Many problems awaiting resolution in medical services and healthcare more generally, including the discouragement of many primary care physicians.

Nonetheless, digitization of clinical records can be done very cheaply, with minimal effort on the part of most physicians and their staffs, but with small to large results to physicians and patients alike from doing so.

If you among others want to keep your “head in the sand” regarding the issue, not much I can do about it.

My perspective at the moment is that widespread use of computer information technology by physicians will take a generational change for that reason. We’ll see.

I know very few physicians that find any usefulness of this scam, besides funding some IT-people nad making people's medical records easier to read for "experts" like Wendell&CO.

EMR won't solve our problem with too few doctors in the system and a situation that is bound to collapse.

Let Murray take his EMR with him and start seeing the patients. Then he can submit the claims to CMS and be all happy, lol.

Karl O Marx

It is Wendell Murray. It is not a question of belief, it is a question of facts. My comments reflect my experiences and the experiences of many practices who have successfully implemented a fairly wide range of EMR systems, not self-promotion. That is an offensive comment, but typical of the response that one hears from those who do not know what they are talking about.

In any case, the returns on investment in out-of-pocket cost and opportunity cost are substantial, both in dollar amount and in practice quality improvement.

Productivity gains vary by size of practice and current practice management procedures. A low level of productivity gain is usually a function of lack of changes to how physicians schedule their workflow and how they utilize resources, such as other clinical personnel and often more importantly patients themselves, many of whom hunger for electronic interaction with their physicians. The biggest productivity gains in primary care primarily accrue in the form of electronic prescribing that occurs with the pressing of a button on a tablet PC and the ordering of lab or other tests from outside the practice. This must also be at the press of a button to achieve material productivity gains. Many other areas of lesser productivity gain, but all together can be substantial. Financially better documentation almost always leads to higher coding levels and therefore higher revenue for the same volume of work.

In general I have found that physicians in almost any size of practice tend to think that they can select a system, negotiate terms to acquire it and install the software on their own without knowledgeable advice. The point is that they almost universally cannot, even if one or some of the physicians involved has some or even substantial technical expertise. That is almost always (but not always) a recipe for disaster. The expertise and assistance are not all that resource-consuming, but are a necessary ingredient to successful implementation.

You are assuming that something is actually being automated. This isn’t factory automation. We are merely substituting media, pen and paper, for keyboards and bytes. The data acquisition is not being digitized, merely the repository of the data. And for practices that already do an efficient job and don’t share a lot of data or need to make that data available over a wide distance, the process is not one that is time saving or efficient. In fact, it may never replace the efficiencies of the paper chart.

Probably the best thing to do is to assume that EMR is coming. You can start looking at products and thinking about a transition. The more you know what is available and what you want then the better decision you can make.

Perhaps small offices who hold out will find that eventually the big players will come along and fold them in.

Certainly looking at your paper records with some knowledge/thought about how those would be converted to EMR could help position a small business for the eventual transition.

But consider a differential diagnosis where acuity makes a difference in management, say, anemia, iron deficiency or internal bleeding? Could you trust this record’s assertion of rosy cheeks a week ago after seeing that entry?

I would argue that state laws requiring the maintenance of a medical record had been violated by the repeated nonsense. If it was a simple error, how many times will the simple error repeat itself unless the doctor had not made the record of a real examination?

Sure I can envision an advantage for practices with multiple locations or special circumstances but it is wrong to make a blanket universal claim that EMR is beneficial for all practices. And even for those that it provides a slight benefit, is it really worth the cost?

Obviously, the quality of the EMR software is important. I purchased a top-line program, at that time A-4 and now Allscript. In EMR software, the adage you get what you pay for is dead on.

The biggest problem with EMR is the customization of the software to the individual practitioner and practice. My partner and I spent a significant time to set up the program and it works great. I would recommend the vendor strongly.