3GeronimoPA Posted March 29, 2013 Share Posted March 29, 2013 Ok, these Army people are on crack. For those not in the know, the DOD uses AHLTA as it's EMR. In that EMR is the ability to + and - signs and elaborate in free text over a multitude of history and physical items. You can check 100 boxes for each part of the body or you could just check one box and free text. Not great but I favor the check a box and free text option because it allows me to do what I have to do, saves me from fishing for specifics etc. There is also an option to use templates. So if you have a standard H&P for URIs you can ask your questions, do your exam, select the "+" mark on what is positive and "Auto Negative" all of the negatives and essentially "Wham-bam-thank-you-ma'am" the common things as to not get hung up. I also am a fan of this system but I am told "only relics use that" and I don't consider myself a relic. For the not so relic-ish there are these things called AIMS forms which is a super-template apparently that has a special screen or some crap that allows you to free text in certain boxes and presents you standard "yes" "no" boxes and can be generalized to include your standard History and JHACO mandated items so you can keep the man off your back. These forms can also be made specific to address body parts or specific complaints. Again, I don't hate it but it is the second most (behind deployment) reason for providers getting out of the military. This is the EMR context. So Western Region Medical Command has decided that it is now an order to use "TSWF AIM forms" (a specific type of AIM form) specifically the "Core" form for all patient encounters. The TSWF Core has things like Advanced Directives, living wills etc... You know the stuff my 18 year old infantryman with knee pain really wants to talk about in his 15 minute appointment:O_O:. The cited reason is, "Everyone is switcching to this so providers all across the DOD can "Copy/Forward" your note". This is a coder's wet dream because it has all of the *** pain associated that is required to generate a high coding value and then providers can go back to being their lazy selves and "Copy Forward" someone else's initial *** pain. Thus, not only are they mandating a one size fits all template for babies, dependent spouses, geriatric retirees, and Airborne angry axis II Hooahs who want their knees to feel better so they can go kill something, they also are encouraging fraud and malpractice by way of this "copy-forward" business. I share a patient load with a General Medical Officer (A Doc who hasn't performed a residency yet) who is a smart dude but I don't even "copy-forward" his notes when I see a follow up from a patient he initiated. Why would I trust a provider across the US or maybe even the world and steal their note!? Worse yet, when you use the "mandatory form" you get garbally-guck about living wills etc all mixed in with your history. Its totally irrelevant and stupid. Then, to my chagrin, we got the "Soldier-Centered Medical Home" training which is the Army's stupid version of the "PCMH" which of course they inseminated it with their own idiocy so they could ride stupid ideas under the umbrella of national law. Then we got hit with the patient satisfaction stuff.... You guessed it, 20 year old Joe infantryman up here in Alaska who doesn't want to walk 10 miles in snow shoes at -20 degrees with 100lbs on his back up a mountain comes in for sick call is no longer allowed to be assessed and released to do the maximum amount he safely can do because his job is hard and he will complain as he always does that this PA didn't coddle him and encourage weakness. Now I must "delight him". Where in the world do they find these people with no idea what they are talking about and convince them that they should be the front runners on changing our system? Resignation letter is in the works.... Link to comment Share on other sites More sharing options...
