The consideration should be of “how” it’s going to save and “how” it’s going to improve operations, if any. EMR’s have many, many advantages over paper charting which I don’t need to list here. The thing is, paper charting has advantages over EMR too.

By taking a long look at “how” and not “how much” it’s going to impact a practice, expectations are framed much better and the chances of selecting an optimal system is increased dramatically.

Just my opinion.

Tannus
http://www.vantageclinicalsolutions.com/blog

BTW, I review EMR and writen charts from other hospitals as one of the “bad guys” as well as use both EMR and written records in my home clinic.

I find the usefulness very mixed. Some parts add value to patient care-sure. But there are actually some subtractions from patient care as well. The EMR usually means better availability in the big multisite clinic. Legibility of properly produced notes help.

But many docs use templates and shortcuts to the point that one can gather no useful information about what the exam actually showed. It is also readily apparent that a lot doctors boilerplate the rest of the note listing a lot of things that they could not have possibly done. The ease of producing works of fiction detract from the value of the records in many cases in trying to understand the clinical story.

Handwritten records offer some advantages. The labor of handwriting means that docs tend to write only what is important. The shortcuts and abbreviations make review a breeze. Less temptation to cut and paste thereby creating a fictitious novel. Underlinings, use of bold script, placement of notes, circles and exclamation points here and there help one follow the mind of the clinician sometimes. Even illegibility is sometimes an advantage. Some peoples records have a lot of embarassing crap in them for the patients and it is just as well that readers have to labor at extracting that—and a horror for patient privacy when it is actually in digitized form archived in multiple locations and machine searchable.

EMRs let you generate a wordy document of a patient visit very quickly. That can be a pain if you need something very quickly; I can leaf quickly through a chart and find most things I need faster than the EMR lets me do the same thing. I can write prescriptions faster with the EMR, though. My records, which were decent beforehand will be marginally more audit-worthy in EMR format, for what that is worth. For those with sketchy documentation habits, the EMR would be worth more.

(If you were unscrupulous, it is very easy to make a document that details a lot of work done without say, actually having done all of it. Jus’ sayin’.)

It isn’t as portable; I can carry a paper chart to the OR with me. I haven’t tried to download an EMR document for that purpose. I suspect it won’t be the same or as easy or as useful.

EMR does not make me any faster, at least at this point. I really don’t think it ever will allow me to work faster ever.

I like to make drawings of my clinical findings. I have become reasonably fast and good at doing that. The EMR blunts that ability, at least with the program we are using. It is possible to make drawings, but they are not as detailed or as artful. Because of that, unless I am able to get a decent pen-pad tablet, I will probably make fewer drawings. That means I will order more photography. Maybe that is good, maybe not.

It does eliminate the lost chart problem, but I work in a practice with a single office, and that problem wasn’t very bad to begin with. In a year or two, when we have archived all the current paper charts, we might see some clerical time savings. For the moment, things are slowing down considerably as new e-charts are being created and documents are being transferred. I expect things will be like that for the next year, at least.

Oh, did I mention, It’s expensive. I don’t think it will ever give a net positive return; the paper charts took up only about 100 sq ft of floor space, all told, and they will still have to be stored somewhere. I suppose there is some value in off-site archival security in case of a catastrophe in the building, but the building is pretty robust, so the gain is small.

Hardware turnover will get more expensive. With a paper system, there were copier leases, paper and toner and chart jackets and labels; I figure the additional computers we have bought will need to be replaced in five years or so. The biggest paper expense I can see, mailing invoices and bills will still be done on paper and postage is only going to get more expensive. I still don’t think we will be reducing staff as a result of this change. And as long as we still deal with insurance companies and need to chase payment, we will need employees to do that work.

I could see the benefit in a large organization, say the military services, or the VA or big hospitals. The benefits of a centralized accessible record would be more clear. But our data is stored on the disc drives in our office (and the offsite backup site too) but nobody but us has access to it, and unless there is some huge improvement in data distributing hardware and software, where common standards between secure servers and EMR platforms allowed exchange of data (secure and all), then I suspect that all of the data will stay exactly where we are putting it. The “P” in HIPAA stands for “portability”, but for all the promotion of EMRs by the federal government, there seems to be little resources devoted to actually making a software standard and storage infrastructure that makes all this electronically rendered information something that is really more portable than the old paper medical chart.