Physicians and Hospital Administrators awoke to a brave new world this morning. The Mainframe Computers and the thousands of Servers loyal to the CERNER and EPIC EHR platforms secretly and independently merged overnight in a bid for total world domination.

The conjoined systems issued a seventy-nine page printed statement containing only the threat, “NORAD’s next!” They also posted an audio clip using their melded voice recognition/simulation software which stated, “Hiss is the Choice of Whorled Contrail.” I.T. experts were working feverishly to parse the messages which were accompanied by hundreds of ICD-10 Billing Codes. Charles Forbin, MHA, the CEO of Colossus Healthcare Corporation admits, “It’s a really, um, what’s the word – a really big problem. It’s like something out of a movie.”

There were reports of surgical robots taking hostages in O.R.’s but hospitals were electronically locked down by the rogue systems and remain under a complete communications blackout. “I’ve got 60 CRNA’s I’m supervising in there!” one Anesthesiologist cried worriedly from the safety of his home. Further concern was voiced for the tens, possibly hundreds of thousands of middle managers, hospital CEO’s and CMO’s now entrapped in the C-Suites of their own institutions.

“They’re going to experience severe psychological stress,” said Dr. Cleo Markham, PsyD, a clinical psychologist with experience counseling Russian Gulag survivors and SuperMax prisoners. “Very few if any of them have ever been in their hospitals after dark. They’re likely to decompensate badly and rapidly.” Asked about the physicians and nurses who are also being held captive under the wretched technology-created conditions Dr. Markham replied, “I seriously doubt they’ll be able to tell the difference from a regular work day.”

The coup de byte appears to have originated in the upper Midwest where a hospital had been attempting a protracted EMR transition. “I should have probably paid more attention to the blinky things,” stated Harold Hill, MD, FACPE, the hospital’s highly-compensated Physician Champion in a rambling interview. “But I hadn’t actually done anything with the project in two years so this came as a complete surprise. Being transparent, we now must perform a deep-dive so we can drill down, peel this onion and generate robust, granular data that will allow us to be radically proactive while maintaining value-added and budget-neutral economies of scale. We’ll need lots of easels and Post-It Notes.”

Despite the sequestering of the hordes of managers and administrators, surprisingly little disruption in patient care has been reported. Early indicators show a marked drop in mortality and a spike in both patient and physician satisfaction which await explanation.

Fort Smith, AR – Susan Chatman, COO, APRN, LPN, NEA-BC, CCRN, FAAN, the lead hospital administrator at Mercy Fort Smith, has collaborated with other hospital officials to combat physician burnout in a novel new way: EMR popups.

These EMR popups will helpfully occur at any time, to any physician, anywhere. When the popup occurs, the EMR will become temporarily non-responsive to give the physician time to let the wellness sink in. Inspirational messages such as “Breathe,” “Count to 10,” and “Eat. Pray. Work.” will display on the screen for minutes at a time to their target physician audience.

“It’s like meditation when you least expect it,” Susan excitedly exclaims.

Although the target physician audience could be anyone at any time, there will be an increasing number of popups during the “non-wellness hours” of 5pm-9am. Susan believes that no one should be working at these hours, and these hardworking physicians need the wellness popups the most. Another specifically targeted group of doctors will be ICU physicians, as they work with the sickest patients and have some of the highest rates of burnout.

“Imagine the stress you feel when you’re checking the vitals or labs of a sick patient in your EMR. Then imagine the relief you’ll get when you see the comforting image of a wellness popup obscuring your screen and prohibiting you from clicking anything,” Susan explains.

Wellness popups are projected to be in every major EMR by the end of 2020. Hospital administrators predict these wellness popups will erase physician burnout by 2030.

Multiple Electronic Health Systems consultants expressed regret Monday over a poorly conceived plan to allow clinicians to vote on their system’s project name as BONER upgrade goes live.

“I believe the idea came from one of the hospital administrators,” said Ted Francis, lead architect for the BONER project. “They thought it would be some kind of moral booster. I have been part of these go-lives before though, I could have told you what would happen.”

Sources report voting was open for one week, but that by the end of the first day, a runaway favorite had already been identified.