3GeronimoPA Posted March 29, 2013 Author Share Posted March 29, 2013 Ok, these Army people are on crack. For those not in the know, the DOD uses AHLTA as it's EMR. In that EMR is the ability to + and - signs and elaborate in free text over a multitude of history and physical items. You can check 100 boxes for each part of the body or you could just check one box and free text. Not great but I favor the check a box and free text option because it allows me to do what I have to do, saves me from fishing for specifics etc. There is also an option to use templates. So if you have a standard H&P for URIs you can ask your questions, do your exam, select the "+" mark on what is positive and "Auto Negative" all of the negatives and essentially "Wham-bam-thank-you-ma'am" the common things as to not get hung up. I also am a fan of this system but I am told "only relics use that" and I don't consider myself a relic. For the not so relic-ish there are these things called AIMS forms which is a super-template apparently that has a special screen or some crap that allows you to free text in certain boxes and presents you standard "yes" "no" boxes and can be generalized to include your standard History and JHACO mandated items so you can keep the man off your back. These forms can also be made specific to address body parts or specific complaints. Again, I don't hate it but it is the second most (behind deployment) reason for providers getting out of the military. This is the EMR context. So Western Region Medical Command has decided that it is now an order to use "TSWF AIM forms" (a specific type of AIM form) specifically the "Core" form for all patient encounters. The TSWF Core has things like Advanced Directives, living wills etc... You know the stuff my 18 year old infantryman with knee pain really wants to talk about in his 15 minute appointment:O_O:. The cited reason is, "Everyone is switcching to this so providers all across the DOD can "Copy/Forward" your note". This is a coder's wet dream because it has all of the *** pain associated that is required to generate a high coding value and then providers can go back to being their lazy selves and "Copy Forward" someone else's initial *** pain. Thus, not only are they mandating a one size fits all template for babies, dependent spouses, geriatric retirees, and Airborne angry axis II Hooahs who want their knees to feel better so they can go kill something, they also are encouraging fraud and malpractice by way of this "copy-forward" business. I share a patient load with a General Medical Officer (A Doc who hasn't performed a residency yet) who is a smart dude but I don't even "copy-forward" his notes when I see a follow up from a patient he initiated. Why would I trust a provider across the US or maybe even the world and steal their note!? Worse yet, when you use the "mandatory form" you get garbally-guck about living wills etc all mixed in with your history. Its totally irrelevant and stupid. Then, to my chagrin, we got the "Soldier-Centered Medical Home" training which is the Army's stupid version of the "PCMH" which of course they inseminated it with their own idiocy so they could ride stupid ideas under the umbrella of national law. Then we got hit with the patient satisfaction stuff.... You guessed it, 20 year old Joe infantryman up here in Alaska who doesn't want to walk 10 miles in snow shoes at -20 degrees with 100lbs on his back up a mountain comes in for sick call is no longer allowed to be assessed and released to do the maximum amount he safely can do because his job is hard and he will complain as he always does that this PA didn't coddle him and encourage weakness. Now I must "delight him". Where in the world do they find these people with no idea what they are talking about and convince them that they should be the front runners on changing our system? Resignation letter is in the works.... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 29, 2013 Moderator Share Posted March 29, 2013 don't be so hasty to resign. not much better in the civilian world. we now have nurses calling back all of our pts to rate their visits on a scale of 1-10 in several categories. 10/excellent is a pass, 9 /very good is a fail. I remember back when 9 out of 10 was considered a good score.... none of this BS at my rural job. it's the only show in town. don't like it mr unhappy pt? drive 1+ hr to go to a place that isn't as good. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 29, 2013 Moderator Share Posted March 29, 2013 don't be so hasty to resign. not much better in the civilian world. we now have nurses calling back all of our pts to rate their visits on a scale of 1-10 in several categories. 10/excellent is a pass, 9 /very good is a fail. I remember back when 9 out of 10 was considered a good score.... none of this BS at my rural job. it's the only show in town. don't like it mr unhappy pt? drive 1+ hr to go to a place that isn't as good. Link to comment Share on other sites More sharing options...
3GeronimoPA Posted March 29, 2013 Author Share Posted March 29, 2013 I may just jump ship, go to law school and do medical defense... At least there are no health administrators there and I will still be doing something good for medicine. We are administratively running ourselves into the ground so much that all we are doing is maintaining systems. A patient could have great care with a note that doesn't meet admin requirements and it'll be judged as crappy care. We could have a patient with crappy care that has his Advanced Directive and Living Will addressed and meet the Joint's requirements and it'll be judged as excellent negative outcome or not. The Master's of Business Administration is piece by piece ruining America more and more. I'm punching the next Lean Six-Sigma mo-fo I see in the face. Link to comment Share on other sites More sharing options...
3GeronimoPA Posted March 29, 2013 Author Share Posted March 29, 2013 I may just jump ship, go to law school and do medical defense... At least there are no health administrators there and I will still be doing something good for medicine. We are administratively running ourselves into the ground so much that all we are doing is maintaining systems. A patient could have great care with a note that doesn't meet admin requirements and it'll be judged as crappy care. We could have a patient with crappy care that has his Advanced Directive and Living Will addressed and meet the Joint's requirements and it'll be judged as excellent negative outcome or not. The Master's of Business Administration is piece by piece ruining America more and more. I'm punching the next Lean Six-Sigma mo-fo I see in the face. Link to comment Share on other sites More sharing options...
