Turns out there is an unintended consequence of many of the current efforts to standardize the way doctor’s practice medicine. It is called de-skilling. De-skilling can occur when physicians and other providers try to adapt to standardized, new ways of doing things. Examples of such standardization include clinical based care guidelines, electronic medical records (EMRs), Pay for Performance (P4P), Patient Centered Medical Home (PCMH) requirements and so on.
Examples of physician de-skilling were revealed in a recent study which consisted of in-depth interviews with 78 primary care physicians regarding EMR use. EMRs are all about standardization – what data is captured and recorded, how data is reported, how data is used, and so on.
Over the course of the interviews, physicians in the study described significant examples of de-skilling behavior. Most indicated that Read more »
*This blog post was originally published at Mind The Gap*
Why do we physicians chart the way we do? Hopefully, we do it perfectly well and have no concerns at all. But where I practice emergency medicine, we are approaching maximum inefficiency in charting.
It all became much clearer when we started using our new EMR system. Let me make it clear, I’m not against EMR. In fact, typing and templates work better for me than dictating. My dictations were usually a mine field of blanks and misunderstood words.
Furthermore, if I wanted to use it, we have a new voice recognition dictation system in addition to our templated chart. Though admittedly, the voice recognition program clearly hates some of my partners, as evidenced by the way they grasp the screen and yell at it (‘Chest Pain, not west rain!’) and by its inexplicable use of profanity in the occasional chart.
But I digress. The problem as I see it is the evolution of the medical record. Why does the medical record exist? Read more »
*This blog post was originally published at edwinleap.com*
I came across this picture of my desk just before we went “all in” with our electronic medical record six years ago:
It was a huge amount of work for our staff to organize and box all those old medical records that were sent off to a site unknown. I remember early on when we tried to get some old records after that happened. People just shrugged – no one had a clue how to retrieve them.
But you know what?
Now that we’re farther away from that time, I can’t say that I miss them.
Still, my current desk looks just as disorganized.
*This blog post was originally published at Dr. Wes*
Electronic Medical Records are coming. The economic stimulus bill (furious spinning kittens notwithstanding) assured this.
Under the terms of the bill, CMS will offer incentives to medical practices that adopt and use electronic medical records technology. Beginning in 2011, physicians will get $44,000 to $64,000 over five years for implementing and using a certified EMR. The Congressional Budget Office projects that such incentives will push up to 90 percent of U.S. physicians to use EMRs over the next 10 years.
Practices that don’t adopt CCHIT-certified EMR systems by 2014 will have their Medicare reimbursement rates cut by up to 3 percent beginning in 2015.
(From Fierce Health IT)
There will be even more money for implementation. We look forward to our checks (and are not counting on them yet).
Now it is time for the flies to start gathering. Wherever there is lots of money, “experts” pop up and new products become available that hope to cash in. Doctors, who are never lauded for their business acumen, will be especially susceptible to hucksters pushing their wares. It seems from the outside to be an simple thing: put medical records on computers and watch the cash fly in.
Anyone who has implemented EMR, however, can attest that the use of the word “simple” is a dead giveaway that the person uttering the word in relation to EMR is either totally clueless or running a scam. It’s like saying “easy solution to the Mideast unrest,” “obvious way to bring world peace,” or “makes exercise easy and fun.”
Run away quickly when you hear this type of thing.
Just like becoming a doctor is a long-term arduous process, EMR implementation happens with time, planning, and effort. It’s not impossible to become a doctor, but it isn’t easy. With EMR adoption, the most important factor in success is the implementation process. A poorly implemented EMR isn’t simply non-functional, it makes medical practice harder. A well implemented EMR doesn’t just function, it improves quality and profitability.
How do I know? Our practice ranks very high for quality (NCQA certified for diabetes, physicians are consistently ranked high for quality by insurers), and we out-earn 95% of other primary care physicians. EMR allows us to practice good medicine in a manner that is much more efficient.
So how’s a doc to know who to trust? What product should he/she buy and whose advice about implementation should they follow? There are many resources out there. Here are a few I think are especially worthwhile:
- Buy a product that is certified by Certification Commission for Health Information Technology. CCHIT is a government task force established to set standards for EMR products. Its goal is to allow systems to communicate with each other and enable more interfaces in the future. The bonuses for docs on EMR are contingent on the system being CCHIT certified (think of it as something like the WiFi standard).
- The American Academy of Family Physicians’ Center for Health Information Technology and the American College of Physicians both have tools to help member physicians decide on an EMR. Your own specialty society may, too.
- Several professional IT organizations have programs to improve EMR adoption, including HIMSS and TEPR.
- Austin Merritt has written a good article of advice on his website Software Advice that underlines the importance of implementation.
The best advice I can give, however, is to visit a doctor’s office who is using an EMR successfully. This office should be as close in make-up to your office as is possible. You should be able to look at how they do it and see yourself in that situation. Never buy a product before visiting at least one office like this (no matter how good the sales pitch). When you visit, make sure you ask them about the implementation process. How did they do it and how hard was it?
Which EMR do I recommend? Remember, I have been on EMR for over 12 years, so haven’t had much of a chance to shop around. You hear raves and horror stories with every product. Here is some basic advice:
- Get a solid CCHIT-approved brand that has been around for a while
- Don’t pay as much attention to price as you do function. Since the EMR will be absolutely central to the function of your office, it is a dumb mistake to overly-emphasize cost.
- Realize you are paying for a company, not just a product. It is not like buying a car, it is more like having a child or getting married. REALLY research that side of things. A good EMR with a bad company behind it should be avoided like the plague.
- See how connected the user-base is as well. A solid user group will do much to make up any deficiencies in the product and/or company.
So much time is spent shopping over EMR products, but buying an EMR is like being accepted into Medical School; your work is just beginning. That’s OK, because like medical school, the effort put in gives a very worthwhile product.
**This post was originally published at Dr. Rob’s blog, Musings of a Distractible Mind.”