Tuesday, February 12, 2013
EHRs, and how sometimes common wisdom is incorrect
I have the wonderful opportunity to speak with many physicians across the country. Recently in Omaha, I had breakfast with some academic internists. The recurrent theme these days involves the unintended consequences of electronic medical records (EMR) and especially the challenges imposed by the meaningful use requirements.
Once again the government imposed a regulation without understanding the unintended consequences. Since time is the most important attribute of an internist's day, anything that slows their daily activities means that they cannot spend as much time with patients.
I am a big fan of EMRs, but (and this is the key point) they must be designed and tested by practicing physicians. EMRs should make writing notes easier. EMRs should enhance sharing of data amongst physicians.
Unfortunately the promise of EMRs is failing. In order to accomodate "meaningful use," the screens and clicks seem endless. The EMR does not look right in most circumstances.
Our EMRs don't talk to each other, partially because of HIPPA and partly because each vendor uses proprietary databases.
EMRs could possibly improve care in the future, but today they have become a nuisance. From the New York Times articleIn 2nd Look, Few Savings From Digital Health Records: "Many experts say the available systems seem to be aimed more at increasing billing by providers than at improving care or saving money. Federal regulators are investigating whether electronic records make it easier for hospitals and doctors to bill for services they did not provide and whether Medicare and other federal agencies are adequately monitoring the use of electronic records.
"Technology 'is only a tool,' said Dr. David Blumenthal, who helped oversee the federal push for the adoption of electronic records under President Obama and is now president of the Commonwealth Fund, a nonprofit health group. 'Like any tool, it can be used well or poorly.' While there is strong evidence that electronic records can contribute to better care and more efficiency, Dr. Blumenthal said, the systems in place do not always work in ways that help achieve those benefits."
We need a "time out", but what will we get?
"Federal officials say they are drafting new rules to address many of the concerns about the current systems."
AAARRRRGGGHHHHHH!!!!!!! New rules--that should solve the problem (please read this sentence with great sarcasm). The rules are the problem. New rules will only create new problems. Get real practicing physicians to help you. Not computer geeks, not wonks, but real docs in small private practices.
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.
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Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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One of the most popular anonymous blogs written by an emergency room physician.