ClickCare Café

Hospital Consolidation May Not Improve Data Sharing or Interoperability

Posted by Lawrence Kerr on Thu, Jul 26, 2018 @ 07:00 AM

helloquence-61189-unsplashThere has been an increasing trend towards consolidation in the healthcare field. Hospital systems buy other hospital systems, with the promise of cost-savings, improved results, and better data-sharing and interoperability.

In many ways, this is common sense. If we’re all part of the same organization, or even under the same roof, it stands to reason that we will be able to share data and collaborate more effectively.

Unfortunately, though, this doesn’t appear to be the case.

Using data from the 2014 American Hospital Association (AHA) annual survey and the 2015 IT supplement that included more than 2,000 hospitals, researchers found that consolidation enough wasn’t enough to improve interoperability.

In fact, it took several additional circumstances for interoperability to improve: centralized organizational governance, a specific business model, and an integrated insurance offering. 

Of course, achieving interoperability and data sharing is a hugely complex endeavor that can take time to come to fruition. It's not a race, and there are many precautions and complications that arise.

That said, I find it fascinating that even merging with another organization doesn't necessarily make it more streamlined for healthcare providers to collaborate, for data sharing to happen, or for interoperability to be a reality. 

My take on why? I believe that true data sharing and healthcare collaboration only come about through intention and through workflow changes on the part of healthcare providers. Yes, the organizational structure affects it. Yes, EHR interoperability plays a role. Yes, being under the same roof can make collaboration simpler than being in separate buildings. But ultimately, healthcare collaboration comes down to the choices that individual healthcare providers make. It's the choice to ask a question of a colleague, regardless of how that question gets asked. 

That's why we're so passionate about hybrid store-and-forward telemedicine® (like iClickCare) as a tool for healthcare collaboration. It doesn't require being under the same roof, or in the same organization, or even using the same EMR/EHR to collaborate, share information, and coordinate. It doesn't require that everyone in your organization use it or that everyone is "on board."  It just requires a 30-second download and then as-you-have-time consults with colleagues. Everything is archived so you can find it later -- and it won't conflict with your EHR. 

The above study certainly demonstrates that we can't wait for large structural shifts to practice medicine in ways that we think are right, and useful. We have access to the tools and structures we need now -- it's just a matter of acting on that.

 

Try the iClickCare 14-day evaluation

Tags: hybrid store and forward medical collaboration, EHR, care coordination

Healthcare Collaboration Mistakes the VA Is Making (So You Don't)

Posted by Lawrence Kerr on Thu, Jun 25, 2015 @ 07:30 AM

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I'd like to start by saying that I have huge respect for the VA (of course). The work they do is deeply honorable, incredibly challenging, and skillful. Especially as we approach our Independence Day, I believe that the VA is a key part in protecting our nation. 

That said, they do face the challenges of being a large, underfunded government agency. And the scandals that have roiled the institution over the past few years reflect the challenges that so many organizations face, even if (slightly) less bulky and (a little) less underfunded. And the VA potentially reflects the same solutions that we all need to consider if we're to advance -- it's just starker in their case.

Exhibit 1: a year after the Department of Veterans Affairs was scandalized by long wait times (as well as falsifying wait times), the number of veterans on waiting lists of one month or more is now 50 percent higher than last year. Not for lack of trying, either. The VA has expanded care. Its doctors and nurses have handled 2.7 million more appointments, while authorizing 900,000 additional patients to see outside physicians. Physician workloads increased by 18-21% in most regions. And yet the department’s deputy secretary, Sloan D. Gibson said, "if we don’t do something different we’re going to be $2.7 billion short.”

Exhibit 2: the VA has developed an in-house system to allow caregivers to access their patients' records across the agency's facilities. (Something you would think would be a nonnegotiable for anyone providing medical care.) The VA is currently looking for an EHR for the system (an $11 billion bid) but it seems that most of the options won't be interoperable across the VA system. "I feel like we're in a thicket here and we can't get out," Sen. Bill Cassidy (R-La.) said. "We're about to spend $11 billion on a system that the VA's system is not interoperable with? Please tell me that I'm absolutely wrong."

The VA's challenges of interoperability, collaboration, and capacity are challenges we all have. And missteps may be impossible for them to avoid -- but that we probably can.

