Passage : Health News

A Matter of Perspective

Jeanne Johnston — Thu, 16 Jul 2009 23:18:00 GMT

I love to toss off the headset and get a change of scenery, and find myself occasionally rummaging around other Advance boards to see what's up (did you even notice they've got like 243 magazines skewed toward different areas in health care?) Lately,...(read more)

Why Plan Ahead When You Can Panic Now?

Jeanne Johnston — Tue, 05 May 2009 12:34:00 GMT

Some of us in the medical field (especially transcriptionists, I think) are in a unique position to observe certain trends in society. If you work a clinic account, your work has definite seasons, even if you don't: Fall brings school physicals and general...(read more)

Globalization or Protectionism?

Jeanne Johnston — Fri, 27 Feb 2009 14:57:00 GMT

I see this week there is some outrage offshore over the new stimulus bill, specifically the part relating to the H-1B visas that have allowed foreign workers to come to the US, illustrated nicely in this article on India Times--and especially in the ensuing comments. Of course, many of these visas have gone to Indian engineers, IT specialists, and medical professionals, creating a very powerful subculture (both here and there) . The threat of losing these visas has many angry at the US. As our new President has indicated, there are still more important changes coming that may well impact us more directly, depending on specifics. Just off the top of my (admittedly lazy) head, I believe at the very least, companies that offshore will lose certain tax breaks, and though they certainly won't try to clamp down outright on firms that already have substantial offshore investments, I'm betting they will figure out a way to discourage any from moving more of their workforce away.

Those MTs who remember the resentment over the last decade or so about the loss of our jobs offshore and the resultant impact (all bad) on our wages are sensing a little irony here. We were admonished on the realities of globalization when our jobs filtered offshore, but now when someone threatens to bring jobs back, it's protectionism? I can't help but wonder if they'd see this in a little different light if they were talking about Indian jobs going to Chinese workers willing to work for a fraction of their wages. . .

I have to admit that I can see the rationale for globalization. A most fascinating demonstration of how that works correctly is evident in a game devised by Buckminster Fuller (creator of the geodesic dome), called the World Game, which is kind of the antithesis to the war game, Risk. Players (anyone from grade school kids to corporate bigwigs) represent countries, corporations, human interest organizations, etc., and are given unique resources and assets. In the ensuing hours, players trade their assets and quickly learn that it is possible to remain competitive AND profit if everyone cooperates. Greed may make for short-term profit, but it's necessary to factor in public opinion and mutual benefit for long-term successes. In the end, everyone compares notes and realizes that friendly cooperation makes for the most profits all around, to say nothing of world harmony. (Cue sunshine and daisies.)

Of course, communism works well in theory, too. The problem is that human nature tends to ruin things, especially when greed, profit, and personal gain manage to dominate as they have in the last two to three decades, which have been all about corporate profit and not at all about equity, and the entire world economy has reached the breaking point. The sweeping changes that threaten to rock our world are simultaneously frightening and exciting, and may well test the sensibilities borne of the Boomer generation. Can peace, love, and harmony really defeat the "evil axis" of world bankers, corporations, Big Oil, Big Pharma, and the insurance industries? Close to home, will a "government of the people, by the people, and for the people" once again become something more than lip service?

Obviously, we're running on hope here. I think there is still room for globalization and mutual benefit, but not at breakneck speed for the benefit of the elite few at the expense of the rest of us. If you go back to the feedback from this article, there is as much understanding as there is anger. Some are crying for a boycott of US companies overseas, which I think is just fine because face it--McDonald's, KFC, and Coca-Cola haven't added much to world culture as they have served to homogenize and dilute it. In emulating America, many countries seem to have lost sight of what makes them unique and worth preserving. I find many replies to this article especially insightful, like the one who suggests it's silly to expect the US to offer jobs to foreign workers whilst Americans sit around jobless and homeless, advocating logic because, "No one will share his food with an outsider if his family is starving."

