Dear ACO General Hospital:

Thanks for contacting me about my most recent blog post.  I’m sorry to scare your administration about HIPAA information, but I am equally concerned about that and will always do my best to respect the privacy of my patients.  At your request I hid even more of that information.

I know it’s kind of embarrassing to have that kind of thing made public, and I am overall grateful that you did not take it personally that I put the transition of care documents for all to see.  My goal was not to embarrass or ridicule, it was to point out what our health care system is driving us all toward: replacing patient care with documentation.  You are being encouraged by the system to produce those ridiculous documents, as they are part of the deal you accepted when you became ACO General in the first place.  ACOs are supposed to encourage continuity of care, but what they call “continuity” is simply sending us a huge document with a lot of useless stuff in it.  As you know, all I really need is the following:

Dr. Rob:

Phil Moscowitz, your patient, was in the hospital this week after he ate a spoiled egg-salad sandwich.  He got a CT scan of his abdomen, which was negative (to rule out appendicitis), and had labs which were inconclusive.  He was better when he left the hospital, but we want him to see you to make sure he’s better.

Thanks tons!

ACO General Hospital

Doing that kind of letter would be easy for you, would help me far more, but would not meet the ACO criteria of care continuity (even though it would be doing a much better job).  This is the insanity of the system: You are forced to turn that short paragraph into a 20-page document.  It’s why I left the system in the first place.

I also realize you don’t have much control over the super-fancy EHR product you use.  You paid a bunch of money to them so that they could help you reap the ACO reward.  It’s how business is done in most hospitals.  Just like with meaningful use for doctors, the additional incentives you get will eventually become a penalty for those who don’t follow that course.  The government uses the siren call of extra money to trap us in these crazy systems.

Yes, the EHR vendor could do much better than to make you look foolish with those documents, but that would (of course) involve paying them extra money or hiring more people on your own to improve on it.  Unfortunately, even though that would be the best thing to do for the patients, you are penalized when you try to make the lousy system actually help patients.  I know.  That’s one way in which the hospitals and doctors share the pain: we are forced to choose between good business and good patient care.  It sucks, doesn’t it?

I hope you find a way to send me more useful information.  Really, the documents I get sent now are almost not worth sending.  They are really terrible.  I have a feeling, though, that something big (Ebola, maybe?) will have to happen to show just how terrible things are.  When codes, checklists, and documentation are rulers of the land, the doctors and hospitals become the indentured servants and the patients end up in the dungeon.

Hope things start to look up for you.

Sincerely,

Dr. Rob.

P.S.: Don’t snicker, Wanna-be Smaller Hospital.  Yeah, you don’t send me that kind of garbage, but you are the one who treated me like a nobody.  At least ACO General is sending me information.  I don’t hear anything from you.

Rob Lamberts is an internal medicine-pediatrics physician who blogs at Musings of a Distractible Mind.