A disgruntled patient posts a critical comment about a doctor on the Internet. The doctor is furious and wants to get the comment removed to make sure it doesn't harm his practice or reputation. What can he do?

He could have his lawyer send a letter threatening a lawsuit to get the offending remark taken down. But that rarely works. Or he may attempt to flood the site with positive comments. But what happens when these tactics don't work?

Most lawsuits filed against bloggers and hosting sites (ie, physician rating sites) by doctors for defamation (or other actions, such as claiming interference with a business contract) have failed. And filing these suits can lead to unexpected negative consequences. Really persistent bloggers may continue to post. Drawing attention to the negative comments can even attract others who don't know the doctor to post negatively as well.

Dr. David McKee, a neurologist in Minnesota, learned the hard way about the unintended consequences of filing a defamation lawsuit in response to online postings by a disgruntled patient.

After consulting on an 85-year-old stroke patient, the patient's son posted derogatory comments about Dr. McKee online and filed complaints with various medical associations. The doctor sued the patient's son.

Dr. McKee's lawsuit was dismissed. The judge stated that the comments posted online were not defamatory. Rather, they were an emotional discussion of the issues. The fact that they had been placed online did not make them defamatory. There was not enough information to form the basis of a lawsuit.

However, Dr. McKee's filing of the suit drew public attention to the matter. Afterward, more than 60 derogatory and negative reports were posted against him on medical rating Websites. Most of these came from people who were neither his patients nor had any personal knowledge of him. Knowledge of the lawsuit appeared to spur anger and revenge from some who didn't even know the doctor.


More Damage When Doctors Strike Back


In another case that backfired, Dr. Jonathan Sykes, a California plastic surgeon, sued a patient who put up a Website criticizing him and his work.

Sykes performed a series of facial cosmetic procedures on Georgette Gilbert in 2003. Gilbert was appalled by the results. She not only sued Sykes for medical malpractice but also created a Website relating her experiences with Dr. Sykes (including before-and-after photos), as well as information and advice for those considering plastic surgery.

Dr. Sykes was a prominent professor of plastic and reconstructive surgery at the University of California, Davis, Medical Center. He had been featured in local and national publications touting his expertise in plastic surgery. In the eyes of the court, this made him a "limited-purpose public figure."' As a result, the court dismissed his lawsuit.

When Gilbert refused to close down her Website, Sykes filed a cross-complaint for damages and injunctive relief based on publications appearing in the Website that were allegedly defamatory and caused Sykes emotional distress and loss of business. Sykes ended up paying his own lawyers, plus Gilbert's legal fees, estimated to be in the range of 6 figures. Her Website stayed up and he got more negative publicity.



Were You Really Defamed?


To save yourself trouble and money, it's important to know what constitutes defamation, how to prove it, and how to defend against it.

Defamation is the communication of a false statement purporting to be fact and that causes harm to reputation. Written defamation is known as libel, while verbal defamation is called slander. Statements of opinion are usually not defamatory. Opinion can be erroneous and malicious. However, opinion can cross the line and become defamatory.

Rude, insulting, or offensive statements are generally not defamation. The First Amendment provides wide latitude for free speech. Historically, US courts have always ruled in favor of free speech rather than find for defamation.

Typical defamation statutes require a plaintiff to prove that the defendant made a defamatory statement which a reasonable person would find harmful to reputation; that the statement was shared or transmitted to a third party; that the statement was false (true statements cannot be defamatory); and that the plaintiff experienced damages of reputation as a result of the statement. These could include some form of provable public hatred, ridicule, contempt, or degradation which led to damages.

Defamation per se. Some statements are considered defamation per se (by definition). Plaintiffs are not required to prove that the statements were harmful to the plaintiff's reputation (state laws vary).

Defamation per se typically includes false statements presented as fact concerning a plaintiff's trade or business (stating that the plaintiff is no longer in business, can't get credit, or is engaged in illegal activity); false statements presented as fact indicating that the plaintiff has a "loathsome disease"' (eg, leprosy, sexually transmitted diseases, HIV, hepatitis, tuberculosis, or mental illness); false statements that the plaintiff is unchaste or sexually impure; false statements that the plaintiff has been involved in criminal activity or convicted of a crime.


What Should You Do?


Consider the pros and cons, as well as alternative ways to deal with the situation, before deciding to bring a defamation lawsuit. One way is to place as many positive statements as possible on any Website containing negative comments. Another is to ignore the comments and practice good medicine. As with any business, a loyal following will counterbalance any negativity. Some patients have always made disparaging comments about doctors. The Internet only serves to amplify the level of the rhetoric.

Despite the fact that the 2009 American Recovery and Reinvestment Act gave wellbeing frameworks a monetary impetus to accomplish Meaningful Use of Electronic Medical Records, numerous medicinal services associations have battled to catch esteem. As the capacities and modernity of EMRs keep on developing, there is a broadening isolate between social insurance associations that outfit the abilities for an upper hand and those that are injured by poor convenience, work processes and appropriation.

