Controversial question. They see patients relatively infrequently and don't do chronic care. So, how do they benefit?
I can see the multi-office groups benefittingt and perhaps saving on t-scription costs, but is that enough given the costs of some of the EMRs and the availability of Dragon to do the dictations?
Lowell Kleinman, MD www.drkleinman.com www.old-fashionedhousecalls.com
I believe that surgical specialties need an EMR to the same degree that an EMR helps prevent WSS(wrong side surgery). What degree is that?
Robert Gleeman, Medical Journalist for EMR Update.com Email: robert@emrupdate.com Tel: 1-650-968-6359 Skype and ooVoo user name: robertgleeman EMR progress is a matter of fact. EMR Update supports your right to know.
I agre that these measures are of value. In fact, I am enrolled in several of these programs. However, I do not need an EMR to participate in them.
To this point, the MCARE project I am enrolled in requires that we manually enter the data into their registry software. I believe my EMR will eventuaklly link to it directlty, but for now I hired someone to manage the data.
So, while registry functions are important there are less expensive ways to perform them than getting an entire EMR.
I am still wondering if there is a ROI for a single-officed physician who does not do chronic care.
I don't understand your point Robert?
grenadadoc1:The Maintenance of Certification that the American Board of Surgery has initiated has a section that deals w/ outcomes. This is my biggest issue w/ current EMR's, including the one that I use. There is no good way to generate that kind of data yet. As we move to a more granular data model, my hope is that this kind of information will be much easier to extract from my DB.
Ironically enough, NextGen just announced our relationship with the American Board of Internal Medicine. This is the first ever relationship between a certifying board and an EMR. This isn't relative to the American Board of Surgeons, but I would imagine we will pursue similar relationships with other certifying boards to facilitate an efficient way to report clinical performance data.
http://www.nextgen.com/press/ABIM-NextGen-release-FINAL.pdf
Patrick
DrQuit: I don't understand your point Robert?
It's just a hunch, because I couldn't find any studies to back it up, but I believe that EMR helps prevent wrong side surgery.
I have seen how some EMRs have human figures on surgical templates where three dimentional representations of the human body make it very difficult to confuse the side needing the surgery. Perhaps something like this:
I am a fan of NextGen and obviously EMRs so don't take this the wrong way.
Do folks feel that the marketplace is heading in a direction whereby physicians are going to have to purchase software to participate in these P4P programs?
Are we going to be footing some of the costs of tracking and managing data?
Does it even make sense for us to be doing this as it is far from our core business?
Congrats on the announcement! You really get your money's worth with NextGen.
DrQuit: I am a fan of NextGen and obviously EMRs so don't take this the wrong way. Do folks feel that the marketplace is heading in a direction whereby physicians are going to have to purchase software to participate in these P4P programs?
Too late, Lowell. Feelings hurt... Damage done... I think that as time goes on and preventative care and quality measurement becomes an even hotter topic in medicine, the choice to move forward with an EMR will become a clearer choice for those still on the fence. In the meantime, those who still swear by a paper or dictation-based practice will still be hesitant to convert.
I could probably write volumes on the last two of your questions. Let's see if I can provide you with the cliff's notes version of my own opinions.
DrQuit: Are we going to be footing some of the costs of tracking and managing data?
I think that depends on how you look at it. If you are only moving toward an EMR to avoid the cost of manually tracking and managing data, then I suppose the answer is yes. If this is just "icing on the cake," with the cake being the other benefits of a good EMR system, then I would argue the answer is no. That being said, I think the answer to your question will be in the opinion and outlook of the individual physician consumers.
DrQuit:Does it even make sense for us to be doing this as it is far from our core business?
I don't think anyone can adequately answer that question at this point in time. You could certainly argue a point either way, but I think the answer will be come more clear in the next coming 3-5 years. It is my belief that the DOQ-IT and other P4P programs will play a pivotal role in "correcting" medical issues faced today. Many of the apprehensive physicians feel like they have enough on their plate than to worry about these programs, and probably rightfully so to a degree. Years of non-stop work and declining reimbursement (among other real issues) can very well cause skepticism in any government program (Exhibit A - http://www.emrupdate.com/members/alborg.aspx ). The other factor is that the scope of P4P goes way beyond our current generation of physicians and patients. The chronically ill patients of today are probably unlikely to pull a 180 degree turn in their disease states. However, through the long term reporting of age and sex-based health maintenance criteria, I believe true disease prevention can be realized. I can't find the quote, but JFK made a point that just because some of the issues we faced as a country during his presidency could not be solved during his term or the terms of many presidents following him, that doesn't remove our responsibility to act now.
The key to acheiving a happy medium is to find a product that can do two things:
I'm rambling now. Have a great evening!
>>> Years of non-stop work and declining reimbursement (among other real issues) can very well cause skepticism in any government program (Exhibit A - http://www.emrupdate.com/members/alborg.aspx ).
Hi Patrick:
Hey- I was born into a communist country (Cuba) from which my family had to leave and we got royally scr*wed by "big government". Docs in Cuba make $30 a month. I guess maybe if THEY had P4P the promised extra $3 would really mean something...
In the USA I'm working in an already overregulated medical industry in which insurance companies and government want doctors to be stupid enough to enroll into P4P for a few extra pennies all the while having to invest in more paperwork, more staff, and of course, into the purchase of multithousand dollar CCHIT certified EMRs which will benefit everyone but themselves.
