Five reasons your family doctor isn’t using EMR

http://www.infoworld.com/t/business/five-reasons-your-family-doctor-isn’t-using-emr-005

I like this quote:

"Physicians are by and large in the business of providing professional time," said Pinhas.

EMR has to either help physicians treat patients better in the same amount of time or allow them to reduce the amount of time to treat patients at the same level of care or provide more time to increase the patient load, he suggested.

Pinhas is a great spokesperson for EMR, but needs to modernize his own product !

 

For me, charting with my paper template is so dang fast!  Most primary care doctors LOVE paper.  That is one of the reasons why so few have seen the need to move to an EMR. 

The next best thing I've found to using paper is MedScribbler.  But I don't get the impression that they want to have anything to do with certifications insurances may require for reimbursement. 

Layne, the current push to c-EHR will eventually wane and disappear. Just ride it out to see what happens. Let the "other guy" buy the c-EHR and waste his money.

The ideal situation that will most likely take over the market is a big government HIE that will tie in all EMRs, including MedScribbler. It could be that we even will end up with a free EMR, a la VistA.

Al

>>For me, charting with my paper template is so dang fast!  Most primary care doctors LOVE paper.  That is one of the reasons why so few have seen the need to move to an EMR. <<

Paper is fast, but it is not as fast for me,  when you see the patient more than once.

There's a lot to be said for paper. Imagine if digital was the norm and then ----------there was paper communication. This would constitute an addendum to the definition of "orgasm."

Yes it is fast but does not give the most critical information on a case - the history. It is usually incoherent, detached, irrationale. It may work for the main Physician generating the record but in this time and age of fragmented care where there are lots of involved parties/specialists, and shift style of work, accurate information without burdening the ill patient of repetitive queries is very important. These developments are indeed disturbing.

Rogerven:

Yes it is fast but does not give the most critical information on a case - the history. It is usually incoherent, detached, irrationale. It may work for the main Physician generating the record but in this time and age of fragmented care where there are lots of involved parties/specialists, and shift style of work, accurate information without burdening the ill patient of repetitive queries is very important. These developments are indeed disturbing.

Coherence is not  function of paper versus electronic documentation, but the nature/complexity of the history, and the ability of the provider to rapidly convert and record that history into readable "story." Bottom line -- THE most consistently coherent histories I have read are those that are dictated and transcribed. However, the powers that be have decided that this is too expensive.

Rogerven:

Yes it is fast but does not give the most critical information on a case - the history. It is usually incoherent, detached, irrationale. It may work for the main Physician generating the record but in this time and age of fragmented care where there are lots of involved parties/specialists, and shift style of work, accurate information without burdening the ill patient of repetitive queries is very important. These developments are indeed disturbing.

Coherence is not  function of paper versus electronic documentation, but the nature/complexity of the history, and the ability of the provider to rapidly convert and record that history into readable "story." Bottom line -- THE most consistently coherent histories I have read are those that are dictated and transcribed. However, the powers that be have decided that this is too expensive.

imemod:

Rogerven:

Yes it is fast but does not give the most critical information on a case - the history. It is usually incoherent, detached, irrationale. It may work for the main Physician generating the record but in this time and age of fragmented care where there are lots of involved parties/specialists, and shift style of work, accurate information without burdening the ill patient of repetitive queries is very important. These developments are indeed disturbing.

Coherence is not  function of paper versus electronic documentation, but the nature/complexity of the history, and the ability of the provider to rapidly convert and record that history into readable "story." Bottom line -- THE most consistently coherent histories I have read are those that are dictated and transcribed. However, the powers that be have decided that this is too expensive.

Pure Brilliance !

I very much agree on both fronts.

Coherent, succinct documentation should be the goal, if effective and efficient  communication and patient care were the goals of documentation.  Sadly those are often NOT the goals.  The goal is to

(1) upcode the visit or at least code as well as possible to get fairly paid.  The "Absolutely Stupid" E & M coding is a major problem.  E & M coding's purpose was to attempt to only pay higher codes if the doctor justifiably spent alot of time on a difficult case.  That attempt is for the most part a failure.  E & M coding is now just used by insurance companies to reduce fees paid to doctors.   Truly the entire way doctors get paid is terminably broken.  It must change.

(2) document as much as possible to possibly save your ass if you get sued.  Excessive documentation for goal (2) hinders coherent/efficient documentation and makes documentation less readable/usable for the provider himself, but definitely for other providers.

Most EMRs are setup to attempt to maximize the amount paid to the provider for the visit by documenting a myriad of useless things.

It is an interesting challenge for the future of Medicine to pay for things that make the care of the patient improved and more efficient, not just spitting out lots of junk.

Not easy I say !

I think the complexities of attempting to "fairly pay" a doctor per patient visit is insurmountable.  The future of paying for medical services is paying per patient per year.  This is especially true in outpatient medicine.