The Cost of EMR Replacement

To meet the prerequisites of the Meaningful Use program, most EMRs were executed utilizing a Big Bang approach, and quickly. Be that as it may, this methodology has delivered a few unintended results and across the board client disappointment. In 2013, with the procedure well in progress all through the country, 66% of specialists surveyed said they utilized EMR frameworks reluctantly, with 87% of these exasperated doctors whining about convenience and 92% of doctor works on griping that their EMRs were “cumbersome” as well as excessively troublesome. In particular, just 35% detailed that it had gotten simpler to react to understanding issues, 33% said they couldn’t all the more adequately oversee persistent treatment plans, and notwithstanding the conviction that innovation would allow guardians to invest more energy with their patients, just 10% said this was happening.

As of late, three conspicuous Boston-region doctors expounded on “Death by A Thousand Clicks.” They contended that when specialists and attendants walk out on patients to focus on a PC screen, they can’t offer the “time and full focus” required to give the correct consideration. They whine that numerous prompts and snaps in an Electronic Health Record framework can unfavorably influence patients and add to doctor burnout.

The therapeutic side was not the only one in communicating disappointment. Emergency clinic official and IT representatives who had supplanted their EMR frameworks revealed higher than anticipated costs, cutbacks, declining incomes, disappointed clinicians and genuine apprehensions about the advantages picked up:

• 14% of all medical clinics that supplanted their unique EMR since 2011 were losing inpatient income at a pace that would not bolster the absolute expense of their substitution EMR

• 87% of medical clinics confronting budgetary difficulties presently lament the choice to change frameworks

• 63% of official level respondents conceded they dreaded losing their positions because of the EMR substitution process

• 66% of the framework clients accept that interoperability and patient information trade usefulness have declined

Today, HDOs are at a junction. They can begin once again with another EMR or streamline the one they have.

Numerous HDOs are desperate and the change from expense for administration to esteem based consideration applies descending cost pressures, compounding the issue. In any case, interwoven fixes have not improved issues. Then again, some endeavored to do an excessive amount of too rapidly and became baffled since they did not have the profundity of experience and information to perform remediation. What’s more, as KPMG finished up subsequent to examining the issue, “The period of time to determine the issues expanded and disappointments mounted as clinical, senior administration, IT and HR staff ended up wasting their time.”

In any case, an ongoing study directed by KPMG as a team with CHIME, shows 38% of 112 respondents positioned EMR/EMR advancement as their top decision for most of their capital speculations for the following three years.

The Benefits of EMR Clinical Optimization

The case for streamlining is solid. Advancement should help HDOs meet administrative prerequisites, upgrade the quality and cost-viability of patient consideration and increment the ROI on innovation. Moreover, advancement of restorative records should build quiet fulfillment since data will be increasingly straightforward and progressively open. On the off chance that this demonstrates genuine, it will set aside less effort to acquire care and patients will likewise encounter increasingly instinctive, easy to understand installment frameworks.

Streamlining ought to likewise add to more significant levels of fulfillment among doctors whose work processes will be increasingly adaptable, whose hours will be diminished and who will all the more effectively secure data since it has gotten progressively straightforward.

How is it working out practically speaking, since increasingly more medicinal services associations are focusing on the clinical enhancement of their EMRs?

The short answer: stunningly better than any challenged expectation:

• Nurses are sparing 28-36 minutes for every move

• Lab test use and medication costs have declined by 15%

• The normal length of stays has been decreased by 5% to 10%

• The occurrence of unfavorable medication occasions dropped by 334 to 481 every year

• Turnaround time for orders was cut by at any rate 60 minutes

• Vaccination consistence arrived at 99%

• Costs of paper structures were decreased by 67%

• Charge catch improved to 64%

• Costs of interpretations were cut by 61%

• Administrative staff (82%) detailed observable upgrades to the operational or monetary abilities of their training the board and EMR frameworks

Coordinating these striking upgrades for medicinal services associations is the proof from doctors:

• 59% report cost investment funds by disposing of the board and paper records stockpiling

• 70% report quicker, progressively exact help charging and generally speaking time investment funds

• 53% report increments in worksite productivity

• 71% portray their EMR merchant to be “meeting or surpassing” their desires for EMR streamlining

How Optimization Can Work

Focusing on the enhancement of EMR frameworks isn’t care for waving an enchantment wand. It must be executed with an away from of what must be done and how to do it. We see two central focuses that will prompt achievement:

Application Portfolio Rationalization:

At most HDOs, IT activities highlight a collection of separated applications, with most enormous associations sending thousands over the venture. Be that as it may, these frameworks are exorbitant to keep up and speak to an ever-developing, noteworthy risk the more they exist. With union of associations into huge coordinated consideration conveyance systems and developing disappointment with the productivity of existing electronic medicinal services record frameworks, huge numbers of these clinical applications can and are being resigned. Mindfully legitimizing a portion of those siloed heritage frameworks can deliver a huge decrease in TCO. For instance, the all out expense of proprietorship can go from $1MM to several millions every year, frequently requiring ~50% of steady yearly IT working expenses over authorizing costs. Authentic of inheritance information takes into consideration legitimate decommission of heritage frameworks, bringing about reserve funds of 80-95% when contrasted with the expense of frameworks’ licenses and foundation.