These are two key learnings from the VA to consider in the effort to find sustainable solutions:

  1. You can't just make physicians work harder -- you have to find a way for the organization to work smarter.
    The fact that physicians output is up by around 20% over last year -- in an organization with infamously overworked providers -- is not a sustainable situation. As we saw last week, this kind of "optimization" is a recipe for burnout -- which is ultimately bad for the organization. Other initiatives, like this one to use telemedicine to decrease workloads -- are going to be a better path forward, even if they have less immediate rewards.
  2. Enable healthcare collaboration, even if it is outside of your EMR or EHR. 
    Interoperability can be very challenging, especially with the existing EMR and EHR options. That said, if medical providers aren't able to share information and collaborate with each other, results and metrics will suffer. We've found that it is often better for an organization to use a collaboration platform (iClickCare is a telemedicine based one) to bridge the gap and collaborate even as EMRs and EHRs catch up with interoperability concerns.

We can root for the VA even as we learn from their mistakes. And if we're going to improve medicine in this country, we must do both. 

 

Hybrid store-and-forward telemedicine is a key solution for collaboration in organizaitons with limited resources. Learn more with our free guide:

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

Tags: medical collaboration, healthcare collaboration, EHR, EMR, medical provider burnout, interoperability

Are You Being "Tricked" into Ordering Extra Tests for Patients?

Posted by Lawrence Kerr on Wed, Apr 22, 2015 @ 07:30 AM

testsinmedicine

My teachers in medical school and residency did not take kindly to me ordering extra tests for patients.

You don't order tests that you don't need, they would tell me. Because when you're not following a logical path, but just poking around for what might come up, you can end up with bad conclusions, bad results, and wasted resources.

However, a recent article in the New York Times reminded me that medical providers are "tricked", guided, and incentivized to order extra tests at every turn. Dr. Zuger looks at how, these days: "Guidelines mandate tests, and patients expect them; abnormal tests mean medication, and medication means more tests."

No one is tricking us, and yet the system can influence us to make decisions we might not otherwise make-- no one's fault but everyone's problem. 

Why does this happen, when most medical providers know better? Dr. Zuger says that "As in education, our test-ordering behavior and our patients’ results increasingly define our achievements, and in the near future our remuneration is likely to follow." Plus, most of the technology we use doesn't help either. EMRs routinely spit out demands for tests that may not be necessary and this kind of poorly designed technology can skyrocket costs in the end.
In medicine, “true quality is extremely hard to measure,” Dr. Welch writes in a related article, “What is easy to measure is whether doctors do things.” And although pay-for-performance may not get at "true quality" completely, it certainly seems like an improvement from the current direct incentives for providers to shower patients with tests in a pay-for-services system that is not intrinsically bad, but is broken.
Ultimately, each of us can only guide our own behavior. When we choose to collaborate, use our EMRs in discerning ways, and let our good sense override the metric of the day, that's when we're contributing to a culture of extraordinary medicine. We see iClickCare as supporting those choices, but ultimately, you can do it with or without a tool to help you -- the important thing is following your own heart, training, and intellect.
For stories of how medical collaboration brings good choices back to medicine, get our free ebook here:
ClickCare Quick Guide to Medical Collaboration
Photo by tyfn on Flickr, used under Creative Commons rights

Tags: telemedicine, medical collaboration, good medicine, EHR, EMR, telemedicine technology

How Bad Tech Can Skyrocket Managed Care Costs

Posted by Lawrence Kerr on Wed, Apr 08, 2015 @ 07:30 AM

tech

 

A sure way to form a bond with any medical provider is to share "war stories" of your EMR / EHR. Whether a specialist or a generalist, and across the spectrum of care, providers struggle with the heavy burden that this technology has created. 

EMRs with poor user interfaces, no collaboration mechanism, and formats that force counterintuitive thinking are hugely detrimental to providing good patient care. They contribute to the shrinking time we have with each patient and, as the article explores, can contribute to making mistakes. 

Things get even worse when you look at the performance of most EMRs / EHRs in managed care system. When the hospital system or ACO is responsible for the full scope of performance and efficiency for each patient, the losses that bad tech causes become compounded. There is an ever-worsening shortage of providers; how can we rationalize even a 20 minutes loss in their time each day due to bad tech? 