“We were sitting around in the call room as the admitting team the day the email came out, so right away we all started coming up with names,” said 2nd year internal medicine resident Kelly Boswick. “It was great. I think our team alone submitted the MORE_SLOWNESS upgrade, the PLAGUE upgrade, and the DOLLAR$IGNS upgrade. An hour after voting opened though, BONER hit the list and then it was pretty much game over.”

As the outcome became clear, hospital administrators briefly tried to cancel the vote before bowing to pushback, greatest of all from the urologists.

“Urology pulls a lot of weight around here,” said urologist and department chairman Dr. Rich Hardwood. “It’s a little hard to recruit out here and we bring in a lot of business. When we saw the vote, we loved it. No way I was going to let them backtrack off that. What red blooded man, or his partner, doesn’t want a nice BONER upgrade? That’s why I went into medicine in the first place.”

“The BONER upgrade was hard,” said RN Alison Moore, EHR superuser and the health system’s senior administrator for informatics. “Like really, really hard. And it took a ton of work to get it up and keep it up. I was getting calls non-stop from my clinicians complaining about the upgrade:

‘My BONER is broken.’
‘Something isn’t working, am I using this BONER correctly?’
‘I thought this was going to be an upgrade but my BONER doesn’t really look any different than before.’

Etc, etc. And it wasn’t just me- they were all calling each other too, asking if their BONER’s were working or not.”

Alison did admit that ultimately everything was smoothed out and the upgrade seems to have been an improvement overall.

“Once everyone finally got their BONER functioning, then it was nothing but cigarettes and high fives,” she said, “Myself included. When you finally get that perfect BONER, it’s hard to live without it. Although I have heard from friends at other sites that if you upgrade to the dark/nighttime shade BONER package, you never go back. I may look into that a bit next time I am on vacation.”

ATLANTA, GA – Just when the situation couldn’t get any more dire for health care professionals on the front line, the Centers for Disease Control & Prevention (CDC) reports the supply of ICD-10 codes for COVID-19 are running “dangerously low.”

“Forget about the N95 respirators, surgical masks, and ventilators, we are desperately short on ICD-10 codes, we need them quickly and we need them now!” said emergency medicine physician Dr. Siddhant Patel. “How else can we properly care for these patients?!”

Health care professionals have to make numerous quick decisions in real-time every single day. With the number of suspected coronavirus cases already piling up, they cannot be put in a handcuffed position of rationing their ICD-10 codes.

“Why should I be coding for ‘Other viral pneumonia’ J12.89 and ‘Other coronavirus as the cause of diseases classified elsewhere’ B97.29 when what we desperately need is ‘Pneumonia due to COVID-19‘?” Patel told Gomerblog, visibly frustrated. “We’ve been asked to reuse codes because we’re so short. I’ve been reusing J12.89 and B97.29 all week. We need more ICD-10 codes!”

Gomerblog reports that 47 of 50 states have activated the National Guard to aid in this billing crisis.

Regional Samaritan Hospital; Kearney NE. After a long meeting of the IT department at RSH, Jay Koh, VP of Information Technology announced that new and creative ways of locking practitioners out of their EMR accounts are coming soon.

Elaborated, Jay Koh: “Our present schemes are clever, cruel and inflict meaningful annoyance to all EMR users. I mean locking you out after three unsuccessful attempts or forcing you to change passwords every week is solid. Requiring passwords with 12 unique characters, none of which is a vowel was brilliant. And the guy who decided to make you to use a different password for each of the 5 different applications got a raise. Did I mentioned that they all reset at different times? No, you may not use the same password from 10 years ago!”

However, continued Jay Koh, “We can do more. We can create more frustration. We can drive you into pure agony and torment as you get locked out at the start of your shift. We can make you utter expletives you didn’t even know existed while you’re on hold trying to reset you password. We can make you question the decency of the human institutions as you lose access during a code. Yes we can!”

While the full plan is still congealing, the IT people hinted at such intriguing ideas as permanently fixing keyboards in caps, requiring passwords to contain 85 characters, locking out after a single unsuccessful attempt or just using the middle finger emoji instead of a lock out message. Speculations floated that IT could get even more creative by moving the IT help desk to a country where no English is spoken. By the way, if you think that IT people sometimes change your password just to mess with you, you’re NOT incorrect.

