Comments on: The real scoop on EMRs http://www.kevinmd.com/blog/2007/01/real-scoop-on-emrs.html Tue, 14 Feb 2012 11:46:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2007/01/real-scoop-on-emrs.html#comment-70667 Anonymous Sun, 21 Jan 2007 05:35:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-real-scoop-on-emrs.html#comment-70667 I think the value of the "efficiencies" are more dubious for practices that have adequately efficient billing and minimal need for records sharing. In my own setting, I might save a little by having throughput to coding and billing from the exam room but it would end about there. I am generally pretty good at getting the appropriate coding myself. I usually don't need to get too much from other doctors outside my practice, so the extramural access would not be of much value. The interface with special equipment that is necessary in ophthalmology practice might be nice, but I don't see that as an improvement in time savings or in chart ergonomics. The costs would be large, however. I really don't see a point where EMR would ever realize cost neutrality let alone advantage. I think the value of the “efficiencies” are more dubious for practices that have adequately efficient billing and minimal need for records sharing. In my own setting, I might save a little by having throughput to coding and billing from the exam room but it would end about there. I am generally pretty good at getting the appropriate coding myself. I usually don’t need to get too much from other doctors outside my practice, so the extramural access would not be of much value. The interface with special equipment that is necessary in ophthalmology practice might be nice, but I don’t see that as an improvement in time savings or in chart ergonomics. The costs would be large, however. I really don’t see a point where EMR would ever realize cost neutrality let alone advantage.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/01/real-scoop-on-emrs.html#comment-70665 Anonymous Sun, 21 Jan 2007 02:08:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-real-scoop-on-emrs.html#comment-70665 While there are certain effeciencies to having an EMR, cost is certainly a problem. An EMR's disproportionate cost in the background of a poor payor mix and reimbursements has put a significant strain on my practice finances. While there are certain effeciencies to having an EMR, cost is certainly a problem. An EMR’s disproportionate cost in the background of a poor payor mix and reimbursements has put a significant strain on my practice finances.

]]> By: Robhttp://www.kevinmd.com/blog/2007/01/real-scoop-on-emrs.html#comment-70656 Rob Sat, 20 Jan 2007 20:10:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-real-scoop-on-emrs.html#comment-70656 The implication is, of course, that you should not bother with EMR and just accept the quality we have. The quality is fine and the problem is the external forces that interfere with doctors' attempts to do good. We as doctors should not embrace technology that may enable change to happen, we should shout angrily at the problems and wait until others fix it.<br/><br/>Sounds like a well thought out plan. The implication is, of course, that you should not bother with EMR and just accept the quality we have. The quality is fine and the problem is the external forces that interfere with doctors’ attempts to do good. We as doctors should not embrace technology that may enable change to happen, we should shout angrily at the problems and wait until others fix it.

Sounds like a well thought out plan.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/01/real-scoop-on-emrs.html#comment-70646 Anonymous Sat, 20 Jan 2007 16:02:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-real-scoop-on-emrs.html#comment-70646 The worst kept secret in the DoD is their pathetic EMR called AHLTA. They have spent well in excess of $10 billion on it so far and lined the pockets of many contractors and businesses for producing an EMR that is as effective as the DMV or IRS. A great government solution... The worst kept secret in the DoD is their pathetic EMR called AHLTA. They have spent well in excess of $10 billion on it so far and lined the pockets of many contractors and businesses for producing an EMR that is as effective as the DMV or IRS. A great government solution…

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/01/real-scoop-on-emrs.html#comment-70645 Anonymous Sat, 20 Jan 2007 15:58:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-real-scoop-on-emrs.html#comment-70645 When I review electronc records from another ophthalmology practice in town, I read the same template phrses over and over. Its long and boring, Only a few words or sentences matter. Very strange. <br/><br/>Also, the American Academy of Ophthalmology apparently is working on a system for its members that adresses our needs. Hopefully it will be much less expensive than current systems, be easier to get runnung, have less ongoing costs, and generally address all of the obstacles that small practices have to face in implementing. I am skeptical. I imagine that other prof societies will try to do the same for their membership. An MD in So Cal When I review electronc records from another ophthalmology practice in town, I read the same template phrses over and over. Its long and boring, Only a few words or sentences matter. Very strange.

