Monday, October 29, 2012

Getting Used to Electronic Health Record

From this...
To this


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

Criterion Rating Averagea
Easy to learn 3.62
Ease of data entry 3.57
Overall ease of use (intuitive) 3.45
Ease of EHR implementation 3.43
Reliability 3.99
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

10 comments:

Anonymous said...

Has any one done a survey on patient satisfaction and or discussed how much it drastically takes away from the patient's relationship?

Having experianced both kinds of charts. In a disaster like NYC is having with a massive power outage there would not be access to EHR or EMR's. On the plus side with the click of a button the pharmacy has your Rx reducing waiting time. It takes away from the personal human aspect and talking about anything outside the medical issue since it takes longer and more concentration in typing and maneuvering the templates. Less eye contact or any humor. I have seen a doctor become like a secretarial robot.

My previous doctor went from paper charts to EMR's but am lucky my current doctor has been able to keep paper charts up till this point. It will be interesting to hear what your patients think. Great that you have been able to hold off until financial penalty of fines from medicare are about to be enforced.
Anonymous

Michael Kirsch, M.D. said...

I've gone through the childbirth of EMR conversion. Yes, I know all of the advantages, such as you have pointed out. Yet, I miss paper...

Have Myelin? said...

I am a very reluctant Medicaid user and I do not want my medical records on EMR.

How would like your own medical records handled?

I like to be treated like a person - paper records I can read with the doctor work for me. We work together, you know...

Why is the government in the electronic monitoring business?
Why would I want the government to have access to my medical information? Big Brother is watching too much?

EEK. I want to opt out.

Toni Brayer, MD said...

Have Myelin: The government is promoting electronic medical records because the United States is way behind other Nations and technology (when done right) can lower administrative cost, improve patient access and patient safety and quality of care. The government will not have any more access to EHR than it does to paper charts. Even now, CMS can see your chart in paper.

Michael Kirsch: I went live on Friday. Got home at 8:30 PM brain fried and numb. It will be a long and steep learning curve.

Anon: Change is part of life. Paper charts will go the way of telephone booths, 8 track tapes, covered wagons and Dr. Welby.

emr blog said...

EMR is a wonderful piece of software if used in a right manner. Nice informative post, thanks!

Anonymous said...

As with any new technology, we humans are always behind the adaptation curve. EMRs are just a fancier way of storing and accessing patient files, the difficulty is in how the physician integrates the use and interaction with the new technology, into the traditional doctor-patient relationship.

There are so many intangibles to that relationship that cannot be quantified or build into a diagnostic algorithm...but physicians need to adapt very quickly or else risk having patients think they can self-diagnose online almost as effectively as visiting their physician who spends the majority of their office visit with back turned hunched over a computer.

The technology is here now, but it is just a tool. It is up to doctors to quickly work out how best to utilize that tool effectively.

So you're right doc, 8-tracks are long gone, but we are still listening to music...so you have to change too unless you want to be on the next covered wagon out of town.

James said...

Technology has really come a long way. Well, since the use of electronic health records is new, I think it is really necessary to properly and seriously train every medical employee and intern. This new process requires employees’ focus and concentration to avoid certain errors with the health records. Every bit of information about a person’s medical record is important, and it needs to be accurate for a smooth medical protocol or procedures and to avoid confusion of any kind.

James Guertin

Ransom Stephens said...

You've only scratched the surface. The incredible advantage to EHR systems is in correlating treatments across large groups of patients.
You know how Netflix can predict what you moveis you like? Sure, they're not perfect, but they're very good. What if your medical treatments could be personalized at that level? Here's the idea:
Patient Al comes in with illness Be. Al's medical history along with vital stats and, coming soon, genetic mock up, can automatically be compared to the entire population. That population is then reduced to people of similar age, condition, genetics who have also been treated for illness Be.
The probability of success can then be calculated from existing data and, more than that, the uncertainty in that probability can be calculated.
The result is that Al and her doctor can make an evidence-based informed decision. Not a decision based on marginal statistics and random treatments performed in studies on people who have little in common with Al, but statistics based on genuinely similar cases. The result is the ability to pinpoint treatments which reduces hits and misses and results in incrementally improved care and massive savings.
Data mining is powerful stuff.

Almeta Tai said...

Like what James said, that’s what technology can bring: fast and accurate results. EHR makes it possible to do away with the pen and paper system to keep track of patients’ medical records. Also, EHR has a better documentation of records. Being just a few clicks away from a patient’s medical information will allow for a faster and better response in providing medical care.

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