Is The Increased Patient Safety Of The EMR Worth The Inefficiency?
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*
I have a purely outpatient practice and went live with my EHR early this year. It’s been an efficiency disaster! I’ve had to cut down on the number of patients we schedule a day because we just can’t see patient and chart simultaneously. I am now a data entry person as well as the physician, and that’s after delegating everything I possibly can to staff. Yes, I could hire another full time staff person to act as a scribe in the exam room but that is hardly creating efficiency in an already bloated health care system where too many dollars are already diverted from actual health care services.
Having experienced 7 months of the new EHR practice reality I’m convinced that the goal is date collection, not efficiency and access to personal health records across the health care delivery system, at least at this point. My EHR, which is one of the biggies, is ill prepared to make my practice efficient. The product will need complete overhaul to do so and I don’t see that coming. I reviewed many products before making my choice and mine is no different than the other leading EHR products that I had to chose from. They all give me a choice of drop-down menu purgatory or templatizing a visit, thus creating mediocre chart notes as a sacrifice for efficiency. I’ve arrived at a compromise to make it through a day with documented encounters, and it’s still required that I hire one more staff member in my office and cut down on the number of patients I see a day. This is certainly not helping the bloated health care system stream line costs.
This topic doesn’t get nearly the attention it deserves. It seems to me that the vast majority of EMRs get two things wrong:
1. Excessive focus on machine-parsable data – The urge to have the computer be able to “understand” the data being entered isn’t unreasonable (it makes things like pulling up past lab results and creating forms a lot easier), but in order to be machine-parsable the doc needs to enter data in specific fields… you can’t just write “Lorazepram 1MG BID” in the note… you must make the machine understand that you are prescribing this drug so it can do interaction check and e-rxing, and this means a more laborious entry process: everything in the note must be quantified is some way. There are some benefits to this, but I think that the costs of this data collection outweighs the benefits in most scenarios.
2. Transferring tasks that were once the purview of lower-level staff onto the doctor. Whereas you used to be able to jot down and note and call in an RX and then hand everything else over to office staff, the systems now try to do much more for you (billing, demographic changes, finding and filing charts, etc). While this is theoretically great and might save man-hours overall, it does so by pushing administrative work onto the doctor’s plate. This doesn’t make sense when the pay discrepancy between the doc and back-office staff is as great as it is.
There are EMRs that do a decent job on both these fronts, but most of the big players in the field will reduce rather and improve your efficiency.