So what are providers and administrators to do? Well, we certainly don't have all the answers, and we know first-hand how frustrating technology can be. But here are 4 things that our colleagues have found to make technology in medicine a blessing, rather than a curse: 

  1. Invest in well-designed technology. Some products invest more in the design of the interface and functionality of the tool. Demand that the tool that helps you care for patients is elegant, easy to use, and helps you do your work in the ways you want to do it.
  2. Change how you work. As Robert Wachter said in the New York Times recently: "In health care, changes in the way we organize our work will most likely be the key to improvement... It means creating new ways to build teamwork once doctors and nurses are no longer yoked to the nurse’s station by a single paper record. It means federal policies that promote the seamless sharing of data between different systems in different settings."
  3. Figure out if there is just a lag time. The New York Times article above also mentioned what Erik Brynjolfsson, a management professor at M.I.T., described as “the productivity paradox” of information technology, in which there is a delay between adopting a new technology and experiencing the benefits from it. This is a reality to some extent, so patience can be helpful -- as long as you're not waiting for a gain that is never going to happen.
  4. As we shared in this post, you are not setting yourself up for success if you make huge investments in hardware. We recommend investing in software (which can be updated, and is generally the lowest portion of costs) rather than hardware which gets obsolete quickly. Use the equipment you already have, the spaces already available to you, and just start. 

 

One way to deal with poor technology at work is by bringing the tools that work for you, on your own phone / device: Bring Your Own Device (BYOD.) The challenge here is whether you'll run afoul of HIPAA. Click below to learn easy ways to stay secure. 

 

iClickCare IS BYOD Secure

Tags: telemedicine, telehealth, EHR, EMR, telemedicine technology, managed care

2 Blindspots for Managed Care in ONC's Health IT Interoperability Plan

Posted by Lawrence Kerr on Wed, Feb 11, 2015 @ 08:26 AM

whitehouse

In the past weeks, the Office of the National Coordinator of Health Information Technology (ONC) published an ambitious, lucid, and fairly comprehensive roadmap to IT interoperability across the country. It follows a 2014 commitment to interoperability and "proposes critical actions that the public and private sector need to take to advance the country towards an interoperable health IT ecosystem over the next 10 years."

The key components of the roadmap are:

  • Establishing standards and "rules of engagement."
  • Creating the conditions for good, safe, seamless sharing of electronic health information for “small” (individual patient), “big” (population level and beyond) and “long” data (wrapping around the individual and telling their health story over time).
  • Motivating the use of those standards through appropriate incentives.
  • Aligning states in policy, payment, and other levers.
  • Making data more portable and transferrable.
  • Creating a trusted environment for the collecting, sharing and using of electronic health information. 

Quite honestly, we're incredibly excited to see this kind of conversation happening at the governmental level. For so many years it seemed that the government was willfully ignoring health IT and telemedicine.

When managed care, care coordination, and PMPM payments are such big focuses, there must also be constructive conversation about IT interoperability.

To achieve this, however, the health IT community must expand its focus beyond institutional care delivery and health care providers, to a broad view of person-centered health. This shift is critical for at least two reasons:

  1. Health care is being transformed to deliver care and services in a person-centered manner and is increasingly provided through community and home-based services that are less costly and more convenient for individuals and caregivers.
  2. Most determinants of health status are social and are influenced by actions and encounters that occur outside traditional institutional health care delivery settings, such as in employment, retail, education and other settings.

This shift requires a high degree of information sharing between individuals, providers and organizations. It is vital that a high degree of interoperability exists between many different types of health IT, such that systems can exchange and use electronic health information without special effort on the part of the user.

The goal of this shift is to a nationwide learning health system—an environment that links the care delivery system with community and societal supports in "closed loops" of electronic health information flow, at many different levels, to enable continuous learning and improved health. This kind of system allows individuals to select platforms and apps to share and use their own electronic health information to meet their needs without undue constraints.

In other words, we need to remember that healthcare is about people. And people have human lives with human complexities that happen outside of institutional settings. To do coordinated care well, that's the reality of the context. And that's why we support medical collaboration that uses hybrid store-and-forward telemedicine® as a key part of health IT. It's the most efficient path to keeping the patient at the center of the technology -- and allowing interoperability to emerge from that center point.

 

If you're curious how health IT and telemedicine can actually contribute to that kind of person-centered approach, watch our 60-second primer:

Watch the iClickCare One Minute Video

 

Image courtesy of automania on Flickr, used under Creative Commons rights. 

