Are Health IT Regulations Causing Stress Fractures?

By Dr. Paul Weygandt, Nuance

Stress fractures are tiny cracks in weight-bearing bones caused by the repeated application of force, usually due to overuse.  I am an orthopedic surgeon, so I was trained to not only treat my patients’ existing condition, but to consider the cause of that condition as well, in this case, that moment immediately preceding the formation of the fracture.  I recently moderated a healthcare technology panel where industry experts, Dr. John Halamka, Dr. Adam Landman, Dr. Keith Dreyer and Dr. Steven Stack discussed “What needs to change to get doctors back to the patient?” One thing is clear, the repeated hammering of regulations, policy changes, and non-intuitive technology is causing fissures in the physician community and, more terrifyingly, between patients and their physicians.

In an interesting twist, as the panelists sat, discussing current industry challenges and the impact government regulations were having on their colleagues and their IT agendas, the House of Representatives was voting to delay the ICD-10 deadline another year.  It exemplified their point –health IT policies are being made without the careful consideration of the many possible unintended consequences these rulings will have on the people most impacted, the patients, their physicians, and provider organizations.  Although the panel unanimously spoke out against a delay, less than one week later, they are again modifying their priorities based on  a rather precipitous Congressional decision made behind closed doors without stakeholder discussion.

I have said it before, but physicians, by their very nature, will go out of their way to help others, often making personal sacrifices to be there for their patients and their patients’ families.  It’s in their genetic make-up.  It’s who they are.  It doesn’t matter the circumstance, because as physicians, even though we know there are limits to medical knowledge, we embrace our role as the last line of defense against the medical “unknown.”  During the panel, I was struck by a sentiment eloquently articulated Dr. Steven Stack, reminding us that historically, physicians’ methods were torturous – bloodletting and leeching – often leading to the patient’s death, yet the infirm sought out such treatment.  Why?  Because these physicians provided hope.  And, while modern medicine has completely changed from those days, what has remained the same is that we still offer that hope.  Sometimes, that is the only thing we can do.  When you remove this element from healthcare, what is left?

Everyone has a breaking point: that moment directly leading up to the formation of a stress fracture.  If you are physician who speaks ICD-10, you probably know it as a variant of M84.xxx; if you are a physician who speaks ICD-9, you may recognize it as a 733.xx code.  But regardless of the codes being used, every physician knows it through his or her patient’s eyes—the searing pain, and weeks of missed track practice and qualifying races for a 17-year old high school athlete, and the feeling of helplessness that the runner’s parent has.

Although stress fractures are rarely visible in a routine x-ray, as physicians, we use our knowledge and clinical experience to diagnose them. In terms of the practice of medicine, many physicians are acutely aware that we are at our “stress-fracture moment.”  The treatment is simple (up to the point where everything “lets loose”); that treatment being relief from repetitive stress. Incomplete stress fractures will heal in time by removing the constant pressure being placed on the bone.  The “stress fracture” induced by our regulatory environment will also heal before total collapse occurs, but only if the offending stress is removed.