The Real EMR Problems

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!

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “The Real EMR Problems

  1. Chris Hickie, MD
    November 1, 2012 at 12:43 am

    Meaningful use has stopped meaningful software development. The US government is now the single largest buyer of EMR software, and the vendors now have to write software to what the govt wants, not what doctors want. This is analogous to how insurance companies get between healthcare providers and patients and force us, as providers, to cater to the insurers. I bought into an EMR almost 10 years ago because I was going crazy chasing paper charts around the office, which an EMR completely eliminates.

    -Chris

  2. Doug Given MD
    October 31, 2012 at 7:56 pm

    Medicine has lost its soul. All we ca do is stare at a computer and be its slave.

  3. Kurt
    October 31, 2012 at 6:05 pm

    We’re FFFFFF’d. I dictated everything from day one. Had an affair with voice transcription but that isn’t ready for prime time. Don’t go into primary care. I regret the day I did it now. Medications are more messed up in the EMR. The elderly can’t keep track and support people carelessly click on lists. At least when someone was writing it down, the brain had to be engaged to the pen. Don’t get me wrong, med lists were messed up with paper, it’s only that they are messed up more electronically and mark my words, there are going to be more unintended medication errors that the world has ever seen.

    • November 1, 2012 at 1:36 am

      You are dead damn right about the increase in med errors coming!

  4. October 31, 2012 at 10:14 am

    This is done because our government-controlled health care system exists to primarily serve the cause of larger government and collectivist thought. Medicare and Medicaid were political moves that used compassion as a motive for a power grab, a move seized upon and propagated by the fearful and weak-minded who believe “solutions” must be right if they serve the greater good, itself defined by government.

    Every med student should be told that by entering this field, they are accepting a life as a government agent, and that their free will and better judgement, as well as their patients’ interests, must be subordinated to a collective will.

  5. Chris Rhody DO
    October 31, 2012 at 9:45 am

    This is so right. I have achieved meaningful use, I’m not sure how. Apparently, I did by generating as much paper as possible. In the form of an encounter summary, drug monograph, and educational handout for every patient. About 10 pages each. They won’t let me put a recycle bin by the door! Still no usable Preventive Med Tracker, it used to be the first page on the left, I got chastised if it wasn’t complete and up to date. Apparently, no longer meaningful.

    And yes what used to take 30 seconds to write takes 10 min to click in (typing for me is as fast as writing). I have worked with some of the people who developed our coding system and done research on it. Their notes are incredibly brief. And still meet the criteria. All this horrendous thing does is force me to over document and drive up the EM code, and the cost of medicine. Really we need to organize a study comparing hand written doc and coding versus EHR. I believe we will see a significant percentage of increased E&M Codes.

    I moved the rant down here as not to interfere with things we may bea able to fix:
    Also dealing with a bad internet connection (they (the healthcare system) get real testy if you track how much that is down), WIndows XP and IE6. That’s right, I actually need a second computer of my own to do internet searches as IE6 is now incompatible with most web sites. Because they can’t afford (time & money) to train IT to upgrade the system. Also they are buying EHR in pieces because Doctors are not bright enough to pick it all up at once (really they said that). Two entire new billing systems in the meantime, one of which “loses” my RVU’s at financial meeting time. And best of all the “ivory tower” main hospital uses a different system. Us peons are stuck with the old one to fulfill contractual obligations. Not that they ever communicated with us well in the past. If the military had a worldwide health record system in 1996 (I used it) why can’t a major Health care organization have one for just their system? They also paid $1600.00 each for laptops that I could buy at BestBuy for $400(my budget was charged 1600 each at a time I was on cash production not RVU’s). Then downgraded them to XP from windows 7. Thought Microsoft wasn’t going to allow that anymore- just low end hardware going to the third world. These have I5 chips. Then went down to IE6 because the EHR wouldn’t run on anything else.

    The only benefit I want from this EHR is one patient record across the system.

    • Luis
      October 31, 2012 at 4:44 pm

      This really ties in well to the accompanying piece on George McGovern. As long as legislation is drawn up by lawyers, you can bet it’s not to make you more successful as a businessman or more efficient as a doctor. Their goals are not healthier patients or keeping solo practitioners from going bankrupt. They will institute mandates to to install EMRs or other unproven ideas because it sounds good to them, costs them nothing, and makes it look like they are doing something to promote health. Never mind that EMRs have never been shown to improve health or outcomes. Only thing Dr Valinoti’s article was missing is the incredible cost and burden to doctors that EMRs impose to their bottom line. The federal incentives with meaningful use are paltry compared to expense in IT, equipment, and time.

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