29 Replies to “How’s That Hopey Changey Thing Working Out For Ya?”

  1. This sort of thing came up in Saskatchewan and probably the rest of Canada when they brought in Medicare. The reality was that there was still lots of money in medicine. To Kitech, good riddance.

  2. O’bummer trolls must be getting paid to do this because otherwise there would be no reason for them to get up this early to leave comments like this.

  4. Many doctors understand that Obamacare is a methodical plan to cull the stupid, the sick, the weak and the elderly, and they want no part of it.

  5. Apologies, I misspelled Kiteck.
    L, a question. Would you willingly be a slave of the state? That’s what doctors are under socialized medicine. They can only work for the state at a rate of pay set by the state, cannot extra bill and have a maximum yearly pay. Out of that pay they have to pay the rent and utilities for their office, their office staffs pay and for supplies and insurance. I probably take home more money than my GP does and I didn’t go through 7 seven years of University and internships.

  6. It’s a pity he apologized for the inconvenience. It was not he who is responsible for the situation that presented itself to his clientel.
    “L” doesn’t understand or is likely unaware of the financially ruinous rate schedule that Obamacare imposes on doctors. Here is an article regarding this in California: http://m.washingtonexaminer.com/doctors-boycotting-californias-obamacare-exchange/article/2540272
    Please note that it isn’t always about money for doctors. Doctors (both in Canada and the USA) are acutely aware of when they are being pigeon holed and lead to involuntary servitude. Remember the American revolutionary’s words (Samuel Adams) “May the chains lay lightly upon your chest” when he chastised Loyalists for the continued acceptance of crown rule. It is for this reason alone that a single payer system would never work in the USA. Americans doctors will not accept what amounts to paltry “wages” when they can freely price compete their skills in an open market (which we do not have in Canada in the broad sense of health care). Anyone who demands of them otherwise is in effect advocating the enslavement of doctors. And that is the ultimate selfishness.
    Please excuse the verboseness of my comment.

  7. I see that Colon (sic) Powell has come out for single payor.
    That was, and is, the plan.
    See, we tried the free (sic) market (sic) and it didn’t work due to capitalist (sic) greed.
    Sick.
    Cloward-Piven pivot.

  8. The single payer result was the plan all along. This was designed to fail and plant the blame. Rationed health care, welcome to crumbling hospital infrastructure, and long wait times, just like Canada. yipee.

  9. I was just on a cruise and obamacare was the topic of many, many conversations. It reminds me of the sponsorship scandal in terms of outrage at least from what I heard over the course of the week. I suspect that there’s far more discontent than even shows up in polling.

  11. I hope the good doctor has his financial records in order as he is about to be subjected to a vigorous audit by the IRS.

  13. Ah yes, sourced from the Daily Kos, “All the news that’s fit to the needs of Obama “(Peace be upon Him)”

  14. Probably the first of many such practice closures. I’ve been in a situation where I had to decide about transfering paper records to electronic form and it would have cost tens of thousands of dollars. I didn’t realize that Obozocare required electronic records; what I’m curious about is whether these will be centralized electronic records. Consider what a treasure trove these would be for the NSA! “Mr. Smith, I see you were treated by your doctor for chlamydia last year. Your wife might want to know about that, but if you cooperate with us in investigating one of your co-workers, there will be no need for us to tell your wife.”
    Recently I did a study of how long it takes to enter data in an EMR compared to paper records in an office with an efficient MOA. The difference was that paper records were 3-5 minutes per patient faster. Last night brought up this statistic at a medical dinner and had agreement from the majority of physicians that EMR slowed down their practice. The main argument from those in favor of EMR’s was that they could graph out lab results and access things faster but there was no disagreement from this group of physicians that EMR’s slowed down office visits. Thus, I’ve decided to go back to paper and won’t be using an EMR except for the one I’m writing myself.
    This may be a great patient recruitment tool. Those people who aren’t desirous of the government knowing what they’re doing can be reassured that not only does any statist agency have to obtain a subpoena to access the paper records, they also have to hire a translator who’s able to convert doctors writing to English. Also, they can’t simply search the records for certain words until they’ve been typed up and entered into a word processing program. Going on a fishing expedition in a paper records based office is an endeavor taking tens of thousands of hours of time. What I’ve found after decades of practicing medicine is that the most important medical information on patients is held inside my head and it always amazes me when I get a call from the local ER asking for more information about one of my patients who’s come in confused and generally I’m able to recall every significant medical issue they have as well as what drugs I’ve recently prescribed for them.
    What it would take me to convert to an EMR now in BC would be a $5-10 EMR surcharge that I’d be allowed to bill for every patient I see who has an electronic record as well as the right to refuse to store my data in a government server. The BC government demands that any physician who utilizes their subsidized EMR’s stores all their data outside of their office in a government server. I would refuse to have my medical records stored in such a fashion as have 80% of the patients that I’ve asked.
    I forsee a sudden and dramatic shift back to paper medical charts in the US in the near future.
    Once scheme I came up with was to have an EMR where both the physician and patient would encrypt the data with their PGP keys. Thus, to view the data would require the patient to input their key after the doctor enters their key. Without the patients key, the data remains encrypted. One reason I came up with this scheme is that, if one is served with a subpoena to produce medical records, one must do so or go to jail. The portion of the medical records that a physician would be able to produce are those that are decrypted by his PGP key. If the patient doesn’t believe it’s in his interest for a court to have access to the records, then he can withold his decryption key without penalty. Presumably doctor and patient would agree on which sections of the medical record were to be doubly encrypted and which would be singly encrypted.

