Why physicians don’t adopt electronic records

Reasons?

1. They are expensive. Expensive to buy and to maintain.

2. They do not make you more efficient, necessarily. If you are a good documentarian and can code your paper charts reliably and defend-ably, you aren’t likely to get much more from an EMR in missed recoveries.

3. They do not make you more efficient. A well-designed paper record is ergonomically streamlined. Completing a chart with a pen does not take much time if done well. Reviewing paper documents like lab (or special studies like ophthalmic visual fields) is much quicker on paper. That means time, which means money. Pull-down pick lists make selecting which boilerplate entry you might want more easy, but in the end it leaves you with a very wordy record that is no more useful to a reader than a paper record, and maybe less so.

5. The staffing changes accrue to large organizations much more than small ones. A solo doctor will not likely be able to cut from a small staff even if chart finding tasks are reduced. Someone still is needed for reception, checkout, telephone answering and the like and the time spent in chasing and posting will not be changed by having an EMR.

6. They make you less efficient during the period of introduction. This is particularly felt by small practices where there may be only one or two doctors that have to go live with an electronic chart. It can take a doctor months to return to a previous level of productivity after adopting an EMR. That makes it even more expensive in an indirect way.

We all know the reason’s why not to switch. However, as someone who grew up in the “EMR” enabled world in residency and fellowship, who worked at insitutions that fully incorporated EMRs, and now in solo practice fully invested in my own EMR, I cannot imaging life without one.

If fact, for those practices that opt choose to forgoe it for the reason’s oft cited by my colleagues above, I feel sad, pity, in a way.

I could never imagine a system that depended on paper charts to deliver high quality and effective medical care.

At the very least, with my EMR, I have average practice HBa1c’s, average blood pressure reports for various cohorts, vaccination rates near 100% (there are always those who to their peril refuse them). And this is ONLY possible with my EMR. And I use that data to enhance my revenue as well. I call those patients’ back for more frequent visits, hence greater encounters that focus on 1 issue – hence templated visits.

to practice day to day without these reports is just following blindly.

Oh, and for me – I found one I can afford. True they are not efficient. Staffing – come on, we’re in the next century – even my front desk secretaries can send SMS messages and youtube on thier iphones, while handling the phones. Incorporate HIT into workflow – bahumbug – if teh clumsy VA and Kaiser’ healthcare systems can do it – so can you.