Benefits of EMR outweigh the cost and learning curve

It’s hard to teach an old dog new tricks, but we can try.

To write or to type, that is the question. To boldly go (according to the latest statistics) where only a small few are going; that is the challenge. Actually, for everyone in the medical profession, the reality of the paper chart is slowly coming to a close.

The digital age is moving forward at lightning speed.

But can you teach an old dog to jump through hoops of fire?

Believe it or not, there is a long line of medical providers that prefer a paper chart to a digital one. I happen to be one of them. Nonetheless, I realized that the transition to the digital world is going to happen no matter how I feel about it. If I could have it my way, I’d like to be “grandfathered” into a provision exempting me from having to implement EMR or EHR. This way I can slowly fade into the dust without having to undergo the learning curve and the cost that comes with this new move to electronic medical records.

Fortunately, I am someone who is capable of transitioning into this new digital age of healthcare, and I am begrudgingly making the shift to the electronic world. So, for the old dogs struggling with the new tricks of the trade, I’ve discovered an evaluation process that is making the switch a little less abrupt.

Making a mental adjustment

The first suggestion I implore you take to heart is to change the way you view digital records. The way that I have done this is by weighing the pros and cons of using them. Doing this has mentally prepared me to embrace the changes as they come.

So let’s start with a comparison between paper charts and digital records.

Paper-based records require a significant amount of storage space compared to digital records. Not only do they take up a significant amount of space, but because we have to save the physical record for at least seven years they seem to pile up on each other exponentially.

In direct contrast, electronic media doesn’t require much physical space at all. And, typically electronic media costs less to store. This means that the room that you are currently using to store all your paper charts could be converted into a treatment room or other usable space that generates revenue.

Mental Note: EMR can help me save room, treat more patients, and generate revenue. EMR is good.

How many times have you heard the statement “You write just like a doctor!” Personally, I find that to be a good thing, since I am one, but we all know the legibility issues our staff deals with day in and day out.

What we don’t always recognize is that issues with legible records and prescriptions contribute to medical errors, which can launch a domino effect of problems. EMR takes the legibility issue out of the mix.

EMR allows you to create a progress note without any mistake as to what you’ve written. You can also make more comprehensive progress notes with EMR which will help improve your medical coding and billing process. Closely documented progress notes equals better payer reimbursements, which means you actually get paid for the work you do!

Mental Note: EMR helps me document my patient’s needs better and can reduce the likelihood of paper chart related medical errors. EMR can help me be a better physician.

One feature of EMR that I find very beneficial to the profession is the ability to gather information and track trends like never before. Tracking trends on paper is practically impossible unless you are manually tracking the information to get trends as simple as the last six or seven HgbA1C for comparison.

With the EMR, in only a few clicks of a button, you can access all the information you need because it’s right at your fingertips. The ability of the system to track and trend data is one of the best ways to help you see real time data that will enable you to implement changes to your practice by identifying trends quickly and as often as you like.

Mental Note: EMR will help me stay better informed on ways to treat my patients and manage their long-term health. Maybe EMR isn’t so bad after all?

With a milkbone or two an old dog can do just fine

The latest data estimates that between 17% – 20% of providers have implemented a basic EMR system. The average EMR system is projected to cost between $40,000- $50,000 to get started, and the price goes up from there if you want to have all the necessary equipment.

Unfortunately, there is no way around the cost and time involved in implementing electronic medical record keeping. There is going to be a learning curve, and you may actually see a decline in revenues while implementation of a system takes place. So be prepared to manage reduced revenue for at least three months while you are still paying your ongoing bills and purchasing equipment along the way.

So it seems, EMR is here to stay and the best thing you can do is discover the most affordable and most time efficient manner of getting things running. It may be hard to see at first, but if you focus on the benefits that outweighing the cost and learning curve, you too can learn the new tricks of the trade with relative ease.

Adam Alpers is a primary care physician and blogs at Medical Billing & Coding for Physicians.

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  • Donald Tex Bryant

    Good comments on the process and trials of changing over to an EMR. One help in offsetting the costs is the CMS program for paying physicians up to $44000 if they meet the meaningful use criteria starting in 2011 or 2012. The meaningful use criteria seem to represent positive outcomes for physician practices too.