  15. // Ah yes, sourced from the Daily Kos, //
    +
    Right. From the horse’s mouth —
    // Kiteck said he is approaching retirement age, and that he and his office are “computer illiterate, //
    He’s old, ignorant & can’t be bothered. Even to check the real source of the electronics requirement —
    // Though Kiteck’s ad blames Obamacare, the electronic health care incentive programs were part of the American Recovery and Reinvestment Act in 2009 — the federal stimulus act — and not part of the Affordable Care Act, according to the Centers for Medicare and Medicaid Services. //
    Physicians are wonderfully conservative. Pharmacists must be laughing.
    &
    Quick-Lube Shop Masters Electronic Record Keeping Six Years Before Medical Industry

  16. As usual and excellent post, Loki. Interestingly yet not surprisingly I wonder if that Kos kid really weighed that into consideration when they dared post that Dailykos drivel here. Oh stars, what was I thinking, of course not.
    Folks, forget about single payer in the United States. If in the similar situation legislatively (Dem. president, super majority Dem. Senate, majority Dem. HoR) that brought Obamacare upon an American’s life were to exist again, then single payer may appear if only in legal form as the law of the land in the USA. But, in practice, it can be said with certainty that that would drive the stake into the American health care system once and for all and may lead even to societal collapse. Think about it. How are you going to get an American doctor in private practice to work for government issued cheese wages as they do in Canada? Threaten them with the loss of their practitioner’s licence if they extra bill or work outside the system for cash as they do here? Yeah, sure great plan. As if the doctor’s shortage in the US were not profound enough as it is without something like that aggravating it even more so. And that’s just scratching the surface of all that could, no, will go wrong with single payer in America.

  17. I hope he has all his receipts in order.
    I wonder how long until the IRS gets an audit notice out to him?

  18. Oh dear. Did that Kos-kid just compare an automobile service company’s record keeping with that of a medical practice? My my. The mind truly boggles. Well, not really.

  19. It must astound God that he produced a human as mischevious and/or dumb as you.
    “Though Kiteck’s ad blames Obamacare, the electronic health care incentive programs were part of the American Recovery and Reinvestment Act in 2009 — the federal stimulus act — and not part of the Affordable Care Act, according to the Centers for Medicare and Medicaid Services. //”
    Both of these acts were produced by the exact same people and in the same year. If you are so dumb as to think they aren’t related and complimentary, you are truly beyond help. Typical useful idiot.
    At a recent visit to my opthamalogist’s office (I don’t care if it isn’t spelled right) for a routine exam, I was ordered to fillout forms that had to do with my sexuality, what illegal drugs did I use, etc. I handed the clipboard back to the girl and said the information required is not germane to my examination. I then said welcome to obamacare. Of the dozen other people in the waiting room all applauded me, stood up, and said hear! Hear! The dumb young broad yelled at me that obamacare was great and I shouldn’t talk about the president that way. The doctor fired her. She can go back to her welfare, ten kids and dope.

  20. Oh, I forgot. The girl told me she had to convert all their records to electronic files before the end of the ear. Medicare demands it. I explained that Medicare did pay my eye doctor bills. And, the information they wanted was private and should not be given to the government.

