Government role in healthcare can be a double-edged sword, and other letters

Regarding the online letter, “Get Catholic Church out of hospital administration” , the governing institution, as well as individual practitioners, should get to determine how they deliver healthcare in accordance with their ethical principles. I would have no objection to the government making payments for healthcare services that it deems necessary to be delivered and thereby favoring certain institutions. However, we should be aware that the government dictating what healthcare should be delivered is a double-edged sword and, in the past has resulted in certain services not being provided, including those with which the original writer is concerned.

Stephen Johnson

Regarding the article "Taking the EHR penalty: Many doc offices may opt out”, there is an underlying reason physicians are choosing to opt out of the electronic health-record “meaningful use” program and EHRs in general. The systems are not creating value that is meaningful. The reason is the clinical provider note function offers no meaningful information except at the end of the note. And that clinical assessment and plan may be limited in scope.

To support this notion of meaningless clinical information, HHS' Office of the Inspector General has issued a report noting doctors are using the cut-and-paste function too often and are creating cloned notes. Are we not surprised by this recent report? After all it was the American Medical Association and then the CMS that created the template for the meaningless note. Now all EHR systems are supposed to be designed to help the provider document the information efficiently, but instead it takes too much time to enter the data. So physicians are reverting to dictating the note. Hence the cut-and-paste feature that helps create efficiency now has become the physicians' worst nightmare.

Is it possible that the idea of creating meaningful reporting of specific clinical information in Stage 1 of meaningful use is because the information is not available in the provider note? So why are the architects of EHRs so focused on meaningless information as presented in the different stages of EHR incentives when in fact the community should be focused on redesigning the provider note so it contains meaningful information that offers the value the healthcare industry is looking for?

Martin Neltner

“Hospital pushes for quiet on the set” is an interesting article—relevant and timely—but only on a superficial level. I fear it perpetuates the problem and does not contribute to a widespread national solution to the noise plague in our country's healthcare system. What are considered “best practices” (many cited in the article) do not actually work. Based on a study my company conducted with the Beryl Institute, only 12% of 241 hospitals trying to reduce noise by following “best practices” judged their efforts as successful. Reducing the patient perception of noise and increasing scores for the “quiet at night” question on the national HCAHPS survey requires a complete paradigm shift, not a hurried leap into easy tactics. Hospitals commonly form a volunteer noise committee and jump right into tactics such as posters and earplugs. The subsequent lack of results will likely produce initiative fatigue after years of trying. Noise prevention must be approached with the same intensity as infection prevention. It should have the same structure, executive support, long-term commitment, monitoring, accountability and vigor. And it should be a facilitywide initiative. Most hospitals attempting it on a unit basis judged their success as “poor” or “fair.” A noise-reduction initiative should begin with a formal and thorough culture assessment to identify barriers and landmines lurking in the future that threaten to kill the initiative before it gets traction. Hospitals then need to establish a system for patients, visitors and staff to report and document noise issues; and there should be a response team to address them promptly. The data need to be analyzed regularly to identify required changes, and those changes should be worked into an actionable quality-improvement plan. Only after all this behind-the-scenes foundation work is completed can any progress be made and sustained.

Gary S. Madaras