There was a nice piece by a Dr. Anne Marie Valinoti in the WSJ recently. She is an internist and the title of her commentary was Physician, Steel Thyself for Electronic Records. Many of you may not be able to read the whole article (need a WSJ subscription) so here are some highlights:
- As stipulated by ObamaCare, Medicare and Medicaid have enthusiastically embraced the concept of a paperless world. Doctors who adopt these programs in a “meaningful” way (more on that later) will be rewarded to the tune of up to $44,000 over five years. For those doctors who say no thanks, reductions in their Medicare payments for service will start in 2015.
- Tasks that once took seconds to perform on paper now require multistepped points and clicks through a maze of menus. Checking patients into the office is an odyssey involving scanners and the collection of demographic data—their race, their preferred language, and so much more—required by Medicare to prove that we are achieving “meaningful use” of our EMR. What “meaningful use” means no one knows for sure, but our manual on how to achieve it is 150 pages long.
- The end product will be lovely: a meticulously organized digital chart, with gorgeous progress notes. Nuggets of data accessible and ready for the plucking by the numbers crunchers. Medicare says the EMR is going to help me “achieve benchmarks that can lead to improved patient care.”
- Documentation is important, but the pointing and clicking and cutting and pasting we are so focused on in demonstrating meaningful use of EMR may be getting in the way of meaningful encounters with our patients.
- With all the data entry the electronic system requires, my laptop presents a barrier between my patient and me, both physically and metaphorically.
- Some of the best doctors I’ve known were famous for the unintelligible scrawl of their hospital chart notes. Yet I doubt that fantastic electronic documentation will translate into fantastic clinical care. The institution of EMR seems to be a case of choosing style over substance, of putting up a few more hoops for doctors to jump through in their quest to simply take care of patients.
- So, excuse me if, like a teenager transfixed by her smartphone, my eyes are glued to my screen at your next visit with me. I am truly listening to you. It’s just that eye contact has no place in the Land of Meaningful Use.
She gets it. The problem is that the EMR is being built to make the third-party payers happy. They are not being built to make the first and second parties happy. You know, the patients and doctors. And that is what is wrong with our healthcare system!