Highlights
- John Asghar MD saw a 60-page, 24-hour chart with only 4–5 pages useful.
- Leah Houston MD and others blame HIPAA, HITECH, TEFCA for “billing fodder.”
- The U.S. spends $100 billion+ annually storing data clinicians never use.
Problem Statement
When Dr. John Asghar, an adult and pediatric spine surgeon, opened a 60-page discharge summary for a patient who’d been in the hospital just 24 hours, he found only four or five pages that actually mattered. The rest—redundant vitals, copied histories, billing codes—was noise mandated by layers of regulation and insurance requirements. As Asghar’s tweet storm (71.6 K views) ignited, clinicians across disciplines piled on: from Leah Houston MD blaming HIPAA, HITECH, and TEFCA for turning notes into billing ledgers, to Bill S declaring “garbage data” the single biggest roadblock to AI in medicine.
From Patient Story to Invoice
- The SOAP-to-Checkbox Shift
- Regulatory Ripple Effects
Clinicians now navigate menus of up to 200 fields per note, each with the force of compliance. The result: a medical record that reads more like a balance sheet than a healing roadmap.
The True Costs of Bloat
- Financial Overhead:
- Clinician Burnout:
- Patient Safety & Experience:
Path to Policy Reform
- Define a Minimal Core Dataset
- Sunset Legacy Templates
- Outcome-Tied Incentives
- Leverage FHIR & SMART on FHIR
- Clinician Governance & Continuous Audit
Conclusion
Dr. Asghar’s 60-page revelation isn’t an outlier—it’s the new normal in U.S. healthcare. And while regulatory frameworks aimed to protect patients and encourage technology adoption, they’ve unintentionally inflated the medical record into a compliance battleground. Pruning this bloat requires coordinated policy reform, modern interoperability, and—above all—a re-centering of the chart on patient care rather than billing codes.
Key Takeaway: Pruning the EMR can reclaim billions, revive clinician morale, and restore the medical record’s original purpose: guiding healing.
Mohammad Jazim 