Finding the right EMR vendor can help navigate mandates

As a physician, not a day goes by without a new acronym I need to look up, a new policy I need to follow, another box I need to click or another criteria I need to meet — and this is just to keep up. While the health care picture and its various unknowns loom ever larger in the news, and health information emails overstuff my inbox, it is worth noting that in the midst of all the new legislative, corporate and regulatory initiatives are many individuals just trying to deliver good medical care to patients. It’s not enough to just have an EMR these days; you need to have a team of people capable of explaining the multitude of imperatives being slung at you from all directions that, inevitably, will show up in said EMR.

Recently, the New England Journal of Medicine published an article promoting the concept of the physician as financial counselor. The article suggests that physicians should take time to discuss the cost of care with their patients. Really? Shall I do this while I am examining their eyes and ears? Or, maybe when they are telling me how they learned to cut their wrists to relieve tension? I don’t think I am the only physician in the country who was a bit taken aback by that article.

Here’s another recommendation: The American Academy of Pediatrics (AAP) strongly suggests that, in addition to the mainstay pediatric questions, we need to have discussions about TV and mobile screen time, guns in the home, managing violence, bullying, postpartum depression, and the list goes on. Anything else?

Don’t get me wrong. I think all these issues are important and worth discussing. But as it turns out, the more thorough I am the further behind I get. Just asking an adolescent female about her periods takes ten minutes.

And then, of course, there is the documentation of the visit, made somewhat more dizzying by the number of entries required by stage 2 meaningful use, pay-for-performance, patient-centered medical home status, etc. EMR vendors need to be as knowledgeable about these requirements as clinicians, and must take them into account as they build and enhance their user interface and workflow, all so that I can focus on what I do best — provide care.

I mentioned acronyms earlier, and that’s because they’re inescapable. There’s an explosion of the creation and use of acronyms littered throughout health care, for just about everything: ACO, ACA, CMS, HIE, ICD-10 … it’s becoming a nightmarish tangle of letters and terms. And each acronym’s accompanying mandate adds to the volume of information we need to keep up with just to stay in practice. How are physicians to keep pace in this seemingly endless line of red tape? I don’t think we can, at least not without help anyway.

I’m looking up terms far too often these days, and I know that when I need to google a term, I am in trouble.

It goes like this: I need to understand what the PHO is telling me about the shared risk contract, how the ACA affects patient co-pays for a WCC if you bill a 25 modifier, and that the ABP needs me to complete my MOC before 2015. No kidding. It’s nuts out there.

I believe this frenetic and dynamic work life we live as physicians is taking its toll. There are more and more primary care physicians retiring — often early — and fewer and fewer medical students interested in taking their places. Even my physician friends who I view as extremely easygoing and positive are finding it increasingly difficult to keep smiling.

There is a growing disconnect between how physicians define good health care and what lawyers, politicians, and insurance executives view as “quality health care.” Most of the decision-makers have never even seen a patient or provided care, yet they can — and they do — dictate how health care is delivered. They are counting on us being overwhelmed and under-organized.

Doctors are selling out to big hospital corporations in dizzying numbers. Fewer and fewer independent groups will have the resources or the wherewithal to remain standing. This is why it is increasingly important that we make sure our EMR vendors have our backs, and become a partner in addressing our needs. After all, an EMR is where all this stuff shows up. This is a tool that actually affects my rhythms during the encounter. This is where I can sink or swim when it comes to certain mandates and demands. The EMR vendor’s role and expectations are changing just as ours are, but the key is finding the vendors that realize that.

Sally Ginsburg is a pediatrician and blogs at the athenahealth CloudView Blog, where this article was originally published.

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  • Margalit Gur-Arie

    You know, I don’t doubt for a moment that finding a good EMR is extremely important for everyday practice, but is it the solution? I mean, is finding a smooth rope to hang yourself with, the best strategy for survival?
    I may be wrong, but I think the right EMR is the least of your problems right now. More here:

    • Steven Reznick

      What an outstanding and well written piece of advice. Thank you Margalit.

      • Margalit Gur-Arie

        Thank you, Dr. Reznick.

  • MarylandMD

    If you think that an EMR is going to do anything to make your life as a physician more pleasant, less complicated or more efficient, then you haven’t been around EMRs very much.

    Getting a new EMR or upgrading your current software may solve one or two problems, but in the process you will also create a whole new set of tasks, inefficiencies, sources of error, and distractions.

    You will soon be asking whether it all was worth it, and perhaps you may even start wondering whether you want to continue being a physician, but by then the EMR vendor will already have your money, and it will be too late…

    • Sally Ginsburg

      Hi and thank you for your comments. I do feel that my life as a physician is complicated, ever changing and exhausting. I wrote this post because, despite the changes in healthcare, I feel there are some EHRs which actually respond to the changes. Fortunately for my practice we do not have to pay for upgrades or new software or servers. All that is done for us free of extra charges. Thankfully for us, our EHR vendor only gets our money if we are happy with their service.

  • Ron Smith

    Hi, Sally.

    I’m a thirty year veteran Pediatrician and a database programmer. I wrote my own software and deployed it in 2000.

    I think I have to disagree about depending on EMR vendors for anything that is going to keep you abreast or out of trouble. The problem right now is that there are so many vendors and absolutely so few understand the process of medicine enough to create solutions that we can actually use.

    I am also a solo Pediatrician with two nurse practitioners. Now I think that the migration to large corporate medicine entities is happening and threatens medicine as we know it. But I also see a resurgence of solo practitioners coming out of this too.

    Our consultant side deals with a practice solution and not simply software. Any software alone has no ability to make a physician succeed. We are about a total solution and that’s why we don’t sell software. We are marketing success and selling our method of practice.

    Finding that kind of mix is just nearly impossible. But we survive by the solutions that we provide as well. How many software vendors do you now actually have to use what they sell?

    I think the best advice is to trust with verification and that goes for the largest to the smallest vendor that any physician is looking at. If your practice process is already bad, don’t expect software to make it better either. Find someone who’s successful and do what they are doing.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • Sally Ginsburg

      Hi Ron,

      Thank you for your comments. As I noted in my post, I am chronically stressed about the changes coming down the pike. What I did want to note is that choosing an EHR vendor IS a big deal and choosing one who will engage with physicians and respond to their needs is very important. I am fortunate that the EHR my group has is very responsive and continually flexing and helping us navigate the uncertain healthcare waters and for that I am appreciative.

  • southerndoc1

    Good post up until the second sentence of the last paragraph. If you honestly think that EMR vendors are going to improve the working conditions of primary care docs, I really don’t know what to say. I’m putting more faith in the man in the moon.

    • Sally Ginsburg

      Thank you for your comments.
      Despite my appraisal of the healthcare situation, I do believe that there are vendors in the healthcare space that are putting vast resources into helping their physician partners. My experience has been that when new hurdles are placed in our way, our EHR vendor helps us by enhancing the product and sending information our way that helps us meet new criteria and goals. For this I am thankful. Our 8 provider practice could not manage without the help we get from our EHR company.

  • Margalit Gur-Arie

    Thanks, I did see the article. I am not sure the numbers published there are the norm…. So I don’t believe folks here are the minority really, but I can’t be sure of course.

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