  21. // Did that Kos-kid just compare an automobile service company’s record keeping with that of a medical practice? //
    +
    It’s a joke son.
    But I think a comment or two is an indicator that electronic medical records are not entirely Un-American.
    //
    Greg Brown · Top Commenter · University of North Texas
    This is a doctor at retirement age who doesn’t want to learn anymore and wants to score a political point on his way out. My oil change shop down the street has electronic records. They can pull up everything about my car in a millisecond. Why shouldn’t my doctor be expected to do the same?
    Peter D’Souza
    Was your oil care guy running a well-established practice at the time he installed his electronic system? Was he required to convert every single record to the electronic system?
    Greg Brown · Top Commenter · University of North Texas
    Peter D’Souza I am an RN at a Veterans Medical Center. When we have a patient present to us here in Texas we can access his medical records in Nebraska and know everything that is going on with him and treat him appropriately. Very powerful stuff. Reduces costs and errors. Anyone that would complain about the “hassle” of electronic medical records is putting the patient dead last in priorities. Pun tragically intended.
    //
    For Loki, a rather more detailed discussion of a Utah private system which outlines how important electronic records can be for saving lives in hospitals, especially in the avoidance of iatrogenic injuries. A short quote —
    // The computer-based system detected 80 times more adverse drug events than the voluntary reporting system. //
    Minimising Harm To Patients In Hospital
    with Norman Swan Australian BC Health Report
    http://www.scribd.com/doc/5304253/HealthCareMinimizingHarm

  23. “I explained that Medicare did NOT pay my eye doctor bills.” Fixed it!Sorry, that made no sense in context. I don’t want to get beat up by all the other seniors for whom medicare pays nothing on vision.

  24. Old Country Boy, having to convert all paper medical records to electronic format is the most idiotic thing that I’ve heard. In Canada, practices that go to EMR’s rarely do so given the expense of conversion. For example, what’s left of my Vancouver practice occupies 60 bankers boxes. Let’s assume that this results in 1500 sheets of paper/box, or a total of 90,000 sheets to be scanned. My predecessor had the habit of stapling multiple copies of lab results to one page and the physician notes are double sided. Because of this, we’re likely dealing with about 180,000 individual documents that need to be scanned.
    Unlike nice clean files from other disciplines, paper medical charts are particularly hostile to scanners given that one might have a lab result that has a scrawled doctors note on it, a stapled MOA note about not being able to contact the patient, a post-it note from the doctor on top of that stapled note, etc. Everything dated and making perfect sense except the only way that one can input probably 50% of this material is to photograph it. I found that photographing charts with a digital camera was far faster than scanning them although my previous receptionist was able to quickly sort the charts into a form where she could scan about 70% of them. Nevertheless, even though she was incredibly efficient, it would take her 30-60 minutes to scan a chart.
    Let’s assume that one has access to such efficient staff (and the boredom of this task can’t be overstated) who are 100% error free and are able to scan 2 pages/minute. This would require 90,000 minutes or 1500 hours to do. Furthermore, a $10/hour person is likely to screw up a lot and thus one will likely end up either paying 2 people $10/hour; one person scanning, the other person checking or $20/hour or more for a very efficient person like my Vancouver MOA. Total cost of scanning my remaining Vancouver charts – some $30,000. I should note that I managed to convince a lot of Vancouver GP’s to store my patients charts in their offices and thus the 60 boxes of charts represent about 40% of the total charts I started with and thus scanning of all of my Vancouver practice charts would have cost $75,000. Needless to say, I shelved the idea of digitizing all of my patient charts.
    THAT’S WHY statist governments want doctors to digitize all of their charts; a random fishing expedition through a paper based practice would be very expensive for the government. OTOH, if they force physicians to scan all their paper charts then such fishing expeditions are much easier but one is still protected to some extent by the very nature of physician handwriting which will likely remain undecipherable even when handwriting recognition programs are routine.
    So, the new anti-statist stance by physicians should be keeping of paper charts, or using strong encryption with a patient supplied password on EMR’s to really annoy statists. Given that I’ve recently found that using an EMR slows me down considerably, I’m sticking with paper unless I’m compensated for my additional time to use an EMR. Expect this doctors practice closing to be just one of many thousands as, despite the stupidity of Canadian medical systems, not one has even considered having physicians be forced to use an EMR.

  25. Is it really true that Canadian doctors are largely “anti-statist”? Judging by the public comments of bigwigs in organizations like the CMA, pharmacy associations, etc., they seem to have lurched radically to the left. That doesn’t mean all medical personnel agree, but these people managed to get themselves elected somehow.