Of course, this is only the tip of the iceberg and the effects of the stimulus package and more specific measures to undo the damage offshoring has caused are more likely to impact us personally. It will be interesting to see the long-term effects on wages now that MT wages have been driven so low that many of us can't even afford to stay in the field even if we can find jobs and few people are willing to consider entering the field given its dim prospects. The law of supply and demand would indicate that wages should go up, but now that speech recognition has replaced the offshore MT as our biggest nemesis, I'm not holding my breath.

"Interesting" times indeed.

Where Have All the Nurses Gone?

Jeanne Johnston — Thu, 19 Feb 2009 13:31:00 GMT

I know I whine a lot about MTs being the first and hardest-hit casualties in a budget crunch (and I wasn't even around with you vets who were relegated to the supply room downstairs next to the morgue because MTs have always been so highly respected), but obviously, that's my reality and it's hard to see beyond your world when you're struggling to simply survive. With all the talk of the economic stimulus package and how much of an impact it will really have on real people, you pretty much have to poke your head up and see how everyone else is doing. End result is that I've had a little wake-up call this week to give me even more to feel pessimistic about.

Those of you who decry the bastardization of what was supposed to be our representative (AAMT is long dead--it's every MT for herself) and advocate channeling our indignation into organizing a union are, in my humble opinion, dreamers. Cats lend themselves to herding better than MTs, and with most of us working harder than ever for less money than ever, there's not a lot of incentive to volunteer our precious time to any extracurricular activities. We are long past the point of no return. The ship has sailed. MT is fading fast and it's all about automation, baby. Yadayadayada and so forth.

What has reinforced my rosy outlook, you ask? If I have to pick one thing, it might be this message board thread. I can't even distill it into a pithy Reader's Digest version, so I hope you do go and read at least the first post. The gist is that MTs may have simply served as the canary, dying in the mines to warn the rest of the healthcare system that something Bad is swooping in. Obviously, executive bonuses are as big a problem in our world as they are on Wall Street, but I was naïve enough to believe that nurses--people with a strong union, fer cryin' out loud--were probably safe from all this. Apparently, nothing could be further from the truth. Nurses are hurting. Budgets are shrinking, nursing staff is dwindling, nurse-to-patient ratios are growing, and they are leaving the field in droves--if not bailing out of the acute care scene for an easier life in private practice, simply leaving nursing altogether. One poster here claims 50% of nurses have left already (sorry, I'm too pressed for time to research that figure, but it's not hard to believe). These are people who are crucial to the system--the backbone, if you will. Anyone who's ever been in the hospital knows you're lucky to see a doctor for three minutes a day; it's the nurses who do the work, which means everything from monitoring vital signs to scrubbing Granddad's butt when he's been incontinent to simply connecting with an anxious patient as a human being. I thank a nurse for my son's life, because she recognized he was septic when no one else did. The fact that nurses even need a union to fight for their due is obscene.

Heck, when someone asks my opinion for a field to get into, I've always recommended nursing. I've nudged my own daughter that way. It's a field that should always be secure, right? It pays well, especially in comparison to other jobs these days. It comes with great benefits and perks. It's got to be a soul-satisfying job--you're not selling someone junk they don't need, you're providing something society really needs and values, right? It's something that can't be outsourced (oops--not so fast there. . . imported nurses are gaining a huge foothold in hospitals in some markets) and it's a job that you can do anywhere in the country, yes? In our area, nurses are so desperately needed that the local public hospital is helping to pay your way through vo-tech, getting you into a job after only three months' training so you can earn as you learn, and even buying up property around the hospital to provide affordable housing to its employees. Great deal, huh?

