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Documenting To Death: Are EMRs Eroding The Soul Of Medicine?

Electronic medical record systems (EMRs) have become a part of the work flow for more than half of all physicians in the U.S. and incentives are in place to bring that number up to 100% as soon as possible. Some hail this as a giant leap forward for healthcare, and in theory that is true. Unfortunately, EMRs have not yet achieved their potential in practice – as I have discussed in my recent blog posts about “how an EMR gave my patient syphillis,” in the provocative “EMRs are ground zero for the deterioration of patient care,” and in my explanation of how hospital pharmacists are often the last layer of protection against medical errors of EPIC proportions.

Considering that an EMR costs the average physician up to $70,000 to implement, and hospital systems in the hundreds of millions – it’s not surprising that the main “benefit” driving their adoption is improved coding and billing for reimbursement capture. The efficiencies associated with access to digital patient medical records for all Americans is tantalizing to government agencies and for-profit insurance companies managing the bill for most healthcare. But will this collective data improve patient care and save lives, or is it mostly a financial gambit for medical middle men? At this point, it seems to be the latter.

There are, however, some true benefits of EMRs that I have experienced – and to be fair, I wanted to provide a personal list of pros and cons for us to consider. Overall however, it seems to me that EMRs are contributing to a depersonalization of medicine – and I grieve for the lost hours genuine human interaction with my patients and peers. Though the costs of EMR implementation may be recouped with aggressive billing tactics, what we’re losing is harder to define. As the old saying goes, “What good is it for someone to gain the whole world, yet forfeit their soul?”

Pros Of EMR Cons Of EMR
Solves illegible handwriting issue Obscures key information with redundancy
Speeds process of order entry and fulfillment Difficult to recall errors in time to stop/change
May reduce redundant testing as old results available Facilitates excessive testing due to ease of order entry
Allows cut and paste for rapid note writing Encourages plagiarism in lieu of critical thinking
Improves ease of coding and billing to increase reimbursement Allows easy upcoding and overcharging
Reminds physicians of evidence-based guidelines at point of care Takes focus from patient to computer
Improves data mining capabilities for research and quality improvement Facilitates data breaches and health information hacking
Has potential to improve information portability and inter-operability Has potential to leak personal healthcare information to employers and insurers
May reduce errors associated with human element May increase carry forward errors and computer-generated mistakes
Automated reminders keep documentation complete May increase “alert fatigue,” causing providers to ignore errors/drug interactions
Can be accessed from home Steep learning curve for optimal use
Can view radiologic studies and receive test results in one place Very expensive investment: staff training, tech support, ongoing software updates, etc.
More tests available at the click of a button Encourages reliance on tests rather than physical exam/history
Makes medicine data-centric Takes time away from face-to-face encounters
Improved coordination of care Decrease in verbal hand-offs, causing key information to be lost
Accessibility of health data to patients Potential for increased legal liability for physicians

Your Doctor Will Now Be Fined For Putting Time With You Above Time With Your Chart

It’s an age-old problem, made more complicated by our new era of electronic medical records: optimizing collections in a time of unprecedented price pressures on our health care complex. With the economic downturn and declining government payments for services, everyone in health care is feeling the pinch.

It is no secret that work not billed will ultimately be work not paid. Hospitals and practice managers, adept at business principles, know this. Deep down inside, doctors know this, too. Historically, doctors dictated when they billed their patients, even if it meant waiting over a week to do so. If a doctor was to take a vacation, some of those billings could wait until his return.

Not so any longer. Read more »

*This blog post was originally published at Dr. Wes*

Using ICD-9 Codes To Describe Your Morning


6:00 AM

Alarm goes off.  Hit snooze button. CIRCADIAN RHYTHM SLEEP D/O IRREG SLEEPWAKE TYPE ICD-327.33


  • Alarm goes off for third time.  Ready to hit snooze button, but knee in ribs from wife prevents more snooze button procrastination.  CONTUSION OF CHEST WALL ICD-922.1, ADULT MALTREATMENT UNSPECIFIED NEC ICD-995.8
  • Feeling tired, go to make a pot of coffee. CAFFEINE ADDICTION ICD-304.40
  • Fill bowl with Lucky Charms and start eating. UNSPECIFIED NUTRITIONAL DEFICIENCY ICD-269.9, HYPERGLYCEMIA ICD-790.29


  • Realize that coffee pot needs to be turned on for it to make coffee. ATTENTION DEFICIT DISORDER, ADULT ICD-314.00, LISTLESSNESS ICD-780.79
  • Read more »

*This blog post was originally published at Musings of a Distractible Mind*

If Attorneys Billed Like Physicians

Imagine if lawyers had to bill like doctors:

Beginning July 1, 2010, under the Legal Billing Obfuscation Act of 2009, lawyers will receive their payments for services rendered after approval by a central US government Payment Distribution Authority (USPDA). To receive payment from the Authority plaintiff and defendant complaints must be coded and filed electronically using the International Classification of Legal Complaints, 10th edition (ICLD-10), copyright © 2009, American Bar Association and Legal Proceeding Terminology (LPT) codes, copyright © 2009 American Bar Association. The full publication of each of these codes will be available in print March 1st 2010 and in electronic form on DVD in July 2011.

To familiarize lawyers with the new coding scheme requested by the USPDA, a small sample for the complaint of “Spilling” is shown below: Read more »

*This blog post was originally published at Dr. Wes*

The Canadian Health Care System: Just Like Ours

Why paying for health care is so difficult:

a gigantic, complex raft of billing codes which are seemingly designed to haunt you in your sleep. With thousands of codes, and with frequent revisions to the fee schedule, it’s difficult to imagine a bureaucratic system. . . more challenging to decipher.

American health care?  No, Canadian.

Some problems are inherent to health care, regardless of who pays for it.

*This blog post was originally published at See First Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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