Joelseff Posted March 29, 2013 Share Posted March 29, 2013 I'm punching the next Lean Six-Sigma mo-fo I see in the face. Bwahahaha! That made my day. My stupid EHR just had an "upgrade" last night that screwed up the superbills so now I have double work....they didn't go over all this crap in PA school. I spend MORE time documenting than actually diagnosing and treating it seems like....don't get me started on the Medicare required data points for a wellness exam.... Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Joelseff Posted March 29, 2013 Share Posted March 29, 2013 I'm punching the next Lean Six-Sigma mo-fo I see in the face. Bwahahaha! That made my day. My stupid EHR just had an "upgrade" last night that screwed up the superbills so now I have double work....they didn't go over all this crap in PA school. I spend MORE time documenting than actually diagnosing and treating it seems like....don't get me started on the Medicare required data points for a wellness exam.... Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
HMtoPA Posted March 29, 2013 Share Posted March 29, 2013 My main beef with AHLTA has always been how easy it is for a provider to just tick boxes when documenting their ROS & PE. It's ridiculous. I saw an NP last year for a shoulder strain and I swear she never laid hands on me. I recently looked up the AHLTA note, and you would think that she did a full physical on me! No S1 or S2 heard? No **** - she never pulled out a stethoscope! Nor did she do the full neuro exam she documented, etc., etc. It makes me livid. Like you, I rarely copy forward, on the premise that garbage in = garbage out. I'll sometimes copy forward current meds, PMHx, PSHx, etc. - but only if I've actually confirmed it. As you said, EMR's are a medical coders wet dream, but we really need actual clinicians designing this software. Link to comment Share on other sites More sharing options...
HMtoPA Posted March 29, 2013 Share Posted March 29, 2013 My main beef with AHLTA has always been how easy it is for a provider to just tick boxes when documenting their ROS & PE. It's ridiculous. I saw an NP last year for a shoulder strain and I swear she never laid hands on me. I recently looked up the AHLTA note, and you would think that she did a full physical on me! No S1 or S2 heard? No **** - she never pulled out a stethoscope! Nor did she do the full neuro exam she documented, etc., etc. It makes me livid. Like you, I rarely copy forward, on the premise that garbage in = garbage out. I'll sometimes copy forward current meds, PMHx, PSHx, etc. - but only if I've actually confirmed it. As you said, EMR's are a medical coders wet dream, but we really need actual clinicians designing this software. Link to comment Share on other sites More sharing options...
Joelseff Posted March 29, 2013 Share Posted March 29, 2013 My main beef with AHLTA has always been how easy it is for a provider to just tick boxes when documenting their ROS & PE. It's ridiculous. I saw an NP last year for a shoulder strain and I swear she never laid hands on me. I recently looked up the AHLTA note, and you would think that she did a full physical on me! No S1 or S2 heard? No **** - she never pulled out a stethoscope! Nor did she do the full neuro exam she documented, etc., etc. It makes me livid. Like you, I rarely copy forward, on the premise that garbage in = garbage out. I'll sometimes copy forward current meds, PMHx, PSHx, etc. - but only if I've actually confirmed it. As you said, EMR's are a medical coders wet dream, but we really need actual clinicians designing this software. Did she note, no s1 or s2? Were u dead? Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Joelseff Posted March 29, 2013 Share Posted March 29, 2013 My main beef with AHLTA has always been how easy it is for a provider to just tick boxes when documenting their ROS & PE. It's ridiculous. I saw an NP last year for a shoulder strain and I swear she never laid hands on me. I recently looked up the AHLTA note, and you would think that she did a full physical on me! No S1 or S2 heard? No **** - she never pulled out a stethoscope! Nor did she do the full neuro exam she documented, etc., etc. It makes me livid. Like you, I rarely copy forward, on the premise that garbage in = garbage out. I'll sometimes copy forward current meds, PMHx, PSHx, etc. - but only if I've actually confirmed it. As you said, EMR's are a medical coders wet dream, but we really need actual clinicians designing this software. Did she note, no s1 or s2? Were u dead? Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted March 29, 2013 Moderator Share Posted March 29, 2013 Excited about serving in the Navy! Thanks for giving me something to look forward to ;) Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted March 29, 2013 Moderator Share Posted March 29, 2013 Excited about serving in the Navy! Thanks for giving me something to look forward to ;) Link to comment Share on other sites More sharing options...