Also, the American Academy of Ophthalmology apparently is working on a system for its members that adresses our needs. Hopefully it will be much less expensive than current systems, be easier to get runnung, have less ongoing costs, and generally address all of the obstacles that small practices have to face in implementing. I am skeptical. I imagine that other prof societies will try to do the same for their membership. An MD in So Cal

]]> By: Blog, MDhttp://www.kevinmd.com/blog/2007/01/real-scoop-on-emrs.html#comment-70644 Blog, MD Sat, 20 Jan 2007 15:32:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-real-scoop-on-emrs.html#comment-70644 I disagree with the conclusions of this article. While it is true that the current state of EMRs is sub-optimal, the <i>principle</i> is valid. <br/><br/>The article states, "In medicine, our fundamental activity is not stocking warehouse shelves or ordering merchandise from vendors. Medicine involves one human listening to, talking with and examining another." <br/><br/>Medicine also involves doctors attempting to recognize patterns within the prose of a patient's history, and the course of a patient's symptoms. Physicians look for order in the chaos of a patient's life in order to determine the diagnosis and appropriate treatment. Think about how we organize our notes and thinking. <br/><br/>An EMR that follows a national standard allow for us to perform large-scale outcome studies, it would allow for us to save money by identifying therapies that don't work. It would allow providers to avoid repetitive tests and treatments. It would accomodate the fragementation within our current healthcare system, with the same patient being evaluated by their PMD as well as multiple consultants, hospitalists, etc. It would save time by avoiding the repetative taking of the same history, and by avoiding repetition, it would avoid errors from being propagated.<br/><br/>The bottom line, however, is that until EMRs follow a national standard and until the architects of these symptoms realize that a bottom-up approach (a system that addresses the fundamental necessities first) will be much easier than a top-down (a system that tries to accomplish everything all at once), we will continue to struggle and spend/waste money. I disagree with the conclusions of this article. While it is true that the current state of EMRs is sub-optimal, the principle is valid.

The article states, “In medicine, our fundamental activity is not stocking warehouse shelves or ordering merchandise from vendors. Medicine involves one human listening to, talking with and examining another.”

Medicine also involves doctors attempting to recognize patterns within the prose of a patient’s history, and the course of a patient’s symptoms. Physicians look for order in the chaos of a patient’s life in order to determine the diagnosis and appropriate treatment. Think about how we organize our notes and thinking.

An EMR that follows a national standard allow for us to perform large-scale outcome studies, it would allow for us to save money by identifying therapies that don’t work. It would allow providers to avoid repetitive tests and treatments. It would accomodate the fragementation within our current healthcare system, with the same patient being evaluated by their PMD as well as multiple consultants, hospitalists, etc. It would save time by avoiding the repetative taking of the same history, and by avoiding repetition, it would avoid errors from being propagated.

The bottom line, however, is that until EMRs follow a national standard and until the architects of these symptoms realize that a bottom-up approach (a system that addresses the fundamental necessities first) will be much easier than a top-down (a system that tries to accomplish everything all at once), we will continue to struggle and spend/waste money.

]]> By: RJShttp://www.kevinmd.com/blog/2007/01/real-scoop-on-emrs.html#comment-70642 RJS Sat, 20 Jan 2007 14:46:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-real-scoop-on-emrs.html#comment-70642 <i>"Each has purchased a system, at huge expense, from a vendor who is in competition with other vendors and unwilling to work from a common language. There is no push for cooperation."</i><br/><br/>I hate to suggest government intervention as a solution to anything, but maybe it would be for the best if there was some neutral governing body for future EMR development -- like ICANN is for the big 3 TLDs. Maybe that AMA could set up a governing technology body or something?<br/><br/>It almost seems like that unless there's a standard hammered out by someone with authority -- and without a financial stake in a proprietary protocol -- this is a problem that will never be solved.<br/><br/>And that is a depressing thought. “Each has purchased a system, at huge expense, from a vendor who is in competition with other vendors and unwilling to work from a common language. There is no push for cooperation.”

I hate to suggest government intervention as a solution to anything, but maybe it would be for the best if there was some neutral governing body for future EMR development — like ICANN is for the big 3 TLDs. Maybe that AMA could set up a governing technology body or something?

It almost seems like that unless there’s a standard hammered out by someone with authority — and without a financial stake in a proprietary protocol — this is a problem that will never be solved.

And that is a depressing thought.

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