Better Tools for Medicine pt. 1

May 1, 2018

What will be the innovations that, like better compilers and GarageBand, free the mind from lesser concerns and provide new speed and ability to experiment in Healthcare? This will be wild speculation on my part and history does not favor me with respect to being correct. Although I did call that thing where the internet makes phone calls nearly valueless so who knows? Also I called Adam Sandler back when he was just an occasional performer on an MTV game show called “Remote Control” so maybe you had better listen to me. 


The game is to describe at a high level, problem solutions that would free up time and mental effort for medical professionals and so potentially make space for innovation. What innovation? I won’t even speculate. Would anyone have made the call that faster compilers would enable us to create all the cool software in the world? Of course not. Innovation by its nature is unpredictable. I merely assert, with some logical support in earlier posts, that if we can speed up the tasks between the real tasks, and remove mental concerns, we open the possibility that smart humans will create wonderful things and then other smart humans will create things on top of those things and so on.


Or maybe medicine, by its nature, only works in a plodding manner. Maybe faster innovation leads to faster harm or maybe just seeing more patients each day.




The most urgent and obvious problem we need to remove is everything related to billing, both large and small. A doctor, a nurse, a physicians assistant, a phlebotomist, anyone who provides actual healthcare and who does any thinking about what is wrong (or right) with patients and what to do (or not do) about it should ever have to think about any information even vaguely related to billing.


For any of my (currently zero) readers living outside the United States this might seem an odd place to begin. Well, here in in the good ole U S of A, a staggering, unconscionable fraction of medical documentation is executed in order to facilitate reimbursement. For doctors who bill more for thinkin’ than for doing stuff- that means you internal medicine dudes and dudettes- the need to document how much mental effort was expended on a given patient tends to override the need to document the actual medical information about the patient.


This makes sense because physicians only have so much time and they (or often their employers) need to make that sweet bank in order to pay for luxury yachts, gold back scratchers, and in some cases food and shelter and maybe school supplies.


Fortunately the powers that pay have created a system which is a reasonable way to estimate, formulaically, just how much cogitating a given patient required. Unfortunately there is no system which influences a person’s pay which will not ultimately be gamed. Doctors expend time and, more importantly mental effort on documenting just so...3 items from column A, 2 from column calculate the correct billing level. In current EMRs with their template based documentation docs can easily paste the correct text blocks to both get paid at the correct level and maybe document the patient’s situation accurately enough to be of value later.


We like to think what you need to document to bill and what you need to document for patient care are the same. The government and payers have worked hard to make this so, but they can never do it exactly. From a billing point of view they only need it to work on average. If one patient was actually more difficult than the documentation and formula indicate but another is less so, it all averages out. 


But we want the correct documentation for every patient and doctors should not have that nagging voice in their heads when they are trying to record accurate data about the patient. They should not be thinking about how their manager told them they were billing less than they should for the past two months and I certainly don’t mean to imply anything but you know that I am implying you need to get your billing levels up and...


The whole point of this blog post is, analogously to the tools in the previous two posts, we want to remove this nagging voice, this low level background noise, to free up mental capacity. This could mean docs work more efficiently, can see more patients, or simply have less stress. These would be obvious direct benefits of freeing them all from even knowing what the word “billing” means. 


My hope is that it would also lead to innovation, a different way of practice which in turn leads to even more different ways to practice and inspires the creation of tools (maybe even software) to further amaze me.




How could a product and/or service eliminate the need for doctors and other medical professionals to think about billing without making it impossible for the billing system to work? How could we have a system, or systems, which result in doctors getting paid something reasonable and fair and proportional to effort and maybe even result? How could this new way prevent over billing, over prescription, over ordering, and over thinking?


Assuming we could come up with some such combination of product and service how could we possibly get it implemented in a world that already has embedded interests in the form of government and private payers? Aren’t there laws and regulations? Don’t people have insurance plans that are difficult to change? Don’t insurance companies and government have almost no incentive to do this? Wouldn’t they fear it would lead to them having to pay more money to doctors leaving less for their own yachts, golden back scratchers and food?


You make some excellent points, voice in my head. If I knew how to create the product/service and a clever strategy/hack to get it universally implemented against the wishes of the embedded interests, I’d be out starting that company instead of writing the blog that no one is going to read.


But, and this is an important point, I am not the greatest genius in human history. Even my mom doesn’t think that. Just because I don’t have the plan doesn’t mean someone else can’t have the plan. Anyway, these things almost never go according to a plan. You think Uber started out with the idea that it would be great if getting taxi service everywhere in the world weren’t such an inconsistent pain in the ass? Of course not. They started as a service to hail limousines in San Francisco. Heck, the founder at first thought it was such a niche he handed it off to one of his less competent friends. He only came back after it started to catch like wildfire. For those of you who have little experience with wildfire, I hear it is the flaming equivalent of the early days of Uber.


So yes this is my first idea, we need a combination of software and service that operates quietly in the background, “detects” actions and thoughts of doctors, and somehow arranges for them to be equitably reimbursed for these thoughts and actions while simultaneously being very resistant to gaming.


Go out and make that and when you are a billionaire don’t forget your old pal, Erik... 

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