Published in the Orange County Register: October 10, 2014
What does the Dallas Ebola virus experience tell us about the U.S. health care delivery system? It is the first demonstration to the world that Obamacare and a delivery system that focuses on large groups of people over individuals has failed us.
These population-based practices require needless record keeping. To comply, doctors have been forced behind a computer rather than engaging with their patients.
We have known for some time that the Ebola virus is spread by the transmission of bodily fluids. We also know there is no cure. In the case of a possible pandemic in 2014, the mortality rate could be as high as 50 percent.
As of Oct. 2, 2014, the Centers for Disease Control reports: 7,157 have contracted Ebola in Africa and 3,330 have died of the virus. The only way to limit the spread of the disease is to contain it. The first line of defense must be to quarantine patients.
And yet, Thomas Eric Duncan entered America and announced to a triage nurse in an Emergency Room that he had just come from Liberia. Afterward, it was reported that while in Liberia he moved a known Ebola patient to her deathbed. Not surprisingly, he developed a fever and flu-like symptoms but was nonetheless sent home where he continued to expose family members and children to the virus.
We can admonish the Liberian government for allowing him to get on a plane after lying on a report. But we should also scold our public health agencies for not establishing protocols to triage anyone entering the United States from Guinea, Liberia or Sierra Leone and quarantine those exposed to any sick person for a full 21 days.
Duncan, who died this week, was failed by the American health care delivery system. “Meaningful use” and other government quality parameters in electronic medical records only track population-based care parameters. Compliance is reimbursement-focused, not patient-focused.
To that point, Medical Care Group, a practice management company advertises, “If you want the incentive money but don’t have time to read up on it and implement, that is our specialty. We will work with any qualified vendor to get your $18,000 per physician this year and your total of $44,000 over the next three years.”
Mandates for electronic medical record keeping systems have made doctors commoditized robots delegated to filling out forms rather than hearing our patients’ concerns and finding complex solutions to their problems. We have put our brains “on hold” while we execute our way through processes that are more about government regulations and reimbursement than patient care.
These mandates do not work. None of the once-lauded government quality programs has been shown to decrease cost or improve quality. Dr. Hayward Swerling has reported, “meaningful use, as things stand in 2014, has not shown to improve patient care.”
Sarah Kliff of the Washington Post stated in January of 2013, “savings have not materialized” with the use of the Electronic Medical Record. She also notes that doctors have been slow adopters of the EMR. That is because the EMR is the wrong utility to improve quality care. Quality care requires communication among professionals; the transference of salient data in the proper context.
By most accounts, there was a breakdown in communication in Texas Health Presbyterian Hospital in Dallas.
If a productive dialogue had taken place, the doctor would have appropriately isolated the patient, protecting many from exposure, saving our nation from the angst of the spread of this offensive virus. I call on my collaegues to step away from a computer culture that does not work and get back to the business of collabotive care the old fashioned way.
Let’s open the conversation. Dallas has shown us that our patients’ lives depend on it.
Marcy Zwelling-Aamot is the past president of American Academy of Private Physicians.