The PJ Tatler

An Obamacare Mandate Connection to the Dallas Ebola Case?

The blog Enjoyment and Contemplation has a transcript of an NPR broadcast from earlier today. NPR almost connects the Ebola case in Dallas to an Obamacare mandate — they just don’t do the math. The speakers here are NPR Morning Edition host Steve Inskeep and NPR science correspondent Geoff Brumfield.

INSKEEP:  Geoff, I want to ask about one other thing.  Of course there have been many questions about why it was that the man with Ebola at one point checked into a hospital and was sent away again.  Is it better understood how that happened?

BRUMFIEL:  Yeah, Texas Health Presbyterian Hospital has released more details about how this was overlooked.  What happened was, last week Duncan showed up sick at the ER.  Now, he told the nurse he had come from Africa.  The nurse reported that, but the electronic system was set up so that doctors never saw that. Duncan went home and came back a few days later in an ambulance.  In between that time, he may have infected other family members; so this little misstep could have had big implications.

INSKEEP:  A problem of communication.  Geoff, thanks very much.

The math that they fail to do is why electronic records have largely replaced other forms of communication in today’s medical system.

The federal government keeps pressuring doctors to switch to exclusively electronic medical records.  The 2009 Obama“stimulus” bill spent $20 billion dollars trying to give doctors “incentives” to adopt electronic medical records.  Apparently that wasn’t enough; Obamacare is now trying to force doctors, threatening to cut their Medicare reimbursements if they fail to implement electronic medical records to the government’s satisfaction.

Many doctors hate being forced into the government’s electronic record-keeping system.

If the electronic records system doesn’t mandate a question such as “Have you been exposed to Ebola?” personnel may not ask it, either because there’s no place in the system to check it, or out of fear of violating HIPAA law.

The particular hospital where this is taking place, Texas Presbyterian Health Hospital in Dallas, has seen the problems that come with being forced to do everything electronically. It can limit the amount of information that doctors and nurses can gather, and it limits interaction and facetime as medical professionals have to spend more and more time on data entry than talking directly with patients.

This New York Times story from January 2014 reports that they came up with a partial solution. Some doctors have “scribes” follow them around to do all the data entry while the doctor actually practices medicine.

DALLAS — Amid the controlled chaos that defines an average afternoon in an urban emergency department, Dr. Marian Bednar, an emergency room physician at Texas Health Presbyterian Hospital Dallas, entered the exam room of an older woman who had fallen while walking her dog. Like any doctor, she asked questions, conducted an exam and gave a diagnosis — in this case, a fractured hand — while also doing something many physicians in today’s computerized world are no longer free to do: She gave the patient her full attention.

Standing a few feet away, tapping quickly and quietly at a laptop computer cradled in the crook of her left arm, was Amanda Nieto, 27, Dr. Bednar’s scribe and constant shadow. While Ms. Nieto updated the patient’s electronic chart, Dr. Bednar spoke to the woman, losing eye contact only to focus on the injured hand.

“With a scribe, I can think medically instead of clerically,” said Dr. Bednar, 40.

Without much fanfare or planning, scribes have entered the scene in hundreds of clinics and emergency rooms. Physicians who use them say they feel liberated from the constant note-taking that modern electronic health records systems demand. Indeed, many of those doctors say that scribes have helped restore joy in the practice of medicine, which has been transformed — for good and for bad — by digital record-keeping.

Chances are, the nurse in question here had no “scribe.” And the electronic system mandated by Obamacare lacks any place to have medical personnel directly ask a patient if they have been exposed to Ebola.

So, an Obamacare mandate connection to the Ebola case.