I will start with full disclosure. I still use paper charts. While I think my practice of medicine is "uber"-up-to-date...the truth is it could be 1950 when you look at my patient records. Charts are huge and some patients I've seen for decades are on volume 3, just to make them manageable. So this very week I am coming on board with a full blown, state-of-the-art Electronic Health Record.
The government is pushing EHRs and, in fact CMS (Center for Medicare and Medicaid Services) has already imposed a 1% penalty on doctors that are not doing e-prescribing of prescriptions. The penalty goes up to 1.5% in 2013. There are also some large incentive dollars connected with "Meaningful Use". It is a complicated set of criteria put out by CMS that pushes physicians toward investing in the EHR.
With all of these incentives why haven't more physicians converted? For one it is darn expensive and the best systems require large groups or hospital funding to make it financially feasible. Staff needs to be trained, equipment purchased, software and licenses purchased, Internet technology (IT) support is needed and the doctor's productivity and ability to see the same number of patients declines. And it totally changes how you and your staff do your work.
The advantages are numerous, however. Having access to instant, legible information all in one place, shared by all of the caregivers is huge. The EHR gives easy access to consultant notes and all tests. When I am on call at night or weekends I can see my patient's information and it will prevent medical errors. The EHR can be programed to give "alerts" for drug reactions, needed screening tests and medical information.
So it is a no brainer that we all need to switch to the 21st century and start using technology to help us deliver better care.
I have already gone through an entire day of training and will be using more of my "free" time this week to abstract my old charts, learn the system and develop my own practice templates in the new EHR. I will need "at my side" IT support when I first start using it with patients. I think my patients will understand if it is clumsy at first. And they will surely like the ability to see their own lab tests and make office appointments on-line.
I am looking forward to the change but also wary of what is ahead. Internal Medicine is already a grinding specialty with low pay and long hours. Spending more hours with an EHR is not appealing but I hope the benefit to patients and safety makes it worth it in the long run.
The graph below is on a scale of 1-5. 1=poor, 3=neutral and 5=excellent. You can see that none of the EHRs scored very high with the Physician users.
Satisfaction with EHRs by Employed Internists in large Practices
|Easy to learn||3.62|
|Ease of data entry||3.57|
|Overall ease of use (intuitive)||3.45|
|Ease of EHR implementation||3.43|
|Adequacy of vendor training program||3.55|
|Vendor continuing customer service||3.63|
|Interactivity with other office systems||3.29|
|Value for the money||3.46|
|Physician overall satisfaction||3.51|
|Staff overall satisfaction||3.55|
|Appearance/overall usefulness of the end product (eg, notes, consultations)||3.68|