Effectiveness and Automation:

EMR advancement can create cost decreases up to 10% through increases in operational productivity. Time-stepped, occasion information driven work process improvement – Clinical Cycle Management (CCM) – produces quantifiable profitability and productivity gains, yet more critically, upgraded clinical choice help. Profiling an EMR application takes into consideration powerful and rich use information gathering, including clicks, mouse developments, and time spent.

Examination of these work processes, utilizing a worldly inquiry apparatus, takes into account recognizable proof of bottlenecks, poor work processes, and other time sinks. It shows both individual client action, just as total information, and lets you characterize sensible EMR “undertakings.” It gives the premise to acknowledging work process streamlining proficiency increases through workspace adjustment, preparing, mechanization through macros and EMR UI Augmentation. Such investigation additionally encourages the capacity to present ongoing clinical choice help through work process mediations. Making this a stride further, clinician produced clinical mechanization would totally robotize a clinician choice.

Estimating Success

An actualized EMR doesn’t ensure an arrival. Associations that neglect to appropriately coordinate and use EMR abilities can rapidly wind up in post-execution limbo, deadened by disillusioned clients and disappointing supplier execution. Embracing an information driven way to deal with improvement gives associations the capacity to analyze and address issues by estimating and assessing execution across explicit measurements.

Assume, for instance, that the workdays of suppliers are impracticality long, or, that regardless of the establishment of an EMR, efficiency is no superior to anything it was before the new framework was received. This circumstance can be tended to if the new EMR gathers – as it must – effectively reportable information. There ought to be operational information assembling that records informing and entrusting to light up work process openings and venture objectives to be benchmarked preceding improvement endeavors. On the off chance that workdays are still excessively long and efficiency is still excessively low, the EMR must be set up to analyze explicit windows of time – framework hours out of every day or potentially the extent of experiences that incorporate the utilization of EMR documentation devices (versus free content).

On the off chance that suppliers report that the measure of time they go through with patients has diminished and that patient hold up times have expanded, the EMR must be customized to evaluate complete patient time per experience and all out clinician time per experience. In the event that the nursing staff reports that it is taking more time to catch up with patients, there must be records of the normal time it is taking to react to understanding calls and of the normal time required to contact patients in regards to strange test outcomes. On the off chance that care groups express worry that they are not adequately dealing with their diabetic patients, for instance, it is basic that consistence rates with forestalling screening measures and normal HbA 1c scores are precisely caught.

Conclusion: Driving Outcomes Through Optimization

EMRs have not yet accomplished their maximum capacity, suppliers are exhausted of their wasteful aspects, and more assets must be spent to upgrade the first ventures. Be that as it may, an appropriately coordinated and completely used framework can build up the establishment for critical and supported hierarchical enhancements in Health Delivery Organization effectiveness, end-client fulfillment, and information quality – and the full use of an EMR to its ability will excuse and legitimize venture. To achieve this, HDOs must address the insufficiencies that compromise profitability, including appropriate preparing and IT support, full usage of robotization capacities, and work process improvement. In the event that this is done, it will bring about an expansion in supplier limit. What’s more, by expanding supplier limit by an extra three visits for every day (averaging $150 per visit in repayment), HDOs can possibly build income by more than $60,000 per supplier every year.

For some EMR end-clients, execution is as yet obstructed, causing proceeding and frequently mounting disappointment. An AMGA Physician Retention Survey found 11.5% supplier turnover rate among cutting edge practice clinicians. Losing and supplanting a solitary supplier costs at least $250,000 however the genuine expense regularly surpasses $1 million. An emphasis on supplier maintenance through upgraded RMR communication creates genuinely critical returns; expanding maintenance by only four suppliers compares to $1 million to $4 million in reserve funds in costs related with supplier misfortune and substitution.

With the move from fixed-charge repayment to esteem based consideration, HDOs are required to exhibit and record their viability estimating and revealing results. With results quantifies straightforwardly connected to money related motivating forces and repayment rates, information liquidity and quality is of more prominent significance, rendering exact data a priceless resource. Knowledge into execution and results information permits HDOs to accomplish quality measurements and cultivate continued execution improvement. A hearty EMR improvement procedure can – and will – help HDOs understand the guaranteed an incentive from execution of an EMR. EMR improvement is the driver of key esteem and can – and will – become a practical upper hand through authority, advancement and estimation.

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