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It's your tax dollar at work. The hospital will collect from Medicaid.
You are able to add a correction to your records if you find an inaccuracy, although I'm not sure who will read it since some records are voluminous and more cumbersome to handle and locate data than in a paper record. That's why you should have a copy of pertinent records that you keep with you.
You're absolutely right, Dr. Zinj. Think of how the IPAB will use the expanded data under ICD-10 to keep track of more minutiae in medical records and decide whether to pay based on cost/benefit analysis. I'm sure you have read Dr. Ezekiel Emanuel's Lancet article in 2009 about the Complete Lives System.
It is so important for you, as a patient, to have copies of your medical records (at least, the pertinent parts) which you keep in your possession. I've been in hospitals a lot both for myself and for my family members and have used the record that I have to point out to the doctor what was there before, particularly because I have not always gone to the same hospital. For example, I had an EKG done in southern California when I had chest pain and when I followed up back at home I had a copy of it which the doctor was glad to have and copied it for their own records. Don't rely on the electronic record. Know what is in it. You have the right to read your record (for a fee).
Travel data was not considered a high priority until now, so most likely Epic (and other EMR systems) didn't automatically put a red flag on it. People who program the system have to be told what the providers want. Right now, travel data is a high priority so the programmers jumped in there and changed the screens to grab that data and put it in a priority setting, or flag it in red, or put it in capital letters. The trouble is, there's only so much room on a page and you can't make the typeface so small that nobody can read it, so sometimes important data is on a second page and the doctor or nurse has to actually scroll to read the whole thing, which is something that sometimes doesn't happen. Now that travel data has been flagged, maybe the providers will look at it, although we all know that patients lie so just because travel data is priority doesn't mean what the providers read is true. A patient might lie if he thinks he won't get treated if he tells the triage nurse the truth.
Sure. You're absolutely right. And they haven't even instituted the minutiae of ICD-10 with 140,000 codes detailing practically everything and making it possible to assign a value to those codes (they do it now with ICD-9, but there's only 40,000 codes there) and have some criteria for deciding whether to pay for that code under Medicare/Medicaid. ICD-10 has been postponed for a year. Coincidentally (or not), the IPAB (new board under ACA that will assign values and decide the cost/benefit of payments) has also been postponed for a year. Maybe there's an election to get past first?
This really shouldn't be a surprise. I worked for many years with the effort to go electronic (ending in 1995 when I moved out of the job I was in) and have worked with electronic records up until 2007. I have not seen a great advantage to the electronic record, especially if the power goes off. Any medical record is only as good as the people who use it. First, they have to enter the data and then somebody has to read the data. Whether it's electronic or paper, this is still is still true. Scrolling through multiple screens to try to read the data takes time and most people I've talked to hate the electronic systems because you have to search to find what you want. Obama wanted EMR so that info could be shared everywhere (privacy issues?) but, as Michelle points out, Epic doesn't want to handle data from other people's systems; they prefer to try to have a monopoly (a so-called integrated system, universally accessible). What Obama proved to me was that he knew near to nothing about electronic medical records because he mandated that this be done within five years (it's now overdue). The cost is high (but the govt subsidizes physicians, hospitals and clinics in the implementation) and there's no guarantee that the data is any better or more accurate than on paper, or that it's accessible all around the town (it's not). So, hospitals have to prove they are engaging in "meaningful use" of the EMR (more waste paper and regulatory compliance costs). The EMR is not a useless pursuit, but it's overrated both in terms of accuracy and accessibility.
In response to:

Dr. Emanuel's Death Wish

Dot462 Wrote: Oct 07, 2014 2:03 PM
We have to remember that old Ezekiel wrote the Lancet article in 2009 that outlined the Complete Lives System, a method of applying cost/benefit analysis to health care rationing. The N.I.C.E. system in the U.K. applies cost/benefit analysis to decide whether to pay for certain procedures/treatments for persons who are not going to be able to contribute to society. Old Ezekiel has been a main advisor to Obama in development of the ACA. Obama pushed off by a year implementation of the Independent Payment Advisory Board, which probably will be using cost/benefit analysis to decide with greater specificity what treatments/procedures are appropriate for Medicare/Medicaid to pay for. I am looking forward to the day when Old Ezekiel decides he's lived long enough and he goes out in the snow without clothes on and waits to freeze to death. They say you just go to sleep.
In response to:

Ebola and Obama

Dot462 Wrote: Oct 07, 2014 1:40 PM
Thank you, Dr. Sowell. Looks to me like the reason many people no longer trust what govt officials have to say stems from the many lies that have been told by agency officials like the ones from the IRS, the State dept on Benghazi, etc. When Dr. Frieden tells us he's "100% sure" that nobody can get Ebola from sitting next to someone on an airplane he is flying in the face of infection control measures. Who would trust such a doctor? Nobody knows how the NBC photographer got it; he wasn't engaging in direct patient care, was he? Even the CDC website says that Ebola can live on surfaces for hours and even days. Letting people fly in here from Liberia and Sierra Leone is bad infection control. Airlines are also at fault because they are putting their passengers at risk when they allow people to fly on their planes who have been in west Africa within 21 days. People will lie in order to get out of west Africa and come to the U.S. where medical treatment is better. This epidemic may approach 10,000 cases by the end of October; it is hard to control if people can fly in here with west Africa stamps on their passports.
The trouble is that there is no really effective treatment for Ebola other than supportive care. We don't have a vaccine. I'm sure that is being worked on, but vaccines don't just hop on the market overnight. I read there's a shortage of IV fluids, which is the main supportive care because of the fluid losses experienced by victims. Pain control is also a factor as a thrashing patient can spread droplets all around them. I guess it's time to buy stock in companies that make PPE and other companies that make IV fluids and morphine.
What has to happen if what you desire can come to pass is that the airlines decide on their own to screen passengers, not depending on natives of the countries involved. I've read that some of these so-called screeners can't even read a digital scanning thermometer. What'll probably happen is that airlines (to protect themselves) will stop picking up passengers in those countries. That might happen if the epidemic spreads to tens of thousands, which WHO said could happen in a worse-case scenario. Passengers need to be screened out prior to boarding in those countries. By the time people get to the U.S., it's too late.
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