The following is an article written by Thomas Carson for November/December 2008 issue of MGMA Connexion.

 

Today's EMR is not the answer for most practices

 

A recent article in The New England Journal of Medicine, "Electronic health records in ambulatory care - A national survey of physicians" confirms what many in the industry have long believed from anecdotal evidence: that adoption of electronic medical record (EMR) systems is substantially below hoped-for levels. The study authors cite three reasons: EMR is expensive, time-consuming and does not fit with established office workflows.

            I have long questioned the viability of the current EMR business model as it applies to the ambulatory care market. Physicians consistently complain that the products are costly and require significant time to use, disrupting their practices and personal lives. The industry responded by calling doctors obstinate and establishing standard-setting bodies to make products even m ore complicated and more expensive.

 

EMR makes Doctors data-entry clerks

 

The frustration most physicians experience in trying to navigate EMR user interfaces causes such a distraction that productivity losses go beyond the time spent on the process. I heard one doctor summarize his EMR experience this way: "I like having the record available online, but I am absolutely exhausted at the end of the day from the extra time spent trying to get it there." This is nonsense. EMRs have turned the physician - the most expensive resource in the health care delivery system - into data-entry clerk to collect information that all too often won't be used by anyone.

            It gets worse. Another recent New England Journal article cited systemic problems with EMR system documentation. Not only is it harder to extract meaning from records, but also the information is often wrong, as doctors try to find ways to shorten time-consuming processes required by these systems. The authors describe a form of clinical plagiarism: "Many times, physicians have clearly cut and pasted large blocks of text, or even complete notes from other physicians: we have seen portions of our own notes inserted verbatim into another doctor's note." They go on to say, "Notes that are meant to be focused and selective have become voluminous and templated, distracting from the key cognitive work of providing care." Not only is the business case for expenditures on EMR systems weak, it seems that the clinical may be deeply flawed, as well.

 

Reconciling traditional, technological methods of documentation

 

            Physicians have good reasons for preferring traditional documentation methods to current EMR options. Patients, naturally, want digitally useful, portable medical records. How do we reconcile these positions? Twenty-five years ago, nobody had to form certification committees or pass legislation to force physician practices to invest in practice management systems to run the administrative functions of their offices. The cost of purchasing and implementing these systems was supported by the demonstrable return on investment, and soon such systems were ubiquitous. The market works.

            What needs to happen for clinical IT systems to make this king of progress? Let's begin by allowing doctors to use any method they want to capture clinical information, including traditional dictation and transcription. More than 80 percent of practicing physicians prefer this approach. Most good transcription companied already use systems that capture audio files and prepare, store and retrieve transcribed notes in digital form.

 

A simple, cost-effective substitute for an EMR

 

            Three technologies, coupled with transcription, provide substantial productivity gains at a fraction of the cost of conventional EMR products:

 

• The Internet is a cheap, fast and secure tool for moving large amounts of data for less than $50 a month. Financial institutions routinely use the Internet to communicate data that are every bit as security-sensitive as personal health information.
• Secure, Web-based document-management systems provide startling productivity gains for many practices, and they don't cost much.
• Web services, such as HL7 and XML data tagging, facilitate data exchange within and between systems with comparative ease (compared with conventional practice, an any case).

 

These technologies, added to contemporary transcription platforms., largely constitutes what the DesRouches, et al, New England Journal article define as a "basic EMR". It's likely that your current transcription service, plus accessible and affordable software, is all the EMR that your practice will need for the next several years.

            The existing EMR model isn't working for physician practices. Our nation's system of market capitalism allows people to try things. If they fail, they can try other things. This rewards persistent, creative people striving to solve problems.

 

This article points out the simple fact that most physician practices over look. It is extremely expensive to research, approve, purchase, train and maintain an EMR in a practice. Often they purchase modules they do not need or find that the package they did purchase falls short of expectations. However, after investing hundreds of man-hours and hundreds of thousands of dollars, you are stuck with an ineffective costly EMR that does not provide the promises you were sold. The practice will never realize a return on investment and will actually lose up to 60 percent of productivity.

 

Solutions to this problem have been outlined by many articles and informed resources in the industry. Find a basic EMR, companies like MediGrafix, Inc. provide such a product with their standard transcription package, that costs little to nothing to initiate that allows the physician to continue to see patients and dictate in the way they are accustomed. This will reap many rewards and grant you the highest participation by physicians.