It seems I have to rethink that now. I've seen how hospitals are breaking under the weight of uninsured patients using the ERs as their only source of primary care. Indigent care has been the demise of many hospitals already, leaving large communities with no public hospital at all. Well-insured patients get the lowest negotiated rates, indigents get totally free care, and the rest of us who either have to pay cash or find our so-called health insurance covers next to nothing are charged the highest rates of all, to take up the slack. (Honestly, what use is insurance that has a $6000 deductible and cap of $80K when a single catastrophic injury can add up to twice that amount?) Doctors, like nurses, are sick of the rigamarole and cookbook medicine they're forced to practice in hospitals (honestly, if there's a strict protocol for every condition, why don't they just use that tech support in India since they love those savings?) and are retreating to private practice. And now, I see that nurses are just as abused as everyone else.

When the foundation of our healthcare system is breaking down, it's time for someone to just scrap the whole system and start over. When you do the research, you see that every other developed country in the world values its people enough to treat health care as a right, not a privilege. Even not-so-swift countries (Cuba anyone?) provide better, cheaper care to every citizen. What is wrong with this system is that we are sheep. Too many people believe the nonsense that universal healthcare = socialism and the end of society as we know it. I bet dollars to doughnuts that sentiment has been fostered by the people who stand to lose the most if we get it: Big Pharma and the insurance industry.

Other countries are run by governments that are afraid of their citizens. When those people are not happy, they protest. Where all of France stages a walkout, government listens. In the US, however, we've lost our rebellious nature. Maybe we've just allowed ourselves to be distracted with celebrity gossip and reality teevee. We have become complacent and afraid of our government. Sure, we can rally a bit of support to "Throw the bums out!" at election time, but I don't see the level of outrage necessary to demand the kind of representation we pay for. We need to become outraged, proactive, and ready to make some demands of our own. There are bankers who have burned through millions of dollars in bailout money, haven't changed the way they do business, and are demanding more. In the meantime, 95% of the country is suffering, including the people we rely on for our most basic needs.

I am just astounded that nursing in particular--and all of health care in general--are not even safe from what's happening. It's not just about MTs anymore, and woe to us all if someone doesn't fix this.

EMRs for Better or Worse?

Jeanne Johnston — Thu, 12 Feb 2009 13:39:00 GMT

As I watched this week's first official presidential press conference, the thing that stood out to me (well, after the outrage at all the political posturing and stonewalling that are getting the stimulus plan nowhere) was a comment that reminded me of Pres. Obama's gung ho stance on EMRs. Mainly, I guess my feeling about this subject has been tainted by my own experiences with the automation of medical transcription and the abysmal impact speech recognition has had, not only on the field of MT, but also in driving the quality of the medical record down to the lowest common denominator. How will the EMR fare any better?

As a patient (more accurately, the daughter and mother of patients), my own experiences with EMR are mixed, but leaning heavily toward the negative. When I had to take my mom to the ER with an allergic reaction (repeatedly), we spent hours repeating the same information to everyone we dealt with--the receptionist, the triage nurse, the nurse in the cubicle, the doctor (when he finally came). Oddly enough, entering the information in that form did not seem to mean it was there for the next person, merely that they had to enter it all again, too. Shiny new workstations took up precious space and in the exam room; that even meant that every person who came in to treat the patient was guaranteed of hitting their head on the monitor and/or running into the keyboard. Subsequent trips were similarly not simplified by the information monster, sadly enough. It wasn't enough to simply show her ID bracelet so they could key in the number and call up her very recent past medical history. . . We once again had to repeat everything to everyone. By the third visit and after sitting in the waiting room for three hours (apparently, it was prime heart attack time at the nursing homes), she finally allowed me to play doctor and we bailed to head to the nearest drug store for a box of Benadryl.

This was a very expensive private hospital (the only one in my little burg) and clearly, some software salesman had sold them a very expensive system with the promise of saving them transcription expense and streamlining their record keeping. I notice he wasn't around for the fallout when they put it into practice and had doctors and nurses doing my job for them. Is it a savings when you pay a nurse $30/hr to enter data versus a transcriptionist who's nowadays lucky to get hired for 6-7 cents per line? How about that doctor who has to spend 15 minutes fumbling through a wizard and then has no patience to deal with the face-to-face patient care because he's got to run off to the next one and do it again? (My mom's doctor looked up from the monitor, declared that she didn't look too bad and dashed off a prescription. We waited three hours for less than 60 seconds of actual care.)

