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Sometimes Little Changes Can Add Up: The Extra Work Of The EMR

“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*

Does The EHR Carry The Risk Of Making All Patients Look Alike?

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*

Improving The Physician’s Experience With EHRs: More Training Required

Physicians need at least three to five days of training on new electronic health record (EHR) systems to achieve the highest level of overall satisfaction, but nearly half of new users get three or fewer days of training, according to a survey.

AmericanEHR Partners surveyed physicians’ experiences with EHRs to achieve some meaningful use requirements. (The group is a web-based resource for EHR system selection/implementation developed by the American College of Physicians and Cientis Technologies).

AmericanEHR Partners used a 139-question online survey to collect data form physicians, nurse practitioners and physician assistants about their use and satisfaction with EHRs and health information technology. Survey data from more than 2,300 physicians in conjunction with five different professional societies was collected from April 2010 to July 2011. Results appeared at the group’s website.

There were Read more »

*This blog post was originally published at ACP Internist*

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 Read more »

*This blog post was originally published at The Happy Hospitalist*

Solo Practice Vs. Integrated Health Systems: What’s Best For Primary Care Reform?

The buzzwords of cutting-edge primary care reform – the medical home, coordination of care, electronic health records – have usually been associated with large integrated health systems such as Intermountain Healthcare, Group Health, and Kaiser Permanente. If you believe the arguments that economies of scale and financial resources give such organizations built-in advantages over the traditional small group practice, you may be inclined to believe that solo practice is going the way of the dodo. Indeed, immediate past AAFP President Roland Goertz, MD, MBA penned an editorial a few months ago, “Helping Small Practices Survive Health System Change,” that, while touting some services that the Academy offers family physicians in these practices, betrayed a decidedly pessimistic outlook on their long-term future.

Not everyone agrees, however. In the September issue of the Journal of Family Practice, Jeff Susman, MD cast solo practices as vital engines of primary care innovation: Read more »

*This blog post was originally published at Common Sense Family Doctor*

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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