Since I already have an EMR that I have programmed for the past 17 years, and which has worked well for the workflow of my particular office, I will fight tooth and nail the intrusion of these forces into the medical system in the USA. Or at least into my office...
>>> It is my belief that the DOQ-IT and other P4P programs will play a pivotal role in "correcting" medical issues faced today.
Most "medical issues" revolve about the perceived cost savings which can be brought about by socialist pinheads in government and in the insurance industry that want to deny medical care to patients through the use of IT. Of course, HIMSS/CCHIT will be there to make a quick buck.
Al
Rodney Dangerfield:
"Some dog I got too. We call him Egypt. Because in every room he leaves a pyramid."
(Hmmm... maybe P4P stands for "pay 4 pyramid"? )
Al Borges, M.D.
● Oncologist in a Small Group Practice in Virginia
● My website URL: http://msofficeemrproject.com/
I like the JFK reference as i believe we have a responsibility issue on our hands. We are giving care to patients and they entrust their health to us. Thus, we have a moral responsibility to do the best we can. That includes lots of things such as staying up on ourr CME and acting on registry data.
However, as a member of the "small to medium sized group" club, I am having a hard time maximally acting on the registry data. While it's not exactly a tectonic shift in the way we practice medicine, it is requiring systems changes.
One approach is to have the EMR generate the data. This can be simplified with automation of reports and many of the things we have discussed here. Another approach is to have someone else manage the data, including acting on it.
Such is the case witth my local IPA which happens to be using NextGen. The docs are on the ASP model and the IPA plans on culling the data for the docs. Perhaps, as I have suggested to the IPA powers that be, the IPA could assist us in acting on the data. They could call patients, etc thus relieving theoffices of this task.
I think offices should focus on what they do best; provide care. I suggest that they should outsource the data piece.
Lowell
Al - sometimes I think you give government too much credit for being organized enough to formulate a P4P idea with the intentions of getting docs to do more for less. Yes, if *** Cheney was behind P4P I think we would have reasons to be suspicious.
DrQuit: Al - sometimes I think you give government too much credit for being organized enough to formulate a P4P idea with the intentions of getting docs to do more for less. Yes, if *** Cheney was behind P4P I think we would have reasons to be suspicious. Lowell
Lowell,
Not to turn this into a political thread (please, please, please) but it seems to me that it is Hillary and the gang who are looking to have government regulate all our medical care. On the other hand if it was Cheney, I would imagine that penalties for noncompliance might be more "interesting"?
To address your original question - I believe that there is real value in EMR implementation for surgical specialties. For one thing, in many respects the adoption of an EMR for these guys is easier. For most of them a much reduced subset of templates is required and what they do is more easily templated - e.g. if I am an Orthopod who is a sports med guy, I need knee pain, shoulder pain, and ankle pain templates and I am covered for about 90% of what I do (if I am further specialized I might need just the knee pain template). Standard procedure information - patient prep, patient positioning, medical devices, anesthesia requirements, wound dressing, postop meds, etc. can be defaulted in and put on a template to facilitate surgical scheduling. Routine postop visits can be also defaulted in with the ability to chart exceptions and complications - so if I am seeing a patient during the global billing period ( during which I am not getting paid for each visit) I can literaly complete my follow-up documentation for a patient with no postop complications with 3 or 4 mouse clicks and in about 15 seconds.
Further, where templates get complicated for primary care folks is during the "discovery" period. Specialists usually have a pretty good idea why people are there - Doc, my vision is blurry in my left eye. They don't often get the "I just don't feel right" patient. Plus they are generally treating a specific issue and are not following patients over a long disease course with multiple contributing factors. They generally don't need, nor want to produce the long narrative HPI which can be difficult on a patient by patient basis for the primary care folks.
On the benefit side, recording their data in a structured format obviously allows them to develop good outcome stats, comply with whatever reporting requirements they have or will have and will allow them to adjust their patient treatment modalities based on their own particulart outcomes data and not have to rely on anecdotal stories, case studies from I have a viewpoint vendors or national statistics. If they are practicing good medicine, they will be able to show that. If they need to do better, they will know that. If they are operating on the wrong knee as Mr. Gleemen postulated, I think they have bigger problems than whether they get the right code on their office visits - although the documentation of the visit postop will be a breeze! I suppose they could even do a "wrong knee" template!
As a specialist with both primary care and specialty tendencies (GYN only), I think Bob makes some good points. EMR is great for my annual physicals/pap smears because the whole thing is pretty much templated. On the surgical side, most of my patients walk in and tell me whats wrong, so my HPI's are pretty easy ("I have fibroids and anemia, and my PCP told me I need a hysterectomy...")
I use dragon for my a/p because I find that if I template that aspect (although freqeuently I can), I lose alot of the nuances of the discussions I have had with patients.
The one great thing I love about my EMR is an automatic generation of my preop H&P. I bring my patients in for this visit, spend a fair amount of time reviewing risks,benefits, and alternatives. I don't have to re-dictate this. It is in my template for the procedure. Saves alot of time when doing 6-8 hospital procedures a week. You can also tie prescriptions to this, preop forms, orders, etc. so that I don't have to think about anything on the backend.
Document management is also very important as you are getting back op note dictations, path, etc, and you want them easily accessable.
It's starting to sound like the sub-specialties are benefitting more than primary care!
Documentation issues seem paramount and they seem to be readily addressed. Preop and postop notes sound easily templated.
What of the P4P type stuff? What sort of tracking do you guys and gals need to do?
BTW - Congrats to Al Gore...he reads this forum frequently and this is the best place to communicate with him.