MIPS

1. ——— is slow (2 pph/patients-per-hour), and really limits speed efficiency and quality and safety. It is harder and takes much more time to document and enter orders using ———  than any other EMR I have used wity includes: Cerner-Powerchart, VA-VistA, Epic, and even paper (T-sheet, Generic Template). Of all the documentation tools I have used, ———- is the absolute worst and slowest and most dangerous.  I can’t believe a company that is so focused on numbers can at the same time employ such an inefficient system like ———.  Honestly, the fastest documentation system was using generic paper templates (3.5 pph) where HPI, ROS, PE, and orders could be filled out with a pen in an unabtrusive manner while getting the patient history.  You leave the room and orders and most of the chart was already done.   As far as EMR goes, EPIC is the best (2.8 pph). 

2. The Emergency Department should be allowed to give verbal/written orders to our nurses which can be later cosigned . ED physicians face continual interruptions by nurses. Instead of a quick response like “yes” or “make it so” to a question like “Can I give 1000mg tylenol to Rm 21 for fever?”, the ED physician is forced to stop what they are doing,  interrupting our train of thought, and enter this order.  These interruptions lead to mistakes.  The interruption is a result of the fact that only one order can ever be entered  in at one time by the physician (even with 2 ——— screens open).  This is a significant bottleneck.  Also, many times ED physicans are forced to leave a patient bedside to enter orders instead of giving verbals or having written orders taken at the bedside. Many other services at ———take written verbals except for the ED.  All other hospital I have worked at accept verbal/written orders.

3.  ———needs more rooms.  We have an excellent new ED faculity, but are forced to see patients in a chair in the hallway because all our ED rooms are continually filled with admitted patients boarding in the ED (10-15 nightly).  It is unfortnate that the new ED was not designed to provide more rooms than our old ED.  This was an unfortunate oversight.   We had already outgrown our new ED even before moving in.   The ED physician is scrutinized for almost every aspect of our decision making.  Who gets scrutinized for not planning to supply enough staffed rooms in the hospital and ED?  

4. I am supportive of following all hospital, federal, national protocols and guidelines.  However, the ED and hospitalist are easy targets.  We are too busy working to even speak up for ourselves.  It seems that if healthcare can easily divert attention onto the ED, then everyone’s attention is diverted away from other issues.  In my opinion, the ED is neither the problem nor the solution, we are just easy.  

When the insurance mandate and penalty associated with the Affordable Care Act was being debated by the Supreme Court, the justices asked the question again and again, “Can the Federal government punitively require people buy brocolli”.  The federal government can prohibit harmful behavior, but does it have the right to require and punitively enforce what it deems to be good behavior?  This issue came up in Canada with proposed penalties for persons failing to use gender neutral pronouns ‘ze’ and ‘zir’. Now with MIPS, the federal government is penalizing/fining doctors for not complying with MIPS requirements. Is this fascism?

Thank You