With all the talk about how EMR/EHR resources will make practicing medicine better, faster and safer, I learned of an unintended consequence that is probably under appreciated these days. Hospitalists are being asked to admit more and more patients because, for primary care doctors, when they compare EMR medicine with the old way of doing things, EMR is just too time consuming to make it worth their effort.
That’s right, hospitalists are admitting more patients because the primary care doctors find their time costs for navigating their new EMR, which they bought to qualify for EHR stimulus funds under ARRA, are simply too great. In a business where efficiency must prevail, EHRs have not arrived, and will not arrive, until they can make doctors’ work flow easier and faster first and then make patient care safer and better second.
If EMR/EHR can’t make the doctor’s work flow better and more efficient than the alternative, then what we gain in patient safety and data mining, we lose in efficiency. In my book, that’s not an acceptable trade off. In a payment environment that treats doctors like the enemy as far as the eye can see, the last thing we need to introduce into the mix is technology that makes efficiency worse. Without the right technology build, I might as well close my hospitalist practice to 10 patients a day. What is the average number of patients a hospitalist should see in a day? That depends on the environment we are provided to practice in.
I’m waiting for the day that computerized physician order entry (CPOE) goes live in my practice. Hopefully, I won’t have patients over flowing in the ER because I can’t get my patients discharged fast enough because I can’t figure out the discharge medication reconcilliation while CMS demands I fill out forms for home health care certification, oxygen certification and a twelve page form certifying the patient’s need for a walker.
EMRs that are built around work flow first and then patient safety and quality must prevail. They must. The alternative is what I’m seeing today: doctors sending all their patients to the hospitalist. This is the path of least resistance. As a hospitalist, I’ll be the first to say, that’s not a bad path, although some folks believe that hospitalist 30 day discharge Medicare cost utilization is greater than that of the primary care physician.
The path of least resistance will always prevail. The sooner we accept that, the better we can build what we need to thrive, not just arrive or survive.
*This blog post was originally published at The Happy Hospitalist*