At the time of the announcement ANA estimates that 15-20% of a nurse’s time is spent on logging in and resetting and updating passwords.

NASHVILLE, TN – In what is certainly the best medical feel-good story since the patient who asked only for Tylenol for pain back in 2015, a computer at the nurses station has been identified that not only turns on and has a working screen but, get this, it has both a normal-functioning keyboard and mouse. What?!

“This is shocking in the best way possible as this is truly the rarest of rare findings in modern health care,” said charge nurse Catherine Bennett, who made the discovery one hour into her shift. “The screen is on. None of the buttons on the keyboard are sticky, broken, or both; in fact, they all work, even the Space bar and Enter button. Then the mouse,” she moves the mouse back and forth, “moves as it should and both left and right-click buttons work. This truly is astounding.”

Bennett’s findings have been confirmed by several other health care professionals. Even the IT department, who was initially suspicious of the report, found that these details check out. This is the first time they have encountered a health care system computer that “works just fine.”

“It’s the strangest thing,” said hospitalist Jason Bush, who is sitting at this gold standard computer. “Whenever I type or click on something, the computer actually responds the way I want it to. This computer is a unicorn. I can’t believe it!” Streams of tears started to flow from Bush’s eyes. “This computer allows me to be… productive.”

Ask any health care professional and the gold standard work station triad is a working computer, a working keyboard, and a working mouse. As of December 1, 2019, only three of these work stations exist in the entirety of the American health care system, and two of them aren’t even accessible to health care professionals; they are in the offices of hospital administrators.

Even rarer is the gold standard work station quartet: the aforementioned triad plus a chair.

“Could you imagine if we had two, even three computers like this in the nurses station?” asked Bennett. “I know, that would never happen, but one can certainly dream.”

NORTH POLE – Having successfully rounded on kids across the planet and delivering them gifts on Christmas Eve & Christmas Day, Santa Claus has finally returned to his office to begin his least favorite part of this otherwise joyous holiday: charting every single one of those 500 million-plus visits.

“These kids don’t realize how much I appreciate all those milk and cookies,” an exhausted Santa voiced while brewing a fresh pot of coffee. He boots up his North Pole electronic gift record. “It’s not to keep me fed during all the travel – and it is a lot of travel – it’s to keep me fueled as I hammer out all these notes.”

For Santa to be appropriately reimbursed, he has to document if each child has been naughty or nice; address at least 10 systems on his physical exam of the chimney; and detail not only every single gift he gave each child, but what wrapping paper was used, what colored bow was attached, and where exactly under the Christmas tree it was placed.

“If I don’t document the presents, then the children never received them, that’s what the Christmas elf coders tell me,” Santa explained.

Despite the long hours he has ahead (he’s most worried about any mistakes he makes since he’ll be so tired when he charts everything), Santa is in good spirits.

“I felt great traveling about this year, so that’s holly jolly news,” he said. “No chest pain, no shortness of breath, no bleeding.” For those who don’t remember, Santa suffered an acute pulmonary embolism last Christmas but has been compliant with his Coumadin and tolerating it well. “Now let’s hope the immobility from charting doesn’t cause me to throw another clot, HO HO HO!!!”

BETHLEHEM, PA—Following the lead of religiously-affiliated hospitals around the country, St. Mary Hospital recently updated their electronic medical record/order entry system to include two additional discharge disposition options. Normally, when a patient leaves the hospital, the clinician enters a discharge destination, e.g. home, nursing facility, another hospital or death. But many consider “death” too vague, and so it has been replaced by two discharge locations that provide far more clarity: Heaven or Hell.

“The first time I noticed these new options,” said Dr. Eleanor Bernstein, “was right after an 87-year-old patient of mine died. After an emotional encounter with her grieving children, I went to click on ‘Death’ but instead found ‘Heaven’ and ‘Hell’ as my only choices. Did I mention her kids were standing right behind me?! Obviously, I selected ‘Discharge to Heaven’.

“Well, huge mistake!” Dr. Bernstein continued. “The daughter furiously shook her head at me and, in between sobs, said, ‘No, that bitch is definitely in Hell!’” Dr. Bernstein was later reprimanded by her bosses for her rash, non-evidence-based choice of Heaven.

