Messages from insurance regarding meds and liability

[nexus73]

We get these messages from insurance companies all the time. Your patient is on Prozac and trazodone...this could cause serotonin syndrome, just so you know (but not really, unless they take all 30 days at once and probably not even then). Or any other list of interactions we don't really care about in day-to-day practice. I used to just trash them.

But we just switched to Epic and they come electronically now, so there's a record of me getting this damn message, and a record that I clicked on it and it was open with me looking at it for 15 seconds. I hate that this comes in, this busy work, that gets dumped on our plate, under the guise of "insurance cares about patients".

So, if I get a warning, which is truly meaningless, about serotonin syndrome and ignore it, don't document anything (because I saw the patient two weeks ago and don't have an encounter open), if ever sued this seems like a great way to paint me as a thoughtless doctor. Like I'm not even taking warnings from the insurance company, who cares about the patient enough to send an automated message. Does anyone know if these messages can be blocked? Why do we bring these EHRs into our lives to make things worse?

If the message said "hey you know the Seroquel you just prescribed to augment this patient with TRD will increase his Tegretol levels a fair amount" that would have been great about 3 years ago...but I never seem to get messages like this. It's always, "You know this patient is on multiple psychoactive medications" including their Prozac, Trazodone from me, PLUS the Gabapentin from PCP for fibromyalgia...dear god prep an ICU bed.

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[calvnandhobbs68]

that sucks, I tell my secretary to basically throw them all in the trash

 

[Sushirolls]

They are meant for ARNPs, prescribing psychologists, PAs etc.
It provides job security for a pharmacist or two somewhere who think they are contributing positively to the health care team.

I have a much longer, negative rant meant for in person on this topic and other peripheral things.

 

[Fan_of_Meehl]

This crap of cumulatively stripping practitioners of decisionmaking authority whilst constantly blowing the trumpets reminding them of their medicolegal risks (even while practicing within well-established standards of care/practice) will continue until the actual practice of medicine grinds to a complete halt. Everyone will be 'safer' then, right?

Two quotations by great men that keep me from throwing in the towel these days:

"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes up short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat." - T. Roosevelt

and

"Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience. They may be more likely to go to Heaven yet at the same time likelier to make a Hell of earth. This very kindness stings with intolerable insult. To be "cured" against one's will and cured of states which we may not regard as disease is to be put on a level of those who have not yet reached the age of reason or those who never will; to be classed with infants, imbeciles, and domestic animals." - C.S. Lewis

 

[mistafab]

The warnings you are experiencing are called a "physician nudge." They are a minimally confrontational warning that is supposed to change prescribing habits. It is created by EMR technologists in tandem with quality improvement staff (typically masters level, nursing, or social workers) and some physicians. No one cares about your clicks in a lawsuit unless you are committing crimes. They don't need to say that you ignored the warning, and prove it with clicks. They can simply say that by prescribing the med, you are supposed to know this side effect and you ignored that it was possible. They can cite the FDA and say the FDA specifically warns that this is possible. You are a dumb doctor because the side effect happened. This takes a lot less work to prove, and gives a prosecutor the same level of credibility. No one is going to waste 50 hours to collect and interpret your lifetime of clicks related to this case as it doesn't actually help a prosecutor.

This is purely quality improvement projects that perpetuate to the Nth factor forever, in constant striving by people employed to reduce outcomes/metrics that measure the quality of care of the facility. It is their job to look for things to improve, so this will continue to grow.

Thankfully, some places are starting to employ people who's job is to literally increase efficiency of EMR, due to the above bloat. Hopefully this starts to role out and become helpful.

 

[wolfvgang22]

Thankfully, some places are starting to employ people who's job is to literally increase efficiency of EMR, due to the above bloat. Hopefully this starts to role out and become helpful.

This is a lot like treating the serious side effects of a medication of questionable utility with another medication that has even worse effects. Aaggh!

I have a lot of anger for the people whose whole career is predicated on causing this misery. Hopefully I never meet one in a dark alley somewhere.

 

[FlowRate]

There are a lot of things to rage about but IMO this is not one of them. Some systems do have an excess of irrelevant warnings. Most of the warnings I get in my system are relevant or, most frequently, relevant to anyone who isn't making the warned decision intentionally. Just click "curr/prev tolerated" or "not relevant" and move on.

 

[comp1]

I like my EMR warnings generally, but they are often hospital specific even across the same EMR, eg Epic. The quality varies. Second the above statements about medicolegal issues. This is not how these cases work. Just accept the pop-ups as the tools they are and not a weapon that's going to be wielded against you.

 

[clausewitz2]

This is a lot like treating the serious side effects of a medication of questionable utility with another medication that has even worse effects. Aaggh!

I have a lot of anger for the people whose whole career is predicated on causing this misery. Hopefully I never meet one in a dark alley somewhere.

Couldn't find the video, unfortunately:

SKINNER Well, I was wrong. The lizards are a godsend.

LISA But isn't that a bit short-sighted? What happens when we're overrun by lizards?

SKINNER No problem. We simply unleash wave after wave of Chinese needle snakes. They'll wipe out the lizards.

LISA But aren't the snakes even worse?

SKINNER Yes, but we're prepared for that. We've lined up a fabulous type of gorilla that thrives on snake meat.

LISA But then we're stuck with gorillas!

SKINNER No, that's the beautiful part. When wintertime rolls around, the gorillas simply freeze to death.