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MILITARY "worse than HMO" paperwork

Discussion in 'Military Medicine' started by USAFdoc, Nov 13, 2005.

  1. USAFdoc

    USAFdoc exUSAFdoc
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    The military does NOT have a monopoly on "paperwork overload"; there are problems in civilian medicine as well. BUT, the military is exponentialy WORSE than anything I have ever seen compared to my civilian experience. Other docs please feel free to add to the below list that shows the military IS THE LARGEST HMO in todays health care market, and all the negatives that go with that. See the next thread for the start of the list. For docs still waiting to get to their military practice, have your pens and your patience primed.
     
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  3. USAFdoc

    USAFdoc exUSAFdoc
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    let me say some specifics on just what kind of worthless paperwork,and sometimes needed but someone else should be doing it paperwork going on.


    1. MEPRS. how about being askedevery month to list how much time you spend doing EKGs,seeoing patients,exercising, deployment training,commander meetings, leave,holidays,weekend clinic etc. Basically you have to track everything you do and send it in so the SG can have his metrics.
    2. Injury reports: so a guy sprains his ankle, well now you need to prepare a form 12 injury report,fill out an injury log, fill out a profile form, perhaps a sick quatrters form so he can be excused from mandatory PT,in addition to all the regular office notes, also,the mil keeps OTC meds like motrin so scripts for those meds as well,...all for just a simple ankle.
    3. 4T profiles: these are all the troops with some sort of illness,pregnancy etc that keeps them from being deployable. Every month forms must be updated,filled out,signed etc, Used to be done by a specific other dept, but like about 20 other things,all are now given to the family docs to do.
    4) PGUI: this is a pseudo electronic med health record. Docs mandated to use it to code patients, even though we already are paying coders to do that job and other paperwork contains the code. The system is slow and was developed for tracking statistics, not patient care. Frequent computer breakdown further add to the unnec part delay of this system. And it still must be printed out and signed to be put in a record (if you can find the patienrts record).
    5)Referals: if a mil doc needs to make a referral,get ready for "hoop jumping" to the nth degree. First the doc must type in the referral and all details into the computer (about a 20 step process NOT including the 1-2 paragraphs needed of patiet hx so that it is not denied). Then it goes electronically over to the other side of the base, then faxed to TEXAS (no matter where your base is). Then they either fax it back to the home base if there is a problem, and mail a copy to the patients home address (if they have it). Then it is up to the patient to call on their own to schedule their appt with the specialist. Results coming back to the doc follow a just a convoluted path.....in the end many referrrals never happen, the military doc left holding the "litigation" bag. This is a far far far cry on the steamlined simple referral process I have as a civ doc.
     
  4. DrB

    DrB Family Medicine Resident
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    Any thoughts onto the military, one day, going paperless? This may solve a lot of the above problems. I know the civilian world is trying to go down that road. Does military med advance the frontier of medicine or lag tirelessly in the past?
     
  5. Homunculus

    Homunculus SDN Caveman Administrator
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    CHCSII is the military's "paperless" system. it's supposed to allow complete portability in a paperless system at any MTF you may go to. it just went live here about a month ago, and the jury is still out. personally i think it works very well for probably 80% of what we see. its shortcomings arise when facing complex patients with multiple issues or ones that don't fit a set template very well. so far i give it a :thumbup: , but things may change.

    --your friendly neighborhood CHCSII qualified caveman
     
  6. USAFdoc

    USAFdoc exUSAFdoc
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    I agree. I have heard good things about it from Optometrist and similar providers that deal with one problem patients. Guess about how often a family doc sees someone with just one problem.......about once a day. It is the norm to see patients with 3-6 problems....now try doing all the typing and data entry for that on a slow system in a 10 min visit.

    And how much doc input do you think goes into making these kinda decisions...........ZERO.
     
  7. Mirror Form

    Mirror Form Thyroid Storm
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    The advantage of CHCS II is that when the patient shows up, you can easily look up old notes, med lists, etc. It's extremely useful from that standpoint. However, in terms of writing notes, it tends to slow most poeple down a bit. I personally think it's okay. The main problem is that you can't draw pictures with it, and pictures and symbols are important parts of many notes. It has some tools that are supposed to allow you to, but using them literally would take all day. I'm actually surprised that the optometrist liked it b/c most ophthalmologists despise it due to the fact that a typical ophthalmology note is packed full of pictures and symbols, none of which can be replicated by the program.
     
  8. USAFdoc

    USAFdoc exUSAFdoc
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    and even if CHCS was FP friendly, which it isn't, the above paperwork drain examples I mentioned are not part of CHCSII.
    CHCSII just made a bad FP job a more time consuming bad FP job.
     
  9. USAFdoc

    USAFdoc exUSAFdoc
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    many people who use EMRs still have papercharts as well. How will the military get referral results ,imaging studies etc put on their EMR (CHCSII)?>.........they won't,and you will still need the chart.....oh by the way,when I saw pts,I had a chart only 10-40% of the time,....now as a civilian,100% of the time!
     
  10. USAFdoc

    USAFdoc exUSAFdoc
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    Another "nightmare" paperwork USAF problem......MEBS (medical evaluation boards). In my 3 years USAF, I had to redo nearly every one of my MEBs, not because they were wrong, but because administration sat on the paperwork so long that they were out of date (limits range from 30 days to 3 months). Also, the politics and nonsense of these boards were unbeleivable. I had an active duty troop with a seizure disorder that was RETURNED to full duty despite the fact that she was have loss of consciousness/seizures on a weekly basis...........I know 1st hand because she was a nurse! I also saw tests have to be repeated just because they were a few months old (like a methcholine challenge for asthma repeated that showed definite asthma previously). Waste of time and money!
     

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