When my son was recently hospitalized with an infection, we opted for a much bigger, better, and public hospital. Once again, they had that evil EMR, only this was a more manageable laptop on wheels. We answered questions once and though people occasionally asked again, it was usually to clarify details as they read from the screen. They were indeed able to call up prior admissions to help jog our memories of past history. The real advantage I saw here was that in everything they did, they were able to answer questions. My son (probably not the easiest of patients because he has to ask WHY and HOW about everything) would ask for specifics and his doctor or nurse could pull it to the bedside and say, "Let's look at your lab values and imaging studies," or "I bet I can find a good illustration online." They utilized this to make the patient a working part of the team and not merely a victim or child. At discharge, they were also able to generate instructions and followup.

Nothing with the finesse of a carefully crafted and conversational dictation, but clearly more along the lines of how an EMR is supposed to work. After the latter experience, I have to say my sadness at being put out of a job was not uppermost in my mind. The biggest danger I saw was that a keyboard itself has got to be a major player in the spread of pathogens. As most of the patients I transcribe end up suffering as much (or more) from opportunistic infections, maybe I'm just attuned to this negative, but clearly, there is no way to prevent the spread of germs when everyone's sharing a keyboard and that device is being wheeled from room to room. This hospital also has instituted a protocol that provides antibacterial foam dispensers to use as you enter and leave each room, but does nothing to sterilize computers, IV poles, and other equipment.

But I digress. In my world, speech recognition engines are poised to eliminate straight transcription. This isn't because the technology is good, but because there are software people selling the product as though it were. I have yet to hear from an MT who's been asked to help develop a platform that truly works and in the end, we're merely asked to correct the gibberish, essentially working twice as hard as we do now, but for half the money. All those great Shorthand macros we've created over the years for those dictators who always say the same thing every time? Forget that it's a time-saver, a wrist-saver, and just plain more accurate to have a whole paragraph pop up with a few keystrokes. Nope, can't use them because the SR engine won't learn unless we work with what's already given to us and make specific corrections. We are working crap wages to train computers to take our jobs, and are supposed to be grateful to have jobs at all. In the end, those long, rambling office notes will no longer contain information that conveys a patient's humanity, but only the facts necessary to fill those key boxes on a form. I suspect the only thing holding them back is the fact that there are too many old-school docs who refuse to dictate carefully enough for SR to understand them. The new kids are learning and the old ways will die off as their generation takes over.

So how will EMR be any better? Once again, we're talking software developers, salesmen, and little to no input from the people who actually have to work with these things. To complicate matters, how does the government mandate a nationwide compliance with EMRs when competing platforms can't even communicate with each other? I think the answer is simple, but I don't see the money guys being too happy about it: There are already FREE EMRs out there (Practice Fusion and Synapse are good examples and seem to get favorable reviews), many developed by doctors with a geek gene on the side. The new technology czar (yes, we're actually supposed to be getting a cabinet position along those lines) should study what's already available and pick the best one. Make it open source--i.e. free to use and to customize--so that everyone's on the same page, and so that no one stands to profit at the expense of our healthcare or livelihoods. This would be totally in keeping with the new agenda to make our government itself more transparent and accessible to citizens.

Of course, I still think the EMR's greatest potential for evil lies in the fact it will serve as a storehouse of private information that can be farmed to deny us care on the basis of preexisting conditions, to deny us employment based on facts no employer should have access to, or to target us for marketers and other unscrupulous people, but at least we could avoid the snafus that have plagued the transcription world. If this administration does manage to do this right, who knows--maybe they really will succeed in disabling Big Pharma and Big Insurance, too, and making health care for all a right, not a privilege.