Tags: telemedicine, medical collaboration, care coordination, EHR, EMR, managed care, interoperability, HIT

What Ebola Showed About Medical Collaboration and EMR Pitfalls

Posted by Lawrence Kerr on Thu, Oct 16, 2014 @ 08:46 AM

medical record resized 600

By now, we've all heard the heart-breaking story of Thomas Eric Duncan, the Dallas patient who was seen in the ER for fever and vomiting and was sent home. Three days later, he tested positive for Ebola and subsequently died.

This is a tragic, unacceptable outcome. But sometimes doctors make mistakes: It's a new epidemic, as doctors we are routinely asked to see superhuman numbers of patients in small periods of time, and things can get past us.

However, in this case it appears that the issue is less about a single provider's mistake and more about the systemic issues that needed to be addressed. In recent days, news sources have reported that the ER doctors who cared for Mr. Duncan never saw a nurse's note in the EMR reporting that the patient had just come from Liberia. Apparently it was this issue with the EMR that caused a deadly gap in communication.

Unfortunately, this kind of problem is neither unexpected nor novel. In fact, although this example was particularly extreme in its consequences, this kind of communication failure is all too common in medicine. We see systemetic problems throughout the medical system:

  • EMRs are often very difficult and counterintuitive to use, understand, or grasp the limitations of.
  • Billing, paperwork, and controls take up most of the time we have with each patient.
  • HIPAA keeps providers from talking with each other about patients in ways that can pass on crucial nuances (or facts about travel).
  • Knowledge and data can overwhelm providers, making it hard to parse what is important
  • Billing concerns demand a checklist focus and mentality or providers can't survive.

So, use iClickCare or not, but collaborate. None of us can afford the consequences otherwise.

 

Image courtesy of communityeyehealth on Flickr, used under Creative Commons rights.

Tags: collaboration, EHR, care coordination, medical collaboration, HIPAA, provider burnout

Is Data Overwhelm Causing Healthcare Provider Burnout?

Posted by Lawrence Kerr on Wed, Aug 27, 2014 @ 03:50 PM

timessquare resized 600

You don't have to be a social scientist to be aware of the trends around medicine, data, and how this onslaught affects us as medical providers:

  • Up to half of healthcare providers are burned out
  • Providers spend increasing amounts of time on paperwork and EHRs, despairing the promise of "time-saving technologies."
  • Finding and managing patient health information is a huge time burden for medical providers.

A recent article by pediatrician Dr. David Denton summarized the ways that technologies like EHRs gather a lot of data but make it difficult to sort through the data that matters. For instance, EHRs often make it more difficult to access the data we need by:

  • Including things that were never done, like answers to questions about exercise-induced chest pain for a 2-month old or a physical exam for a patient with a splinter.
  • Using language or codes that are so unnatural, they're almost impossible to understand or obscure the real problem. 
  • There is usually no logical sorting or prioritization of the data so it can take hours to figure out the real problem.
  • They don't allow collaboration (e.g., 100-page printouts of EHRs are commonly sent through the mail) so collaboration is usually interruptive of patient care (as with phone tag among providers.)

As Dr. Denton said, "I am busier because of these things, but not a better doctor."

Another provider, Dr. Pauline Chen, confirms, "A significant proportion of doctors feel trapped, thwarted by the limited time they are allowed to spend with patients, stymied by the ever-changing rules set by insurers and other payers on what they can prescribe or offer as treatment and frustrated by the fact that any gains in efficiency offered by electronic medical records are so soon offset by numerous, newly devised administrative tasks that must also be completed on the computer."

So is there anything that medical providers can do to protect themselves and their patients from this data onslaught? Actually, there is. Although we don't always have the choice of what EHR we use, or what interoperability issues exist, we can opt into technologies that make it easier to work, teach, and collaborate in the ways we want to. Ironically, adding additional tools can actually help you decrease the amount of time you spend fighting with technology. So if you're considering a tool to support telemedicine, health data, or medical collaboration, here are some key things to look for to help you manage -- not worsen -- the data deluge:

