Saving Billions

Mt. Kilimanjaro, Tanzania

Scott Sturman

fliesinyoureyes.com

“Bureaucracy is the art of making the possible impossible.”

Javier Pascual Salced

Here I go again using personal experience to plant grave doubts in my mind about the promised savings from the Obama health care initiative. According to experts $500 billion in savings can be expected with implementation of electronic record keeping. If it sounds too good to be true then .....

Government agencies save money by reducing the number of employees, cutting salaries, or spending less for more product, but in reality this rarely happens. Government saves money by saving time, ostensibly so employees are free to work on other tasks. If this process sounds nebulous, it is an understatement. How does one compute time savings for public sector employees?

W.R. Priskna addressed this issue in an essay written for Flies in Your Eyes on November 13, 2009 entitled “Saving Millions.”

http://flies-talesoftheblue.blogspot.com/2009/11/priskna-ive-important-job-for-you.html

He recounts how his ideas “saved” thousands of dollars for his Air Force unit by moving the desks in his office every three months, so they were closer to the latrine. This required less time for the pilots to relieve themselves and return to their desks, allowing them to do more paperwork. As a result, Priskna was lauded for his efforts by his commander. There was also a plan to save time by redesigning the Air Force flight suit, but I'll let you read the story.

A major burden with medical record keeping is the volume of paperwork and electronic documentation, both of which have more in common with a legal document than a medical record. Much of the documentation required of health care workers is completed for the purpose of defending potential law suits and is never read again unless legal action ensues. It is an horrendous waste of time and money and begs the question why tort reform was not considered as a way to reduce medical costs. One could make the argument that excessive documentation rations health care in an insidious manner. At every level in the system the process of delivering services is delayed and made unnecessarily complicated which invariably directs more effort into fulfilling clerical needs and less towards patient care.

Some of the operating rooms in which I work use electronic record keeping and others do not. In the venues which use electronic charting the nurses assigned to the room spend a large portion of their time entering data into the computer – the most time consuming part of the process. In fact in many cases it is difficult for them to keep up with their clerical responsibilities, and they are forced to complete charting between cases – time when they normally would be preparing for the next patient. In hospitals where conventional record keeping is the norm, the nursing staff usually is able to care for their patients and complete the paperwork in the allotted time. In both cases, however, it is tempting and relatively easy for hospital administrations to add more superfluous documentation requirements to appease inspectors and purportedly enhance safety.

To hear electronic record keeping described as a seamless system of total medical conductivity where billions of dollars are saved may sound plausible to the lay public, but the promised rewards will never materialize. Bureaucracies do not work this way. A government sponsored system will be expensive to implement, time savings will be off set by larger amounts of data entry, and it will perpetuate a record keeping system which is devised more for legal protection than patient care. How much closer should I move my desk toward the bathroom?