MTs are clearly not the only ones in a bad place right now. Change is inevitable, but it will be interesting to see if greed continues to make policy or if common sense finally becomes a player.

Is it Too Early for an Election Hangover?

Jeanne Johnston — Fri, 24 Oct 2008 14:29:00 GMT

So here I am, on the cusp of a surprise vacation (as in "You've got a mess of PTO and if you don't use it STAT, you ain't gettin' more. . .")--a blessed two weeks with no plans other than a stack of books, a hammock, and perhaps a pitcher of margaritas at some point--and a whole lotta schoolwork to blast through. The timing seems opportune, given that I feel like I've been saturated against my will with politics since about 2000 (here in the land of cronyism and hanging chads) and may go straight up and scatter if it isn't over soon. At least if I'm not at my computer so much, I can pretend to ignore it until the dust settles.

Not that there aren't a ton of issues that are important to me, both personally and pertaining to work, because there certainly are--outsourcing, healthcare, low wages, insurance, and the fact it's getting harder to pay my bills, though I'm working twice as hard. It's just that with a week and a half to go, pretty much everyone knows how they're voting and only a stupefyingly indecisive few are left to convince. Further debates, ads, robocalls, junk mail, and message board scuffles are akin to having to eat Thanksgiving dinner twice in one day to satisfy dueling grandmas--overkill!

Still, I have done this to myself to a large degree. I'm a compulsive petition-signer, without the sense to use a fake email address, so I get dozens of updates and pleas for help daily. Most go in the virtual circular file, but some intrigue the activist in me, especially when they relate to work. Anyone working acute care knows very well how the system is strained by patients' lack of insurance (our ERs are swamped with the indigent, uninsured, and illegals, who see them as their only source of primary care), dwindling benefits (insured patients' coverage, veterans, and Medicare), and a whole spectrum of problems faced by the elderly and disabled. If you've also worked a Canadian account, these problems become really three dimensional in comparison because the differences in systems is astounding.

As remote employees, though, there's not a lot we can do to advocate for patients in the way, say, nurses and social workers do. I can certainly participate on a broader level, though, pestering government representatives about issues that affect us all. I think one of the most important things to come out of this year's campaign is the fact that--despite some snarky attempts by some to denigrate community activists--grassroots activism has become a force to contend with. The internet is mightier than the pen or the sword in that everything travels exponentially further and faster, and citizens who are tired of being ignored by the policy makers have realized they have a powerful collective voice. Anonymous viral email campaigns can also spread misinformation like wildfire, but are countered with an almost-instantaneous fact-check; we're not limited to whatever 30-second snapshots someone puts on TV as a way to get to know candidates because now they are documented for better or worse in the world of You Tube; and our elected representatives are largely only a mouse click away. Those of us too lazy to stand outside the supermarket with a clipboard or man the phone banks at political headquarters really have no excuse not to take part in the process.

Even better, this sense of empowerment seems to have sparked a new generation. After a decade or so of disinterest, I see my kids' peers as suddenly feeling passionate and optimistic about their place in the world. There's a very '60s retro thing happening, if you just pay attention.

To add my contribution to the political information overload, I'll limit myself to one example, as it might feel relevant to others in HIM, as well: Healthcare United, who state they are "a new, national movement of nurses, doctors, and healthcare workers uniting our voices to heal our broken healthcare system." So the MTs and coders are probably still relegated to the basement--when you're telecommuting, you take your socializing where you can get it.

Even better, if you're one of those apparently confuzzled 10% of undecided voters, you can go to their "compare the candidates" page, where they itemize the candidates' stand on the various issues that pertain to us, side by side.

For myself, I'm braving the rain and doing my citizen's duty today (early voting--yay!), so I can coast through the next two weeks and whip up that batch of margaritas with a clear conscience. Honestly, I plan on hitting the pharmacology course with a veangeance--but first, a token gesture to celebrate the spirit of R & R.