  • IVF-MD

    Whether I agree with the specifics of the pros and cons of EMR, would you agree that it makes more sense to put the reasonable burden on the EMR software companies to develop quality software at such an attractive price that it would be crazy not to embrace it? Doesn’t that beat arbitrarily forcing everyone to buy a product regardless of whether it helps us or not? But on the other hand, if it only slightly improves work flow in some ways and drastically hinders it in other ways and costs $40-50K to implement, don’t I have the right to choose what is best for my practice rather than be FORCED to adopt something that doesn’t work? Individual freedom achieves better results than coerced conformity. The reason I use computers way more than the average doctor (in all ways other than EMR) is because it helps me. The reason I don’t use EMR yet is because even with as many software packages as I spend time evaluating every year, I have yet to find one that is any improvement over our efficient streamlined color-coded charting system that we’ve developed over the years. As for typing vs handwriting, it’s honestly easier for me to hand-write a 2 line note while in the room talking with my patient than to go to some work station and type something in. If I need to write a long report, then I do that on my computer (or if I’m feeling fancy, I use NaturallySpeaking dictation software) and print it out after which it takes all of 20 seconds max to put it into the chart (yes, we’ve experimented and timed it). The bottom line is depending on each individual practice, there comes a point where the most efficient way to do things is by varying degrees of using a tangible physical chart and computers. All I ask is that the decision be up to me, the physician, with input from my staff. Can we please not let some central-planning bureaucrat on the other side of the country force me into some one-size-fits-all system rather than allowing my patients and I to utilize the system that best suits my practice? Aren’t there any others who feels this way? Thank you :) By the way, even if I take into account the money that is thrust at me at tax-payer’s expense to convert to EMR, it still is a losing proposition for me. I’ve surveyed colleagues in my field and fewer than half have gone to EMR. The ones who have include those who love it and those who hate it. Again, all I ask is please stop pushing the one-size-fits-all mentality and let each practice freely decide what is the best.

    • Maggie

      There are plenty of doctors who feel the same way as you do….my DH among them. He’s evaluated the EMR/EHR’s available and the level of customization needed, to actually be effective for his speciality (yours also) takes the price beyond reasonable. The current EMR/EHR’s on the market are indeed an attempt to cram all into a one-size-fits-all package that simply doesn’t fit the specialty.

      He doesn’t take medicare/medicaid, so the incentives are moot since he’ll never be a “meaningful” user since he doesn’t interact with the medicare/medicaid system ever.

      Third is the very essence of his practice depends on his doctor-patient relationship and it is probably, as you know, physically challenging to even have a paper chart in the exam room and document effecitvely during the patient visit….it’s just the way it is…..can you imagine, Mrs. Jones, hang on a sec (while vaginal probe is still inserted to do ultrasound) while I type this in….! Oy!

      DH still dictates his notes and has a transcriptionist on staff part-time. He can dictate as part of the exam, can dictate between exams and it works well for his office staff – when the dictation is transcribed in the overnight, any coding issues are caught and noted to be corrected before the claim is submitted – checks and balances work well.

      The top reasons DH has opted to continue with his paper charts:

      1. Cost….as a solo practitioner, his practice cannot and will not take a $85,000 (software, licenses, wiring the office, equipment, time to migrate losses) hit and survive

      2. Customization issues add to the above another $8-10K, further making it unrealistic for the practice.

      3. The cost for the space to store records is less than $3,000 a year for DH (making the arguement above silly IMO) and even if it were as expensive as inferred above, it is space that cannot be converted to generate revenue in any meaningful way.

      4. His cost for a transcriptionist is not high when the fact she double-checks coding issues and catches errors and/or missed opportunites is included in her duties, she’s worth every penny paid!

      5. His hand-writing is flawless. If doc’s simply printed everything except their signature, their handwriting would be easier to deciper. And if one can’t read something, shame on them for NOT calling to clarify to ensure that it says what they *think* it might say.

      6. It will interfere with his exams and doctor-patient relationships in ways he does not want, nor his patients want. He doesn’t *need* to be prompted on what the government deems the latest and greatest, he has to keep up to maintain his practice because it demands it as it is highly innovative (as you know) and requires staying up to date on the latest and greatest and implementing where it makes sense in your practice anyway. He’s not a box checker, that’s for sure!

      7. His patients aren’t statistics in a computer alogrithm, they’re individuals, each presenting with unique little quirks that need to be part of the treatment. Since his patients are statistics, he treats that as they are – individuals.