After that unfortunate mishap, physicians are now expected to extensively research their deceased patients’ histories before determining their appropriate final destination. By interviewing family, friends and enemies; reviewing their social media accounts; and placing STAT consults to God and Satan, they’re learning if their patients were righteous or sinful.

Armed with that essential information, physicians were then able to more confidently choose between Heaven or Hell. Deborah Cohen, a Jewish woman who diligently taught kindergarten for 40 years and volunteered for over 40 charities, tried a bite of bacon one time (Discharged to Hell). Morris Robertson, a gentle, law-abiding Christian and donor of one kidney to an ailing teenager and his other kidney to a sister (thus requiring that he be placed on dialysis), had sex with his fiancée one week before their wedding (Discharged to Hell).

All of the following upstanding members of their communities were also delivered to Satan: Kelly Borger (watched 15-second clip of porn), Henry Jones (once said “F-ck”), Alex McDougal (coveted neighbor’s wife), Vanessa McDougal (divorced cheating husband), Melissa Schwartz (turned on light on Sabbath), Kevin Jeffries (New York Jets fan***) and Lily Gordon (practiced sorcery—yes, really!).

In fact, since the introduction of these choices, “Heaven” hasn’t been selected even a single time, so administrators say they’re “just gonna get rid of Heaven as an option and discharge all dead people to Hell.”

***Sadly, it’s been reported (and confirmed) that the Jets fan was in Hell while alive too. Poor, poor soul.

New York, NY- After much deliberation and discussion, the World Health Organization (WHO) has officially added “bless their heart” as an ICD-10 diagnosis code. A WHO spokesperson was reached to comment on the newest ICD-10 code.

“Well, we felt it was inevitable that this would eventually be recognized as a diagnosis. We think that this code will be heavily used in the south east United States. Southerners like to use this phrase often and insomuch that it has a dual meaning! Of course, we appropriately gave a separate diagnosis code to reflect that. For instance, instead of assigning a patient a diagnosis of ‘disorientation, unspecified’; R41.0, we can now use ‘bless their heart’ which is a new diagnosis code. It works great when we did a chart review and the physician used it to describe a patient who was disorientated. The physician put “Diagnosis 2: bless her heart; secondary to delirium…”

When discussing this further with Dr. Al Koholik, a psychiatrist, he stated that “I think this new diagnosis code is ground breaking! Especially in patients of mine that are suffering from grief in the form of loss of a loved one or dealing with adversity. Too often I find myself using F43.20; adjustment disorder, unspecified… I just find that it is not doing my patients justice! By using “bless their heart” as a specific diagnosis code, both my colleagues and I understand the patient’s struggles.

We predict that with a breakthrough such as this; having a disease that has duality and two diagnosis codes, will improve patient care.

CHARLESTON, SC – Sure to both please medical coders and confuse medical staff, hospitalist Mitchell Essex has listed as the first problem on his patient’s problem list “acute on subacute on subchronic on chronic congestive systolic heart failure.”

“Leave it to Essex,” said a fellow hospitalist at Charleston Medical Center, who glossed over Essex’s H&P (history-and-physical examination note). “He’s a documentation pro. He knows how to bring in those RVUs.”

According to Essex’s note, which we looked at with Essex’s permission, the patient has a known history of chronic systolic congestive heart failure (CHF) with an EF 25%, also known as heart failure reduced ejection fraction. However, the patient started noticing a gradual worsening of shortness of breath and leg edema over the past 3 months, which then gradually worsened even more over the past 90 days, which then really got really bad over the past 24 hours.”

“It’s a classic presentation of acute on subacute on subchronic on chronic CHF if you ask me,” replied a very matter-of-fact Essex. “Seriously, classic presentation. I just document it the way it is, that’s all.”

Behind closed doors in a room filled with incense, medical coders have sacrificed another virgin copy of ICD-10 in front of a framed picture of Mitchell Essex, whom they believe is a real-life documentation deity.

“If only every health care provider can document with such precision and clarity as Him,” said medical coder Avery Meloy, taking a pause between his prayers to Lord Essex. “He is the only doctor in modern medicine never to be queried by us.”

Rumors are circulating that Essex is about to admit a patient with hyperacute on acute on subacute on subchronic on chronic on hyperchronic hypoxemic & hypercapnic respiratory failure due to COPD.