The Culprit: Cut-and-Paste Command
I finished reading an interesting article in Modern Healthcare by Joe Carlson, “Feds eye crackdown on cut-and-paste EHR fraud.” The premise is that “cut-and-paste” invites fraudulent duplication of clinical notes. The Department of Health and Human Services (HHS) wants to biopsy this “security” threat before it becomes too widespread. That’s why they are developing comprehensive guidelines to cure cut-and-paste abuse. Well, it’s my opinion that HHS is missing the mark yet again.
An analogy might be a that a car accident is not the driver’s fault since it was the car that hit the telephone pole and not the driver himself. If people are frauding the healthcare system it is not because of a computer function; it’s about an individual’s lack of ethics and honesty. Mr. Carlson sites that, “Critics say functions such as cut-and-paste make it too easy to bill for work that wasn’t actually performed, especially when the borrowed material comes from a different patient’s record.”
If you believe these critics then gangs of evil Control-C and Control-V commands are roaming the dark internet super highway submitting false medical claims. But let’s not stop the blame there. Don’t forget the “click to submit” button, the “Enter” key and the keyboard itself are willing co-conspirators.
According to Dr. William Bria II, chairman of American Medical Directors of Information Systems. “Every once in a while, a 75-year-old gentleman will turn into a 30-year-old woman, on the basis of cutting and pasting the wrong information into the chart. I’ve seen this personally.” Certainly, when doctors, nurses or staff manually writes data on paper there has never been a mistake or wrong box clicked. All our medical problems are due to those evil computers and applications.
But if EHR applications are so terrible and prone to fraud, why is it that since 2011 HHS given hospitals, doctors’ offices and other providers $17 billion in federal subsidies to cover the high costs to ditch their color-coded manila folder systems in favor of new computerized patient-record systems? Answer, “Hospitals and doctors say EHRs allow them to better document the work they have always done, generating more accurate claims than before while meeting growing demands for efficiency.” But I thought Dr. Bria said that there were mistakes.
Okay, putting all the tongue and check aside, cutting and pasting is not the problem. These are important features to help doctors, nurses and staff to input and manage the tremendous amount of paper work now required by government regulations. If the goal is to slow down service even more then by all means target the evil cut-and-paste.
An alternative might be to realize there are always going to be errors. We are all humans and sometimes the hand does not obey what the eyes see and the brain tells it to do. How about adding in better security and tracking features that identify who have done what. This way when fraud is committed then there is an audit trail to find the perpetrator.
There is always going to be crime especially when large bureaucracies are involved. Their very nature shields individuals from accountability and oversight. In conclusion, go after the criminals and not some silly computer commands.
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