  • Let the humans do the thinking. With EHRs, the computer is what sorts the information. With a collaboration tool like iClickCare, all the information is readily available and chronologically organized, but it is a real, human, medical provider who indicates what needs your attention and what data you really need. 
  • Look for systems that allow natural language. The idea of EHRs is that everything is standardized and codified. So much so, in fact, that pretty soon all of the meaning of the words is lost in the abbreviations and standardizations. We think that collaboration tools are usually better when they allow providers to talk and write in the ways they think -- which is a language that real people can understand.  
  • Demand a solution that doesn't interrupt you. Medical ccollaboration is important, but if collaboration opportunities are constantly interrupting you -- through phone tag or video conferences -- it will be one more source of burnout. So look for solutions that let you collaborate and respond on your schedule (like with "store and forward telemedicine").
  • Prioritize a good user interface. EHRs are usually impossible to use. With all of the effortless and beautiful technology that exists, this kind of sturggle is completely unnecessary.  
  • Depend on photos and videos. While some EHRs allow pictures and videos to be input, most don't. Look for a tool that let's you easily, and HIPAA-securely, upload videos and pictures so that they can be used for collaboration, recollection, and teaching cases. 

For a broader overview of telemedicine options, click here.

Tags: EHR, EMR, medical collaboration, provider burnout

Can I Integrate My EMR or EHR with Telemedicine?

Posted by Lawrence Kerr on Wed, Feb 19, 2014 @ 09:01 AM

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When our colleagues get excited about the possibilities of using telemedicine to streamline and improve the ways they care for patients, one of the first questions they ask is:

"Can I integrate an EMR with telemedicine?"


The short answer is yes.

It is 100% functional, 100% efficient, and 100% HIPAA-compliant to integrate any EMR with any telemedicine system simply by cross-referencing the EMR in the telemedicine system; or by cross-referencing the telemedicine consult in the EMR. We, and dozens of our ClickCare users, have found this to be a simple, low-tech way of effectively integrating the two platforms.

However, if a provider perceives that they must have an automatic, high-tech way of integrating the two platforms, then the answer becomes trickier. Here's why:

Medicine becomes more standardized, regulated, and homogenized every day. When I started practicing, I used to accept eggs from backyard chickens, or the promise of a refresh on my housepaint, as payment from folks without insurance.

As the years went on, it became disallowed for me to take payment in this way… and the expectation of all providers working in exactly the same way became status quo. Some standardization is good, and protects us in crucial ways, but I think we all have a sense that the baby (of creative and passionate medical care) often gets thrown out with the bathwater (of mistakes and inefficiency.) I see this kind of standardization is the way offices are laid out, "tips" on how to greet patients, and rule after rule about managing charts and records.

Another place I see this is in the ways that EMRs seem to be running healthcare providers, rather than the other way around. The EMR market is extremely competitive, with 4,800 different EMRs on the market in 2013. That competition means that EMR providers have an incentive to "edge out competitors" by advocating for extreme integration. It's like going to the salon, getting a great cut, and then hearing from the salon owner that in order to maintain the cut, you need shampoo, conditioner, and gel that cost $180 and all happen to be from their salon brand. EMRs have an incentive for telling you that all technology you use has to be provided by them. 

EMRs and EHRs are fantastic for storing patient information and making it available when we all need it. But telemedicine is not primarily for the storage of information. Telemedicine is for collaboration, problem-solving, teaching, and communication. So consider ignoring the EMR/EHR manufacturer when they say that absolutely everything has to come from them. Use a telemedicine tool that works for you, in the way that works for you, and cross-reference to the EMR/EHR.

We may not be able to "fix" medicine, but each of us can fix the way we interact with the tools available to us, making our lives as providers happier, and the care for our patients better.

Curious about telemedicine options? Get our quick guide: 

 

ClickCare Quick Guide to Telemedicine

 

 

Image courtesy of juhansonin on flickr.com, used under Creative Commons rights.

 

Tags: telemedicine, Telemedicine and HIPAA, telemedicine solutions, EHR, EMR, telemedicine technology, ehealth, telemedicine law

Big Data Moves to Healthcare: A Description. A Warning. A Solution. 2

Posted by Lawrence Kerr on Thu, Oct 25, 2012 @ 03:55 PM

This is Part 2 of a three-part blog post. Emphasis of Big Data acquisition and analysis is supposed to improve healthcare. We emphasize that healthcare collaboration is a way to deal with the massive amounts of data considered to be medical knowledge that has grown beyond mastery of anyone. That said, we also are concerned that attempts to improve quality and profitability remove focus from care and caring. The first post described one source of errors. This second post will show how this error can happen in clinical practice -- with or without healthcare collaboration. The third will suggest a solution. The whole set of the three should bring fair warning to those who hear the sirens of Big Data which is done poorly, and help them look to solutions which are done well.

