Why adoption of EHRs is a transformational event for physicians

Paul Conslato, MD, director of clinical affairs for Lancaster General Medical Group, recently was quoted in the PAMED Better Health Network eZine that the introduction of electronic health records is “the largest transformational event for physicians within the last 50 years.”

Fifty years is a long time and takes us back into the 1960s. Certainly, there have been plenty of changes in the practice of medicine since then.  We’ve seen new treatments developed.  We’ve seen new diseases identified.  And, we’ve seen various changes in medical financing … just to name a few of the changes since the age of 8-track tapes.

But Dr. Conslato’s observation catches my attention, and I wonder if he hasn’t touched upon something historical in medicine that we may not realize is happening.

Can it be that information technology is now an integral part of any exam?  Is it possible that the business of medicine is more real-time than ever before?  Are outcomes becoming more transparent as data collection becomes easier?

Yes, yes, and yes, but that was all inevitable.

I wonder if adoption of EHRs is the largest transformational event for physicians because it’s a generational role reversal within the ranks.  We may be at a time in the history of medicine in which freshly minted medical school graduates can teach our older, experienced physicians a thing or two.

Joanne Cochran, founder and CEO of Keystone Health Center, a federally qualified health center serving the Chambersburg, Pa., area told the PAMED Better Health Network eZine that physician acceptance of EHRs can be a major hurdle for some group practices and can vary greatly based upon specialty and age.

“Our younger, computer savvy doctors took to this like a swan to water,” she was quoted in the January 2012 edition.  “It wasn’t as easy for some of our other physicians.”

The phrase “other physicians” is actually code for older physicians.

Imagine this … new physicians becoming mentors to those with decades more experience in patient care.

Yes, indeed, Dr. Conslato’s observation is a sign of the times.

So, since this does appear to be happening, where do we go from here?  Will the practice of medicine ever be the same again?

I don’t think of myself as an older physician, but I have been practicing for a couple of decades now.  I’m probably a “tweener” when it comes to this issue.  With that said, even I believe I can still learn something new from someone younger than I.

So, I offer the following thoughts.

First, experienced physicians of all ages need to adjust to the generational differences in the adoption of EHRs for the good of patient care.  We may not have a chance to experience all of the changes coming as retirements arrive, but we do have an obligation to the future of patient care.

Second, younger physicians shouldn’t be shy in offering help to older physicians.  Yeah, we know our thumb action isn’t as slick as it could be, but we do admire and respect the thirst that younger physicians have for information technology and how it works to improve patient care.

Marilyn J. Heine is an oncologist and President, Pennsylvania Medical Society.

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  • Anonymous

    EMRs “working to improve patient care?” I’ve yet to see that in a small outpatient setting. It’s more a burden.

  • http://www.facebook.com/profile.php?id=100002388332434 Rusty Ray

    I had my first experience with EHR’s recently during my annual physical exam. You can read my full experience and thoughts on the topic here: 
    http://www.big3news.net/2012/01/30/health-it-incentives-reward-doctors-hospitals-that-adopt-electronic-patient-care-records/

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    Transformational changes is a politically correct way of saying outside sources raising a medical doctors costs and overhead without the doctor having any choice but to participate. As an old fart, practicing for more than 30 years , I have seen the office discharge process change dramatically. Patients went to the front desk with a three part carbon fee ticket, paid a nominal fee for a visit ( $25-50) in the late 1970′s and were given a copy of the 3 part receipt marked ” paid.”  One copy went to the patient who had the option of mailing it to their health insurer for reimbursement. One copy in the patient chart. The ” paid ” and amount was recorded on a ledger card and the third copy went into an accordion alphabetic file.  The employee checking the patient out needed a high school education and no more.  The diagnosis was written in English so that the patient knew what they had.  In the 1980′s Senators Waxman and Kennedy passed legislation making it mandatory for doctors to mail their patients Medicare claims in for them. They found that about 50% of the seniors claims had never been submitted to Medicare for reimbursement. Medicare was overwhelmed with paper and couldnt keep up. The Feds next herded physicians and practices into their lair by declaring that if you accepted Medicare assignment for the claim as a ” participating provider” your claimwould be processed faster and you would be paid 5% more than if you were not a participating provider.  In short time they declared that if you submitted your claim by computer electronically your claim would be processed quicker and again the reimbursement would be higher. Submitting the claim electronically involved  purchasing or leasing a computer billing system including hardware and software, replacing your pleasant front desk staff who had a high school education, with computer saavy data entry educated personnel. This raised everyone’s overhead and cost. At the same time it opened the door for the AMA to develop a cash cow in the exclusive on numerical codes to replace writing or typing a diagnosis in a written language. This additionally forced physicians and office staff to learn a foreign language the new codes. This training and expertise again raised office costs and changed the way doctor’s practiced and coded. It also  opened the door for electronic transmission clearing houses or computer transmission middle men to siphon off some of the payment to further raise doctor overhead. Couple this with the Stark Laws which limited practitioners opportunity to generate ” passive income” to pay for the tech overhead costs in the name of limiting ” self referrals and conflicts of interest.” and I maintain that these were the watershed changes that changed the face of medical and surgical practice physcians learned how to code because they oiwned their own practices and needed to get paid.
    The adoption of EHR’s  is one more change forced on practicing physicians , which is sold as a means to improve health care but essentially has increased physician costs and taken time away from patient care, research and continued learning.  