HMtoPA Posted March 29, 2013 Share Posted March 29, 2013 Lol, typed too fast for my brain. Meant no S3/S4. Link to comment Share on other sites More sharing options...
HMtoPA Posted March 29, 2013 Share Posted March 29, 2013 Lol, typed too fast for my brain. Meant no S3/S4. Link to comment Share on other sites More sharing options...
jsfelder0417 Posted March 29, 2013 Share Posted March 29, 2013 Hahaha. No S1, S2, summation gallops or murmurs Link to comment Share on other sites More sharing options...
jsfelder0417 Posted March 29, 2013 Share Posted March 29, 2013 Hahaha. No S1, S2, summation gallops or murmurs Link to comment Share on other sites More sharing options...
3GeronimoPA Posted March 30, 2013 Author Share Posted March 30, 2013 Excited about serving in the Navy! Thanks for giving me something to look forward to ;) No problem. Anytime you need more motivation just give us a shout. Link to comment Share on other sites More sharing options...
3GeronimoPA Posted March 30, 2013 Author Share Posted March 30, 2013 Excited about serving in the Navy! Thanks for giving me something to look forward to ;) No problem. Anytime you need more motivation just give us a shout. Link to comment Share on other sites More sharing options...
Joelseff Posted March 30, 2013 Share Posted March 30, 2013 Lol, typed too fast for my brain. Meant no S3/S4. No worries doc... ;) just bustin u up some.... Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Joelseff Posted March 30, 2013 Share Posted March 30, 2013 Lol, typed too fast for my brain. Meant no S3/S4. No worries doc... ;) just bustin u up some.... Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Guest Paula Posted March 30, 2013 Share Posted March 30, 2013 My main beef with AHLTA has always been how easy it is for a provider to just tick boxes when documenting their ROS & PE. It's ridiculous. I saw an NP last year for a shoulder strain and I swear she never laid hands on me. I recently looked up the AHLTA note, and you would think that she did a full physical on me! No S1 or S2 heard? No **** - she never pulled out a stethoscope! Nor did she do the full neuro exam she documented, etc., etc. It makes me livid. Like you, I rarely copy forward, on the premise that garbage in = garbage out. I'll sometimes copy forward current meds, PMHx, PSHx, etc. - but only if I've actually confirmed it. As you said, EMR's are a medical coders wet dream, but we really need actual clinicians designing this software. Copy and forwarding past treatment plans and making it your treatment plan will be 3Geronimos dream when he is a lawyer. I have seen articles about the dangers of copy,paste, clicking boxes mindlessly that is unchanged from visit to visit. You may not be reimbursed if nothing changes. Also, pointing and clicking boxes of stuff you never did will lead to lawsuits somewhere down the line. Link to comment Share on other sites More sharing options...
Guest Paula Posted March 30, 2013 Share Posted March 30, 2013 My main beef with AHLTA has always been how easy it is for a provider to just tick boxes when documenting their ROS & PE. It's ridiculous. I saw an NP last year for a shoulder strain and I swear she never laid hands on me. I recently looked up the AHLTA note, and you would think that she did a full physical on me! No S1 or S2 heard? No **** - she never pulled out a stethoscope! Nor did she do the full neuro exam she documented, etc., etc. It makes me livid. Like you, I rarely copy forward, on the premise that garbage in = garbage out. I'll sometimes copy forward current meds, PMHx, PSHx, etc. - but only if I've actually confirmed it. As you said, EMR's are a medical coders wet dream, but we really need actual clinicians designing this software. Copy and forwarding past treatment plans and making it your treatment plan will be 3Geronimos dream when he is a lawyer. I have seen articles about the dangers of copy,paste, clicking boxes mindlessly that is unchanged from visit to visit. You may not be reimbursed if nothing changes. Also, pointing and clicking boxes of stuff you never did will lead to lawsuits somewhere down the line. Link to comment Share on other sites More sharing options...
HMtoPA Posted March 30, 2013 Share Posted March 30, 2013 Also, pointing and clicking boxes of stuff you never did will lead to lawsuits somewhere down the line. Not so much in the military health system (thank you, Feres Doctrine...). Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.