Monday, April 27, 2009

Electronic Medical Records: The Fear Factor

A paperless society is approaching for all of us, which sadly will include the demise of my beloved New York Times, which I cherish each day. Our medical practice will have electronic medical records (EMR) in the foreseeable future, if we can mollify the objections of one of our technophobic physicians. There are several reasons why most physicians haven’t made the move to EMR yet.

First, it is not easy to learn. This is not like getting a new e-mail address. It is a complex software system that is like a giant onion with endless layers of functions that will perform office tasks that have been successfully done manually for decades. It introduces an entirely new computerized culture into the office. This adjustment is particularly difficult for doctors who were not trained in the I-pod era. However, even for the cybersavvy, learning these complicated systems takes months. During this training period, patients, doctors and staffs become frustrated when it takes 10 minutes or longer to perform a task using EMR that could be done in 5 seconds the old fashioned way. During this transition period, patient volume and practice revenue will decline creating financial pressure for the practice. Patients will wait longer in waiting rooms. When they do reach the exam rooms, they will enjoy the entertainment of watching their doctors fumbling with electronic equipment. At least, patients won’t complain about rushed office visits, since their doctors will now be spending plenty of time slipping and sliding on the electronic learning curve.

An EMR computer glitch can shut down a medical office STAT. After a couple of these unfortunate episodes, the frustrated doctor and the frazzled office staff will need to be treated for anxiety and high blood pressure. If the vendor does not provide the urgent tech support that was promised before the sale, then the office chatter will include words and phrases not suitable for a family blog.

These systems are expensive. While a hospital or large institution that is spending someone else’s money can afford it, costs for smaller practices can be prohibitive. Profit margins for many medical practices today are extremely narrow as a consequence of declining reimbursements and rising overhead costs. These practices will confront an enormous financial challenge once EMR is required, unless the cost is substantially reduced or subsided. The Obama administration is prepared to devote large sums of money to incentivize physicans to adopt EMR, but many experts maintain that physician costs would still be prohibitive for many small practices.

EMR systems must be compatible with other software. Would our office, for example, want to invest the money and time in a system that didn’t cleanly interface with all of the different hospitals we work at?

Finally, there are confidentiality issues to be addressed. Despite encryption and other techniques, would patients’ privacy be protected? Your medical record would not in a chart in a filing cabinet, but would be floating in cyberspace. Could security be guaranteed?

EMR is coming and it can’t be stopped. Despite what the salesmen promise, it will cost more than they say, it will be harder to learn than they promise and it will crash more often than they predict. Our office expects to plunge into EMR this year. I expect that it will be as pleasant and comfortable as a 6 month root canal procedure.

These are some technical concerns of going paperless. EMR also is a direct threat to the doctor-patient relationship. This deserves its own posting. Click here to link.

5 comments:

kakkaji said...

I agree with you. EMR will be here and it is a good thing. Overtime all the different EMR will have to interact with each other. It has initial cost attached to it, but it will save duplicate workup and will cut cost of medical care. It should result in to higher reimbursement and better care for the patient.
As far as technophobe doctors are concerned, just like anything if one does not adapt one becomes irrelevant. I hope all the good talented physician welcome this change.
so long...

Michael Kirsch, M.D. said...

Good points. I hope you are right, but many experts aren't so sure that EMR's many promises will be kept, particularly regarding cost savings. I just met with an EMR vendor yesterday who promises the Garden of Eden. I fear that we will have to go through Sodom and Gomorrah to get there.

Anonymous said...

I improperly implemented and used EMR will allow more physicians to hurt more patients faster than ever while at the same time increasing revenue! EHR is not designed to change incentives and unfortunately it is built to accomodate the completely counterproductive E/M coding rules that add nothing to patient care but are essential for maximizing income. Too much hype. EHR is the easy answer that is completely wrong. That being said - with the proper design and in the hands of a motivated intelligent user its a great tool - just like a laparascope or scapel.

KateGladstone said...

Because EMR will crash -- and because it will, as you say, take a long time to implement -- I wonder if MDs aware of these problems are making efforts to improve the speed, legibility, and accident-resistance of their handwriting.

Medically oriented resources are already marketed for that purpose: e.g., the BETTER LETTERS "personal handwriting trainer" app for the iPhone, iPodTouch, and iPad -- http://www.deeppocketseries.com/Better_Letters.php -- and the DOCTOR HANDWRITING REPAIR PowerPoint -- http://www.tinyURL.com/DoctorHandwritingRepair

Also see my web-site: http://www.HandwritingThatWorks.com

n.darsana said...

Thank you Dr for sharing your thoughts. It is interesting to read.EMR is not so complicated as mentioned. It is simple, and user friendly nowadays. It will take just seconds to finish a task.I prefer PracticeSuite EMR software for my billing. Practicesuite have following billing softwares : Chiropractic billing software, Physical therapy billing software, Mental health billing software, Revenue Cycle Management EMR Software etc..

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