    • Anonymous

      Thanks for the perspective. I weep for the naivety of my fellow doctors but more so for the patients that will suffer in the end. 

  • http://www.facebook.com/jcphenry John Christopher Henry

    The largest “transformational” event in 50 years? I suppose it would depend on what you meant by “transformational.” Larger than the effect of new pharmaceuticals? Larger than the effect of DRGs? Larger than the effect of the rise of third-party payment “networks?”

    EHRs haven’t provided any of the promised benefits of centralized information access except within large institutions with single systems. All of the promised benefits and “savings” have been elusive.

    This sounds like health-tech industry cheerleading, for the companies that successfully lobbied for a giant corporate welfare program for themselves on the flimsiest promises based on dismal quality products.

  • Anonymous

    It’s easy to see from those posting early why this is a transformational event for physicians. Change doesn’t come easy for some.

  • Anonymous

    I have no idea what “transformational” means when used like this. Does it always mean a change for the better? I guess you could say that dropping the bomb on Hiroshima was “transformational.”

    • Anonymous

       As usual, southerndoc1 nails it.  Several stout blows to the head with a ball-peen hammer can also effect personal transformation, but few would voluntarily agree to it. 
      EHRs will not kill medicine (although they will prove fatal to many practices) and will not be the last transformation that we go through.  But EHRs  are frustrating because they do not seem to improve efficiency or improve patient outcomes.  That’s why we resist them.  We docs and nurses are busy and motivated people with an important job and we mostly try to avoid pointless activity.  Some business people, in contrast, spend their work lives engaging in mostly pointless if not outright harmful  activity (the advertising industry, anyone, the financial industry?) and don’t have a problem with it.  It puts food on the table and shoes on baby.  Some find it hard to imagine that other people actually have important and useful jobs. This cultural gap is hard to bridge.  (My brother-in-law, an electrical engineer, makes a living designing in-flight entertainment systems for corporate jets. Except financially, he’d be better off teaching high school math instead.)
      Many of he younger docs, in my view (and I am a preceptor for first-year University of Washington med students), have less of a problem with the perversion of medicine by business mores, but they’re young yet.  I expect the next technological white elephant will find them less enthusiastic.

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    In response to Check_that , American physicians have been like chameleons the last fifty years  All the change was marketed by public relations departments to be about improved quality and safety for patients when in fact it was all about improving the bottom line of insurance industry executives, pharmaceutical companies, equipment and supply companies at the expense of time spent with patients and physician reimbursement for services rendered

  • http://dinosaurmusings.wordpress.com/ #1 Dinosaur

    Nonsense! EMRs are just about documentation; ink or electrons don’t matter. The alleged prowess of medical students and trainees hardly trumps decades of actual experience in medicine. http://wp.me/pTwY8-AF

  • http://www.facebook.com/people/Ardella-Eagle/840440226 Ardella Eagle

    Dr. Heine, not fur nuthin’ (pardon the vernacular), but where have you been?  Newly minted med students have been offering fresh perspectives in their respective fields for as long as there have been ‘older’ physicians, however, EHR isn’t one of those instances.  EHR is a ‘natural’ progression of the information technology being used logically in a progressive manner in the information management of the medical field.  All the heartache, heartburn, and headaches that the Profession is going through now are just the labour pains of something new that needs to be worked out.  The ‘bugs in the system’, so to say.
     
    I applaud you for your willingness to adapt to the changing enviorment.  All to often, in multi-physican practices, I see computer savvy physicians chaf under the managerial thumbs of ‘older’ physicians who balk, stall, and often times saboutage their own efforts at converting to EHR and other electronic time management designs.  Science and design may be moving forward, but there will always be the ‘hold-outs’ and mules.

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