Health Information Technology is becoming a bit of a family affair, since my brother, who is an (excellent) ophthalmologist practicing in a fee for service environment, has been pondering electronic health records. His practice is far from the halls of the US Capitol, so I think his viewpoint is an important view of the reality of the overwhelming majority of medical practices in this country. It’s worth a read, so I’m reposting it here. Our conversation was stimulated by two pieces of research recently published (linked on the right).
Sure, you’re welcome to publish anything you want.
I agreed with your assessment. Just as a computer at home or having a smartphone doesn’t really save any time or money, it does make us more productive.
I have no doubt a well written emr will be beneficial to medicine, but I doubt it would be any huge time or money saver.
I dont know any doc with emr, that is more than marginally happy, and no one that saves money or time. And, the records I get are useless, as they are all macro’d out and two pages for a 30 second exam.
In fact they may cost insurers more, because some are marketed as ‘printing money’ for being able to tell you what you need to add in order to upcode the visit.
Right now, I think it is the quality of emr’s that is the problem, at least for ophthalm as we do alot of drawing and do alot of tests that need to be digitally incorporated.
But, I can’t imagine not having an employee file and pull charts wouldn’t save money. And, I would just love for a referring doc to just transmit a patient’s history to be incorporated into my records when they are referred. Likewise, instead of sending an email regarding a patient I am sending a retinal doctor, (which they probably forget), I would love to just send my records over so they know what I had the question about.
The big issue now is the privacy/audit issue. There are now companies that specialize in auditing charts for medicare and private insurers, and getting commission. Much easier to do with emr, as we can just transmit the chart. But, with paper charts, they can’t read them well, and they don’t plan on doctors copying dozens of charts, so they kind of give up.
What do you think? If we believe (as I do) that all doctors are driven to perform well for their patients, what’s the gap here, and what needs to be fixed?
Click below to see what my original response to him was….
I think it’s no different than the computer in your house – you spend money & time on it and you get a better quality of life. You probably wouldn’t throw it out the window. You probably optimize it to your life so that you squeeze maximum value out of it.
On that theme, this paper shows that physicians with EHR feel better prepared, more responsive to patients, more satisfied with their practices, with greater ability to provide quality care for patients
A lot of the problems in hospitals are that the doctors / nurses are not involved in setting the system up and optimizing it because hospitals usually have very skeleton medical leadership to maximize billing, so when they put in a computer system to make ordering easier, they could very well be wiring the same kind of care (good/bad) they were practicing before computerization.
When hospitals involve their doctors and nurses (and patients) as much as possible in setting things up, they usually find out that those people are more than happy to help, even from their own time, if it makes their lives easier. No one wants to wake up and find a computer on their desk that makes their job painful.
When they talk about Kaiser Permanente below, they’re right, we are seeing benefit in quality ( see this presentation, Kaiser Permanente is #1 in the US in mammography screening, and probably in the world now ).
I think overall doctors and nurses should get involved in putting these systems in. In eye care especially, because a lot of the stuff out there is designed for primary care and some specialization, but not very good at manipulating images, and just getting there in measuring for quality. It’s possible that we will end up paying more, somehow (reduced payments, increased taxes), but like the computer in your house, there will probably be increased quality too, it will be one of those things you can’t go without, like a CT or MRI.
Hope that helps…