Spare me the few tired cliches about prostate cancer, diabetes, and sarcoidosis being more common in blacks than whites, or even the slightly increased risk of ACEI cough in patients of Asian descent. We screen Jews of Ashkenazi descent for Tay Sachs without any racial labeling. All that information is readily accessible under the Family History section of the medical history. It is no more than custom which dictates the standard introductory format including age, race, and gender. It turns out I’ve blogged about this before at some length (pretty good post, actually). What is new is the advent of electronic medical records.
Much hullabaloo has been made about federal stimulus funds allocated to doctors as payments for adopting EMRs; “up to $44,000!” Here’s the problem with that figure, though, including how it breaks down (source here):
[M]aintaining [an EMR] costs multiple thousands of dollars a year. Bear in mind that they’re not talking about a lump sum payment of $44,000. It’s $18,000 the first year, $12,000 the second year, $8000 the next, $4000 the next, and then $2000, for a total of $44,000 spread over five years. FOR A SYSTEM EXPECTED TO COST AN AVERAGE OF $10,000 PER DOCTOR PER YEAR, not counting the start up costs, which run in the vicinity of $50,000. $44,000 over five years for something that will cost us $90,000 over the same period? And that’s even if they actually get around to giving out the money in the first place! According to this, in order to qualify for “meaningful use,” EMRs must be used for ePrescribing, for communicating with other EMRs like labs and hospitals, and for transmitting information on performance measures (the paternalistic proxy for “quality”) to the government.
Just because my electronic systems didn’t end up costing me anything, it turns out that even though I bill Medicare less than $25,000, I’m still eligible to apply for some of the stimulus money. So just for shits and giggles, I hooked up with a government funded entity whose stated purpose in life is to help me get that money. Cool.
I’ve had a couple of visits with them so far. It turns out that my freebie EMR has features which I hadn’t bothered using yet, mainly because they didn’t seem particularly useful in the provision of medical care — that’s what I do, remember? — to patients. One of them was a so-called “Demographics” section, right below such vital information as patient name, address, phone numbers, and birth date. This section contains three pieces of information I have to enter, one from a set of radio buttons, and two from pick lists, mechanisms that allow for the collection of what is known as “structured data” instead of just information I type into the EMR “free form”.
The first item is “Ethnicity”. There are three radio button options: Hispanic, Non-hispanic, and Unspecified (the default).
The second item is “Preferred Language”, to be selected from a pick list. I can only enter one option.
The third item is “Race”, again to be selected from a pick list. They include “African or African American”, “Asian or Asian American”, “European or Caucasion American”, plus several other basically meaningless classifications. (For example, what entry do I use for an individual from the Indian subcontinent?) Unlike “Language”, I can enter as many of these options as I wish.
What? The? F?
Aside from the language entry, which could perhaps be useful in a very large, very diverse practice, neither “Ethnicity” (limited to Hispanic or Not) nor “Race” has any possible legitimate bearing on diagnosis, treatment, or any other aspect of medical care. And yet an integral part of Government-defined “meaningful use” consists of completing this section of the medical record.
Interestingly, a stated later requirement is for me to submit information from my EMR to the government, ostensibly for what they’re currently calling “reporting purposes”.
Now, what government function uses demographic data like race and ethnicity (ie, Hispanic or not)? Would that be the tracking of, say, voting patterns? And doesn’t it seem like a handy way to collect that data, neatly sorted by address and birth date, rather than having to use the decidedly old-fashioned, up-to-a-decade-out-of-date but actually legal way of tracking that information through the census?
How Orwellian to require that “Meaningful Use” incorporate the recording of medically meaningless data.
Dinosaur MD (aka, Lucy E. Hornstein, MD) is a solo-practitioner in Family Medicine. She is also a book author (Declarations of a Dinosaur) and posts frequently at her blog, Musings of a Dinosaur, where this post first appeared.