HEAVEN
OR
HELL
The
promise of electronic medical records (EMR) began enticing businesses over thirty
years ago, but the power of EMR is now finally being realized. The science and technology
of medicine and health care have progressed in many ways over the past thirty years, but
the process of health care delivery remains archaic. Health information stored on paper
records, telephonic communication between patient and physician and paper-based
transactions between provider and payer militate against implementing efficient systems.
EMR today can deliver an efficient, standard process, improved documentation for excellent
patient care and appropriate reimbursement, which results in an enhanced lifestyle with more leisure time.
This article focuses on the impact of EMR on lifestyle.
Some physicians who have implemented EMR will describe the impact on their leisure
time as heaven; some physicians will describe the impact as hell. Why the difference?
The decision to implement an EMR flows from a desire
for change. Change is difficult for most people—especially for physicians who are
accustomed to doing things a certain way in their practice over a period of many
years. EMR systems are designed to create efficiencies within a practice by streamlining
workflow and improving communication between patients and physicians, as well as
among the practice staff.
Moreover, EMR systems are designed to complete repetitive
tasks (currently managed by paper flow) and rationalize coding, based on the work-effort
of a patient evaluation/treatment. You cannot fit your existing workflow into an
EMR system. Those physicians who try to maintain the status quo while implementing
EMR will experience a lifestyle hell. Those who adapt to the EMR workflow process
will gain the benefit of less practice stress and more leisure time.
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Most EMR systems are designed for primary care specialties—family
practice, general internal medicine and pediatrics. Then, to accommodate specialty
needs, templates can be created to expand the general EMR to make it more specialty-friendly.
Often, these templates must be developed by the practice to conform to the requirements
of the practice. This is time-consuming, expensive and lengthens the learning curve
to assimilate EMR into the practice. This can be hell. Rather than facilitate efficiency,
this process produces inefficiency and lost productivity.
For many specialties, there are specialty-specific
EMRs that are designed to meet the workflow requirements, patient-physician communication
requirements, and external relations requirements (communications with hospitals,
laboratories, surgery centers, instruments, and payors) that are not available in
the generic EMR. Physicians who adopt specialty-specific EMR will quickly gain the
benefits of improved lifestyle and more leisure time.
What should you look for in an EMR that will give
the benefits of improved lifestyle and more leisure? What inefficiencies in a paper-based
practice can be solved by EMR? How can EMR improve communication between patient
and physician and within the practice?
When we founded digiChart, Inc. in 1999, we made a
Deeming analysis of the workflow in a typical OB-GYN practice. We learned that the
patient does 10% of the work while the clerk, nurse and physician each do 30% of
the work. Our system was designed to change the workflow so that the patient, clerk,
nurse and physician each do 20% of the work, and the system does 20% of the work.
Thus, the system is designed to provide a 30% gain in efficiency in a practice.
When the system is used as designed, physicians will realize a 20-30% gain in efficiency
within 15-18 months. Some of this efficiency is realized as less stress and more
leisure time.
What should you
seek in an EMR system?
1. Does the EMR support your typical day in evaluating and treating
patients? Often, sales representatives will give a canned demonstration that has
little relevance to your typical day. Insist that a sales representative give a
live demonstration of a typical group of patients that you see every day.
2. How does the EMR system support your workflow? Workflow begins
when a patient calls for an appointment, then progresses through the patient arriving
for the appointment, being evaluated by a medical assistant, entering patient history,
physical examination, medical decision making (including diagnosis, laboratory studies,
prescription ordering), communicating with referring and consulting physicians,
and rendering codes for billing. You should insist on workflow documentation that
supports your practice.
3. You will be using the EMR. You make the selection. Often, a
non-physician makes the EMR selection decision based upon his/her experience with
a practice management system—not a clinical system. These decisions will result
in selection of a generic EMR rather than one designed for you and your specialty.
4. Do not base your decision on price. Frequently, the first question
that we are asked is “What does it cost?” That is not the starting point for EMR
selection. Like automobiles, cameras, sound systems and wine, there is wide price
variation among EMR systems. Your selection decision should be based on value, not
on cost. When an EMR system creates value, you will realize much more than your
cost.
5. What will be the impact of your EMR on your support staff? If
you shift work from yourself to your staff, you may improve your lifestyle and gain
more leisure, but at the expense of the lifestyle and leisure of your staff. I often
hear from staff, “Now I am here until 8:00.” That does not have to happen.
6. How will your EMR system affect your patients? Patient-centric
systems support patient-physician communication, reduce late-shows and no-shows,
and build the practice through word-of-mouth satisfaction of patients.
Modern EMR systems—designed for your specialty and workflow— can
add a much-needed dimension to lifestyle and leisure time. We are working longer,
harder, and with more external intrusions for less pay. We are under greater stress
as patients, payors, and governmental agencies expect more of us. Our families suffer
as our demands on our time increase. EMR can be your tool to facilitate dramatic
improvements in your lifestyle and leisure time.