    • Maggie

      Oh, I forgot one shining example of how the one-size-fits-all algorithms are poorly integrated for some specialties.

      DH was evaluating one package and was taking it through a “mock chart” to see how it worked. As part of the inital exam protocol, it prompted to test cholesterol and pending results, flagged a statin may be prescribed with XYZ results.

      DH was a bit shocked….you do not prescribe a statin to someone attempting to become pregnant! He asked if that could be removed or disabled and was told no, it’s a mandatory line in the program….he could ignore it, but if he starts to report quality measures, his lack of response and prescribing by the guidelines would affect his quality score! WTF? Seriously!

      A bunch of other absolutely unacceptable prompts left him shaking his head and more commited to paper than before.

  • Marc Gorayeb, MD

    Before you buy, here’s another question to ask:
    How easily can my EMR system respond to legal discovery requests? You know: requests for medical records, subpoenas duces tecum, deposition requests. Well-organized paper records pose no problem, but a computerized system falls into the “e-discovery” realm.

    Will you be able to produce the information in the form requested by the attorney? How much searching will you be required to do to extract all relevant information from your system? How easy will it be to sequester or exclude irrelevant information? How does the system handle patient-related emails? Are all the communications and notes you have about a patient stored in one electronic folder, or is patient information distributed among a plurality of electronic locations?
    Bottom line: will you have to hire an (expensive) IT professional to respond to discovery requests?

  • Leor Feder

    Good article. I would like to chime in regarding the cost structure you mentioned though. There are numerous open source programs available that reduce the cost burden on a practice. Check out OpenEMR for example. You dont have to spend that 50K to qualify for meaningful use!

  • everyman

    you go on about the benefits of emr and I am in total agreement, but when it comes down to it most private primary care practices will have a very difficult time transitioning because we have the most responsibility per patient, and get paid the least per patient and thus are forced to see 2-3 times as many patients for much less pay. This means we have much higher volumes and while tranitioning to EMR it will take much longer per patient for the sake of data entry, which is absurd, I will eventually switch my practice to EMR, but only after I have paid off my business loan and when the systems have been perfected.

    • Adam Alpers

      everyman, I agree, In the beginning of the article I write that I prefer to be “grandfathered” in and not have to ever convert to EMR. I prefer paper and have for the last 20 years. I have watched and used other Electronic systems and my paper charting has always been faster and more specific for my patient needs.

      In addition, it only takes me moments to write out a prescription where the EMR can take much longer to look up the medication and dosage in the system that I already have memorized.

      We in primary care have always been paid the least and are expected to take on the most (in my humble opinion), and now we are expected to take on the burden of implementing a system that will reduce our revenue even more, while increasing our stress levels.

      There is no easy answer, but I am enlightened by the poplular commentaries related to the process of EMR and how difficult it is in the world “real time.”

      It is important that we as a group continue to speak our mind and perhaps we can somehow, “united” make a change that will actually be for the good of all; Providers and Patients.

  • Leor Feder

    Marc, I am actually surprised to hear you say paper records would be better during a legal audit. Just imagining the mess of papers littered all over your office while the attorneys ransack your practice to build a case makes me ill. With an EMR its a matter of querying a database and either downloading or uploading the file. On a web based EMR it would be even less of a nightmare as you could essentially have the legal audit off site (which would probably also save you the embarrassment from your patients).

  • Solo FP

    Patients have started establishing care with my office because they have heard I do not use EMR. Their old doctor did and the patients hated the whole experience. I have no plans to invest (i.e. waste) any money or time in EMR. As the next few years go buy, the government will offer nominal incentives for docs like me to get on board with EMR. I’ll pass, so they will have nominal penalties in the form of dropping my reimbursement a percent or two each year. For know, I am going to keep banking and paying off debts. Eventually I’ll close my very busy doors and leave behind my ridiculous workload and hours. I’ll be burned out and ready to go work for the VA part time. Sweet! Actually looking forward to it. Veterans are my favorite patients anyways.

    • Mudpie

      My OB’s office recently migrated to an EMR and my OB hates it…..and his nurses hate it – half the medications and/or OTC’s aren’t even in the system, it needs extensive customization and makes the whole check-in before seeing doc a time consuming pain in the ass…..take my blood pressure – hang on so I can enter that in the computer, oops, I hit the wrong key, hang on, hang on, there…..ridiculous!

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