I just love the picture at the top of Charles Krauthammer’s column complaining that physicians are chafing at becoming data entry clerks. It should be labeled “How Many Things Can You Find Wrong With This Picture?” For a start note that the notebook computer he’s using has an ordinary keyboard, that it has no keyboard protection, and that, at least to my eye, he’s using a wireless connection. Just as a clue, keyboards are notoriously hard to sanitize and your toilet seat is probably more sanitary than your computer keyboard.
I actually sympathize with the plight of the doctors. If the physician isn’t his own data entry clerk, a clerk needs to be hired. When you hire a competent medical clerk, it erodes the gains that might be realized from electronic medical record keeping. I am almost literally brought to tears on the frequent occasions when I watch a physician struggling with a recalcitrant computer application, frequently one that was developed with a mind to what was easy to write rather than what was most useful.
One last thought. Based on my first hand experience, the largest single problem in implementing a system of medical record keeping is physician compliance.
Recording all of the data and communication is challenging whether done by pen and paper or computer. Having lived through the transition in veterinary medicine, I feel that it’s made me more meticulous.
We have our technicians rotate in the tasks of assisting with the patient and taking down the notes. The biggest challenge for me has been adjusting to dictation of my exam findings but I’m getting more accustomed to it.
An unexpected bonus is that I’ve realized I can scan the notes made by the techs to make sure I communicated effectively with the client. If the techs got something wrong or the instructions as written are unclear, I know I need to review, recap, and potentially correct before we move on.
Another really positive development with electronic records is he ability to quickly sort data. I can view the list of previous diagnoses, prescriptions, lab work, etc in a fraction of the time it used to take to skim through a patient’s chart. The overall efficiency though isn’t going to translate to cost savings, it just improves functionality.
Based on experience of nearly a half century, of the many reasons to automate a process generally the weakest is to cut costs. My experience has been that automating a process can improve service, ensure that policy is consistently enforced, speed up a process, promote record keeping for future analysis, or allow an organization to provide more goods or services with the same costs as prior to automation but actually cutting costs is darned rare. Maybe I just don’t deal with excessively bloated organizations.
There are also some processes that are impossible without automation but that’s another subject.
The lack of physician compliance is the number two issue. Number one is that all of the EMRs suck. Real physician participation in developing and implementing these systems has been limited. Usually, they are developed to the specifications of the administration and the physicians involved are a few ultra computer geeks. Given the combination of poor design and production pressure, people begin to immediately look for workarounds.
On the issue of costs, I think that is a hard call. I would say from nearly half of a century in medicine that costs have never really been an issue until now. Now that people are taking costs more seriously, it is certainly possible they can help cut costs. We are implementing a system that will take advantage of the an EMR to save millions in costs while, we believe, improving quality. (of note, we first proposed doing this years ago but there was no interest in the past.) However, this will likely be offset by the ability to capture more monies from better billing. However, this better billing effect will likely fade if we continue to move away from FFS.
Steve
I agree that’s a significant problem. I’ve seen the industry leader (can’t remember the name) and two others. They gave every appearance of having been designed by people who knew nothing about medical practices.
As I think I’ve mentioned before my professional experience with medical recordkeeping systems goes back over 40 years.
EPIC is the new frontrunner. We are going to give it a try, at the cost of a $100 million plus IIRC. It is taking over a year to implement. Lots o training. We shall see. I can say that they are willing and able to work with other IT people. I have two sets of people working on three projects with them and it appears things are going well.
Steve