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
I admittedly snorted out loud when I read a New York Times article earlier last week regarding increased physician distraction due to electronic devices, especially with the advent of the smartphone with its emails, text messages, calls, and other alerts that ping intermittently throughout a typical work day.
There is no question that electronic devices distract physicians as the article pointed out… But that’s like complaining about a leaky faucet when there’s a flooded basement and a hole in the roof.
The bigger problem that should be mentioned is hospital bureaucracy which probably creates just as much if not more unintended distractions for physicians and nurses.
What many patients and lay public may not realize is that Read more »
*This blog post was originally published at Fauquier ENT Blog*
“I estimate these changes to your charting work flow will take only five minutes.”
Five minutes is fine if it happens for only one patient. But when it is multiplied by as many as forty patients in a day, the multiples get impressive. Five minutes x forty patients = 200 minutes (more than 1.5 hours a day).
Minor five-minute changes to administrative charting requirements aren’t so minor, especially when you add more time for quality assurance reporting or pay-for-performance initiatives. Suddenly huge swaths of time from a doctor’s opportunity to take care of their patients. We need more care time and less data entry time. Doctors must insist that we not become data entry clerks.
Increasingly, I see the data entry burdens of regulatory health care documentation requirements falling on doctors. On first blush, this seems logical because only doctors (or very capable, highly trained surrogates) understand the nuances required to make potentially life-altering adjustments to the electronic medical record. But when new administrative documentation requirements are added to doctors and other care providers, it Read more »
*This blog post was originally published at Dr. Wes*
I saw it begin to happen in the ’90′s. Residents came to rounds with their daily notes produced on a word processor. The notes were impressive. Legible, lengthy and meticulously detailed at first glance.
Then I started to notice a pattern. The impressive notes began to look very much alike. The thorough exam varied little from patient to patient. And problems that occurred on previous days seemed to persist in the medical record, even when it had resolved. In some cases the previous day’s note was printed only to have one or two additional elements added by hand. It was never really clear what was worse: the lack of effort or the illegible writing.
Our electronic health records (EHR) offer similar options. We can smart text our way to clinical efficiency. Some doctors have entire impressions and elements of the history pre-generated for common conditions. These are advertised features of the most common EHRs. Technology can make us look Read more »
*This blog post was originally published at 33 Charts*
How many patients should a hospitalist average on any given day? What do you think? The Hospitalist asked that question to hospitalists and 421 of them responded. They were given responses in quintiles of 10 or fewer, 11-15, 16-20, 21-25, and more than 25 total patient encounters per day.
Go check out their results. I’m not surprised. But, as they say, there is no right answer. The right number is the number that brings WIN-WIN-WIN-WIN to the patient-doctor-hospital-insurance quadrangle. WIN-WIN-WIN-WIN is possible. It just takes a great understanding of removing the barriers to efficiency. Efficiency and quality of care can move in the same direction. They don’t have to be opposing forces. You can be better and faster if given the tools, whether those tools are driven by IT support, systems process changes, communication enhancement, physical and structural hospital layout changes or documentation support tools. There are many others. Read more »
*This blog post was originally published at The Happy Hospitalist*