EMR is software that medical offices can use to store information about and track their patients. Basically it replaces the paper chart.

Docs can learn to use an EMR, I have and I’ve seen many others use it very well. The ones who took the type to become superusers are the ones who swear by their EMR. My favorite Preceptor told a story of how he was filling scripts and responding to pt emails while on a train b/w DC and NY. His office is in Kansas. Everyone benefited b/c he got his work done when he needed it, and the pts were still able to communicate w/ their doc even if he was out of town.

In a sales pitch, an emr salesman used a line form a doc who said “the program has to give me the info quicker than I can ask for it, or i’ll just ask someone else to get it for me.” Admittedly thats a good goal, but a bit stubborn.

My wife just finished nursing school and they basically force them to do what ever they want. All nurses take an ongoing course in the EMR whether they want to or not. Docs should be the same b/c if we’re not forced to change, we ususally don’t and it hurts the system.

The mark of good software is one that pleases its users. Period. It is not the job of the user to adjust to fit the software, it is the job of the software to suit the user, and the task he wishes to accomplish.

I do know the frustrations of designers, and the frustration of implementors, and I do sympathize. But begin at the beginning, and listen to the problems. Those problems are real for those users, and have to be addressed before they will use the software.

my $.02

The advantages to EMR be it meta-data, accessibility, coding, clinical red flags etc will continue to out-weight the potential drawbacks.

I appreciate the extra effort you docs are taking to make your paper charts right, now imagine how good EMRs could be if other docs took the same time.

I don’t mind constructive criticisms of EMRs but lets correctly place the blame.

As to cost, much depends on what has to be networked, and whether the software in all the networked devices is as well written to afford easy interoperability and in/out flow of data to a database storage device. In my specialty, there is a lot of device-generated data that needs to be attached to patient records: charts, angiography capture, photography, and multiple other device inputs that have to be assembled into a complete chart. All the machines have to work seamlessly with a very high order of reliability, or the EMR will be a failure. Text from chart entries are the simplest components. There are a few privately developed commercial systems in the market, but they are expensive, and the follow-on costs are high too. I have been looking at them for a couple of years now, and there are still concerns. There is also a regrettable history of costly failures of earlier systems whose developing companies went under and for which there was no effective follow-on support. That has made a lot of people cautious.

Most doctors aren’t unwilling to change, and aren’t technophobes either. EMRs are as much a business decision as a technical one, and there are no examples of screaming business successes or clear advantages of these systems in places where they have been introduced. Best case is possibly a break-even, and I haven’t seen too many of those (most were beta sites who got below-market pricing for early adoption) and almost every case took at least a year to introduce the system and create a working database just for intramural use. In no cases have I seen any worthwhile extramural applications. None.

With the margins of third-party payors already trimmed, I just don’t believe there is much of a carrot to offer to those taking the risks and bearing the up-front expense of these systems. Threatening to cut reimbursement for those who don’t buy these systems has a high risk of blowing up in the faces of those making those threats–I would just as soon tell those payors to get lost, if in the end that were the cheaper alternative. I sure don’t owe Aetna or Medicare anything.

COST: I’m curious what you Drs think a EMR cost to purchase / set up because I think you’re fairly mistaken. e-MDS is the top ranked program by MDs on the AAFP website and cost 15K in software and hardware. Honestly, 30K is not that big of an investment if it improves the quality of care.

PAPER VS EMR: Do EMRs have their own set of problems sure, but so do paper charts. Often times, the complaints of an EMR are the result of inappropriate use by the provider, not the software. Besides, paper charts are riddled w/ problems. I’d rather have a chart I can read from anywhere in the world but w/ too much info, than a paper chart I can’t read at all.

CHANGE: Its too bad physicians are so slow to technology. If banks operated like doctor’s offices, you’d bury your money in the backyard. Speaking of which, banks went through the painful adaption period when trying to standardized the personal check. It was a bloody time w/ proprietary systems fighting each other but it ultimately led to huge benefits (same could be said for credit cards).

A time will quickly come where people won’t respect drs who don’t adequately use technology in their office. Pts will want to manage their health electronically whether in the form of PHRs, emails, etc and physicians who don’t adapt will fall by the wayside.

This is a huge problem. Reams of text can be inserted simply with a ‘insert normal exam here’ keystroke. The documentation then appears far more robust than the actual physical exam, review of systems or history of present illness. It leaves the reader with two challanges, 1) find the important bits, those that the experienced focused examiner would have sought and documented in the paper system, among the chaff on the voluminous documentation and 2) determine the veracity of all of the reams of allegedly negative information, simply and mechanically inserted into the text but which might not have been equally rigorously established as negative in the real exam process.
The burden of handwritten (or manually typewritten) notes is that the writer must be parsimonious of word. Excessive ease of documentation leads to recording negative facts more strongly than warranted.