  26. Loki,
    I respect what you are saying, but…
    How many people die each year because they are given the wrong combinations of medicines – something that could be avoided if their medical records were available?
    I understand it may take you 3-5 minutes longer to create digital records rather than paper, but you left out retrieval. Since most records are written once, and retrieved often, if it takes 5 more minutes on the creation side, but saves 30 seconds on retrieval, you only need to retrieve that record ten times to make it worthwhile. A single access from someone WHO IS NOT ON YOUR SITE – like an ER doctor, for example – will save all the extra time you put in upfront, and more.
    I recently went through a three-step between my GP, a podiatrist, and an X-ray clinic. The GP ordered the X-rays, but it was the podiatrist who wanted to see them. Not online, so the clinic said my choices were pay an extra $15 to have them put on CD, and then come and pick them up from their West-end Toronto office, and take it myself by hand to the podiatrist in central Toronto. This would have cost me half a day off work, as neither podiatrist nor clinic were open on weekends.
    I noted my 2nd last GP used dictation software on his computer to speak his notes directly into the machine. As dictation software improves, I’m sure this will reduce the time differential between manual and electronic records (most people speak 2-3 times as quickly as they write).
    EMR makes sense. I understand it’s a PITA for you, but as a patient, I’d rather my records be accessible easily when I travel.

  27. KevinB, I agree with you about the benefits of having an EMR. I’ve been writing my own for the last 20 years and just have a self-written quasi-EMR which I primarily use for timing patient encounters. Combine that with a key and mouse logger for my laptop and I have a very good idea of where my time is spent to the second. A fortuitous chance to help out a colleague by doing a locum in a totally paper-based practice allowed me to obtain high temporal resolution timing data on how long it took to see patients there compared to an EMR based practice. The results were quite significantly in favor of the paper-based practice.
    Rather than letting doctors create EMR’s, the BC governments PITO program has come out with a bureaucratic nightmare of EMR’s they will partly cover but this absolutely required that a central server be utilized. The statists don’t believe that physicians should be allowed to have their own local server and frown upon having any records stored locally in a physicians office for “security” purposes. I reject this model believing that the fastest access times to data are obtained with a local server. The highly centralized server model is the basis of all statist EMR systems and it’s s l o w. The EMR that I’d like to have someday would have every piece of data gathered on a patient in my office server including DICOM files for xrays, digitized EKG’s, all consults in digital form as well as my own records. Depending on the paranoia level of patients, I’d even consider 2 level encryption where sensitive data was encrypted with both my encryption key and a patients personal key which would require both keys to decrypt the data (I don’t have a choice but to provide data when asked to under a court order).
    That decentralized model is the exact opposite of what is happening in Canadian medicine and my response to this is to refuse to go along with it. This is the model that every dentist’s office uses with a local server and no off site storage of data except for backup purposes. Every other organization uses local servers but this approach makes it much harder for statists to get access to data.
    So, for the moment, I’m going totally back to paper records as well as working on my own personal EMR which, if I merged it with Oscar, would give me a fully functional EMR except my code is in VB6 and Oscar is Java and lots of Javascript.
    Providing good medical care is not the goal of statists. Their primary goal is control and by having centralized systems they maintain complete control of data despite the well known increased robustness one has in a system with multiple distributed servers and local caching of data. The don’t give a rats ass about patient conveniences as, in the perverse system that constitutes Canadian medicine, every patient encounter is viewed as a money loser and hence the system is to reduce patient contact with physicians as much as possible leaving the money for the true beneficieries of this system which are statist administrators. In a dentists office, the more people one sees, the better, as this increases ones revenue. Hence the opulent nature of dentists offices along with all of the latest toys like a dental CT scanner in my endodontist’s office and a totally computerized well functioning dental records system.
    From a patients point of view, I completely agree with you. It’s just that doctors can’t charge extra to provide better care and patients are forbidden to pay for better medical care in this country. If you want to see how statists can pervert a simple EMR process, go to the PITO website. This is BC’s bureaucratic system that I absolutely refuse to have anything to do with. From a security point of view, you can’t beat paper records as I pointed out in my previous post. As far as voice recognition goes, there’s no advantage to me as I type very fast and spend more of my time correcting mistakes from the dictated copy than it takes me to simply type something. Was talking to a colleague the other day and he bought the “medical” version of Dragon which works for him but that costs about $1 K. Again, given the lack of any ability to recover that money easily in a Canadian medical practice, it’s not something I’ll be doing.

  28. Dizzy – try reading a book sometime , it might illuminate you.
    Many physicians run efficient , ethical practices without EMR (electronic medical records)
    The forced change is extraordinarily expensive , even using laughably “free” systems.
    Try paying someone to scan 30 years of practice records into pdf like I had to.
    You are an idiot.

  29. Are you a troll or simply an idiot.
    “Pharmacists are laughing”
    Pharmacists will not accept EMR presciptions that are not hand signed with a pen.
    “Idiots are drooling”

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