by Winslow W. Murdoch, MD
The Obama healthcare plan hinges on savings achieved through the implementation of electronic medical records (EMRs) and pays doctors $44,000 over 5 years for hardware and software to embrace this evolving technology. Let us not forget however, that garbage in produces garbage out, for instance, information not suitable for medical decision making.
In reality, data entry is daunting and by far the most expensive aspect of converting to electronic records. Huge amounts of patient data resides in the IT “silos” of insurance companies, hospitals, pharmacies and laboratories. It could pre-populate EMRs, should the principles decide to share it, which largely they have not. Some of the data is accurate, some certainly is not.
Currently, data can only be entered on a patient by patient basis. Unless the relevant medical decision making data is properly vetted and reviewed by the patient, with one on one help by a clinician, it becomes garbage in. An experienced primary care clinician who knows the patient best and has all medical information flowing through their office is the best person to input and screen new information important for medical decisions. They would also potentially shoulder the lion’s share of the burden of data input responsibility and therefore cost of implementing an EMR. These are the same practices that are the most financially insolvent, many on the brink of shutting down. Should specialists get the same stimulus if their input is limited to one organ system?
One of my patients was recorded incorrectly at the hospital as having reported a reaction to x-ray dye, and a breast cancer history. Whenever he goes to the hospital, these continue to be reported on his computer record. The odd times I have had to order a test that required x-ray dye, my staff and I waste hours in order to convince the facility to do the study. I have repeatedly told the hospital IT department that this needs to be corrected, only to be told that there is no current mechanism to correct this.
Interconnectivity is also still a major stumbling block. National standards are far from established. Currently, office based EMRs can get info from the lab and the hospitals, but cannot communicate back to these entities, or with other doctor’s offices. Any interconnected central repository that could communicate effectively in a standard medical decision based format is still many years away from being a reality, and who will pay for this?
To implement an EMR carries a real cost of well over $100,000 per doctor and much more for primary care practices. There are currently scores of vendors. Each vendor stores information on their own proprietary software. Only half a dozen vendors are expected to survive. If your vendor goes out of business, you go back to square one.
Consider these issues the next time you feel like your doctor is slow in adopting health information technology.
Winslow W. Murdoch is a family physician.
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Nice article. Could you please list your references, in particular the $100K statistic.
Thanks.
There is no way to correct an erroneous record, or at least make a notation that some previous record is erroneous?
Of course, the patient with the erroneous breast cancer history will now not be able to buy an individual medical insurance policy, or, if s/he does manage to buy one, will probably have it rescinded when filing a large claim due to “undisclosed pre-existing breast cancer”.
The larger issue here is that the EHR we are expected to adopt most of the time does little to actually improve patient care, it’s about documenting worthless drivel that will never be looked at again by any reasonable human in the process of that patients care. But ask the average Family Physician with an EHR to give you a list of his Diabetics with A1Cs over 9 so you can call them and have them come in, and most EHRs will fail miserably at this simple data retrieval task. Why, you may well ask? Because the drivel we record is for insurance companies and lawyers that add nothing of value to the system except overhead. KJ
If insurance companies gain access to providers’ EMRs, coding bingo goes out the window as a method for primary care providers to get paid adequately for the time they spend with patients. If the information flows the other way, from insurer to EMR, the amount of garbage in my medical record will increase exponentially. My insurance record lists 10 illnesses/conditions for me, only 5 of which are accurate. I do not have cataracts, acne, abdominal pain, chest pain, or respiratory insufficiency, but they’re all in my insurer’s record as reasons for various medical encounters.
All you have to do is look at the junk data pharmacy benefits managers and insurance companies send you about your patients. Examples are: 1. Patient may be noncompliant with medication. 2. Patient on ACE and needs potassium checked. ETC. And these are more extensive systems than your average doc can afford. If it does not make may job of patient care easier then the system is junk. What we need are electronic scribes that can record each and every patient interaction. When that happens then we can show how much PCPs are underpaid for what they provide.
There’s a solution to preventing medical errors in EMRs. There are “scribes” available now who have years of experience proofreading, editing and fact-checking patient documentation before it becomes a part of a patient’s permanent record. They’re called medical transcriptionists. Before sending them all to the unemployment line in order to reduce costs, consider the true costs of eliminating their role from the production of medical records. Do you even have a clue what an experienced medical transcriptionist does on a day-to-day basis?
Yes after 32 years of practice as a primary care doc I MIGHT have a clue what a medical transcriptionist does. They keep me cracking up laughing at the spelling errors they make and you expect me to hire them to check a patients medical facts. Now who’s really clueless in this discussion. There is also no CPT code for “checking the facts” so code no pay.
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