The past few weeks have brought huge attention to the analysis of data to health care. Much promise has been given to disease detection, epidemiology trends, bioterrorism, and business intelligence. Savings are promised as well as improved care.

iClickCare helps erroneous interpretation by including images, words, discussion andWaiting in line for healtcare collaboration judgment.

EMR and EHRs with financial metrics are the foundations upon which Big Data is being built. They are taking up a considerable part, even a majority, of the day in the life of the provider. What of the rest of the day, a day like this one? To be kind in description, less than user friendly EMR's are being inserted into the office work flow. This process is called “Go Live” which is a stretch of definition of zombie-like software.

All of a sudden four exam rooms are filled and three more patients sit anxiously in the waiting room. The first exam room is occupied by an elderly, somewhat demented, 86 year old with black and blue eyes following a fall. His facial fractures are multiple, and not classic. There are fractures across and within the edentulous maxilla, the nasal bones are involved. There is an extension to the orbit on one side. The zygomatic arch is displaced. With difficulty, they could be classified as LeFort II and a half. Not exactly, but sort of close enough. For patient care, the classification does not matter, the treatment will be the same. We will need to code this visit properly, we know. Why? Because and it will take searching through lists of codes.

The second room corrals a crying 13 month old who has just been sent to the office from the emergency room with a dog bite of the left lower eyelid. She is accompanied by two distraught parents and one distraught grandmother. The next room in line finds a pleasant demanding 54 year old who has body dysmorphic syndrome and is very happy from the scar after the facial basal cell carcinoma that was removed but is also very concerned about her aging body, skin turgor, wrinkles and cheek bones.

healthcare collaboration avoids nurses as butler.jpgThe fourth room has another child with a facial deformity and what his mother describes as moderate to severe autism. He is accompanied on the visit by his brother who shares the same spectrum disorder. There are multiple sharp-edged drawers being opened and slammed closed. The mother’s third child is to be picked up from preschool in just a few minutes. Is surgery to be done?

The fifth room is quiet. Just a calm patient who is thankful for the care, and doesn’t mind waiting. Who would want to keep her waiting? Another form of pressure rests within.

We know that all who care for patients find themselves in similar storms. In part, this exacerbated by patient expectation, such as this Scrubs blog from one our Pinterest followers. In part, it is further caused by the frustration of not doing as smooth a job of healthcare delivery as was possible with less mechanical documentation.

Can you see the potential for error in this scenario? More to follow in Part 3 when we will describe the error and suggest a solution...

Click me

 

 

References:

Waiting in line sketch: Jonny Pickton


Tags: EHR, EMR, healthcare collaboration, big data in healthcare, big data

EMRs and Cost. Hyperinflation of Big Data. Healthcare Collaboration 2

Posted by Lawrence Kerr on Thu, Oct 04, 2012 @ 04:25 PM

A second thought about Big Data, EMRs and healthcare collaboration.

Another plausible explanation is that the management of Big Data is doing what it is supposed to do. However, the unintended consequence is that billings increased.

giving directionsMaybe what has been discovered is that a whole lot of free care is now being caught in the documentation sieve. Rightful reimbursement is given for work done now, it is just that no one was aware of it before.

Below is a non-medical analogy involving 3 ways to act when a stranger approaches and asks for directions. Assume the stranger is not a native speaker. 

#1. You tell him the directions -- walk one-half block until you see the store with the red front, turn right. You bill for Code ZDP994564.

#2. You quickly and sternly walk him to the corner, a half block away, and point down the street. You bill for the same code, and add the modifier -- 77 because you are completing the EMR form to exactly describe what you did.

#3. Or, you smile, ask him where he is from and how his visit is going, walk him down to the corner, turn right, and walk with him another half a block until he sees what he is seeking. Was there a modifier for that? Was that billable as “public relations," assistance at a higher level, or counseling? 

In either of the 3 ways, you provided a service. If you coded at different levels, isn't that what was asked for? The Garbage-In is just different. Are we as a society getting what we wanted or just getting what we have asked for -- more precise data? And what was free (free as a smile) is accounted and billed for.

iClickCare enables healthcare collaboration by combining words and images with discussion. 

Click me

Tags: EHR, EMR, healthcare collaboration, big data

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