computer station, positioned so that in order to complete her entries in the electronic medical record, her back had to be turned to the patient.  He noticed that in the large recovery room, all of the patients had the same view of their nurse:  their backs.  

My friend told the nurse, that if she was going to concentrate on her computer, she would need to find someone else to concentrate on the patient.  He stayed with the patient until another nurse arrived to do just that.

The very same thing happened with another patient and another nurse about 2 hours later.  He watched the patient drift down the path of an airway obstruction as the nurse continued typing, unaware.  He intervened to maintain the patient’s airway and once again told this nurse that someone had to watch this patient if she was going to type. 

The electronic medical record (EMR) has been sold to the medical community as a safety tool, when nothing could be further from the truth.  It is a dangerous distraction in critical care areas, no different than if the staff were playing video games.  On the ward of hospitals, the EMR represents worthless and distracting “fluff,” containing meaningless check boxes and details which actually conceal and camouflage the pertinent information critical for patients.

Big hospitals wanted these EMR systems because they were expensive.  They knew the expense would drive many of their smaller competitors out of business.  Big hospitals knew that they would be effective billing tools and would actually increase their revenue, as “templates” could be created for various diagnoses and the charges for supplies would be automatic, leaving no room for their staff to miss a charge opportunity.  Hospitalists can cut and paste from previous day’s notes to fabricate falsely intense evaluations for which the hospital can charge more.  I have written about this in detail, here.  Physicians unwilling to succumb to the hospitals’ hostile takeover of their practices could simply be shut out of the “system” and without access to the computers in the hospital would suffer practice ruin.

Uncle Sam wanted the EMR’s as this provides a window in to how much a person’s healthcare costs, invaluable information if a bureaucrat is looking for justification to deny care based on the expense.  Government epidemiologists are foaming at the mouth with all of the data they’ve got their hands on now.  If you think they will use this information to generate “cost-saving,”care-denying recommendations, you go to the head of the class.  

Physicians were placed in a tough position by the government:  embrace EMR’s or we’ll slash your already pathetic Medicare payments.  As a consolation, taxpayers subsidized the purchase of these mandated systems.  Newt Gingrich, lead lobbyist for the health information technology (HIT) industry, helped his clients make off with billions, having bribed his way to the table to include the mandatory EMR provisions in the Unaffordable Care Act.  

EMR is one of the disastrous parts of Obamacare that most don’t understand.  You should know that this technology represents the end of medical privacy in the U.S.  As more and more people understand the true purpose of the EMR, our business at the surgery center will increase, as we have not implemented and have no plans to implement such a system.  As I’ve said before, “your secrets are safe with us.” I never imagined that not “ratting people out” could be a successful marketing strategy for our facility.

G. Keith Smith, M.D.