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The Electronic Health Record |
Part of the reason for lack of progress is the pure
complexity of integrating the various electronic services that have been
cobbled together to satisfy very specific needs, defined by specialty,
compensation, and broad, disparate delivery models. This has resulted in a lack of a standard
platform for data interchange. There
appears to be some recent progress in the process. In dental Henry Schein has seized market
share with their Practice Management software, Dentrix®, And in Medical a
product called Epic® is dominant with their software for groups from small
group practices to major hospitals.
And there are some obvious forward steps that are
likely to improve healthcare delivery, while controlling healthcare costs. I dental there is the implementation of what
have been called “reason codes” of diagnostic codes embedded in the ICD-10
series of medical codes. These will
allow for development of Best Practices in dentistry by allowing Outcome
analysis. The likely result of such analysis
will be a redistribution of healthcare dollars spent on dental services to
increase preventive services and decrease cosmetic and unnecessary services,
such as crowns on asymptomatic molar “cracked” teeth.
In medicine the trend seems to be a shift from
paying for specific services to paying for health improvement. The developing model is sometimes referred to
as an Accountable Care Organization or ACO, a model that has save literally
millions of dollars in Medicare costs since its adoption by CMS several years
ago.
One of the more intriguing developments of the HER
is the arrival of an entirely new employment opportunity in the health field,
which is the subject of this Post:
Scribes.
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Medieval Scribe |
Physicians have dictated their chart notes for
years, partially because their handwriting was unreadable to other
physicians. What has changed, with the
advent of the HER is that everything
must now be electronically transmissible.
Even with voice recognition, the process is innately redundant. Solution? Have an entry level Scribe shadow
the physician and capture the conversation with the patient. There are security concerns, and
technological restraints, but these are being worked out.
A recent WSJ article discussed the blossoming
opportunity for the field. In 2010 there
were 700 employees. That number doubled
by 2013 and is expected to peak at some 30,000 in the next few years. Cost doesn’t seem to be a problem, since the
physician’s time is a mitigating factor.
Training may be another issue. I
could find no standardized program, but I find that my granddaughter, which is
studying to be a Court Stenographer, may have inadvertently found her future
career.
I wish her the best.
PBS recently did a two-piece on Mark Twain. In my next Post I will share how Mark Twain
has intersected through my life and why his history is worth another look. Please join me.
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