Tuesday, May 30, 2006
EMRs: Where more is less
Doctor comments on JAMA's recent EMR commentary:Moreover, EMR encourages everyone to copy-and-paste the notes of everyone else so that notes become the same from author to author as well as from day to day. Even consultants are assimilated into the oneness of the EMR Borg. A cardiology consultant recently copied-and-pasted the intern's note into his own, even including "consult cardiology in AM" in his recommendations. Perhaps he meant consult a more thoughtful cardiologist.Pages of history, physical exam templates and review of systems can be generated with a single keystroke. Again, reimbursement is the driving factor. Essentially, more comprehensive notes = higher coding = higher reimbursement. (via Grand Rounds)
Posted by Kevin |
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"...more comprehensive notes = higher coding = higher reimbursement"
Sadly this results in less meaninful notes. Since it becomes extremely easy to ad great volumes of detail to the one keystroke standard negative physical exam several things will happen. The real individualized physical exam is never comprehensive; thus the documented exam will record as negative or normal things that were never checked. Second, there might actually be an interesting and highly relevant positive finding, which though recorded gets lost among the needless verbage. Finally, there might be a relevant or important negative finding, but the reader sees the boilerplate text and reasonably assumes that the writer didn't really check that element of the exam nearly so closely as if the writer had selected that finding to be the only documented finding.
The too easily created notes will become mindless drivel not worth the paper they are printed on. The cost (time and effort) to document by hand requires reasonable mental filtering by the consultant; worthless verbage is avoided because it costs time.
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Sadly this results in less meaninful notes. Since it becomes extremely easy to ad great volumes of detail to the one keystroke standard negative physical exam several things will happen. The real individualized physical exam is never comprehensive; thus the documented exam will record as negative or normal things that were never checked. Second, there might actually be an interesting and highly relevant positive finding, which though recorded gets lost among the needless verbage. Finally, there might be a relevant or important negative finding, but the reader sees the boilerplate text and reasonably assumes that the writer didn't really check that element of the exam nearly so closely as if the writer had selected that finding to be the only documented finding.
The too easily created notes will become mindless drivel not worth the paper they are printed on. The cost (time and effort) to document by hand requires reasonable mental filtering by the consultant; worthless verbage is avoided because it costs time.
