PookieMD's Blog: Where Physicians Learn About the Business of Medicine

I have never heard a physician shout with glee, “yay, we’re getting an EMR!!!”

Physicians love to hate this latest technology, and for good reason.  Here’s why we hate ‘em:

• EMRs are comlicated.  When we had paper charts we wrote our notes on one side of the paper, and our orders on the other.  Quite simple.  If we had to read a note from a different doctor, we flipped through the pages.  (Hopefuly it was legible.)  We would open the tab to the lab results and look at them.  (Now, don’t forget that half the time you couldn’t find the chart!!!)
• EMRs are not intuitive.  EMR geeks have given us 10 different ways to do one thing.  We are simple souls– we want one way to do one thing. We wrote our orders on the paper and handed them to the ward clerk.  We don’t care about 7 different ways to order a lab test or medication, we just want to get it done.
• EMRs make us learn a whole new skill set.  We now have to “navigate”, and “cut and paste”, and use “smart phrases.”  We also have to know how to type.  This wasn’t part of our medical education, and we perceive it to take time away from what we need to do–take care of patients.
• EMRs make us feel like clerks.  When my hospital went to order entry, the clerks vanished.  ‘Nuff said.
• EMRs don’t mimic our work  flow.  When I work on paper, I take my note out, and have labs and other notes open on the table in front of me, so I can synthesize data and come up with a coherent plan.  EMRs make it difficult to mimic this work flow.
• EMRs don’t talk to each other.  There are a kazillion different EMRs out there that hospitals, offices and clinics are adopting.  Those of us that work at multiple different settings have to learn multiple different EMRs. 
• EMR  bulders forget that the EMR is a tool, not the end product!!! The end product is patient care.  The tool should be used  to enhance and deliver improved patient care.

You would think that I am a part of the anti-EMR faction.  Well, I’m not.  I’m a pragmatist.  EMRs are here to stay.  Make the best of it.   Be an influencer in a positve light–get involved to make EMRs better at your institution!

So my fellow chip heads, here is a comparison on web based and client/server  EMRs.  Pour yourself a cuppa joe and focus!

Web based EMR: as noted in the last post, this EMR is based on logging in to the Internet to a secure site that hosts the software for the EMR your practice is using to replace those obsolete paper charts. 

Requirements: should be accessible from any computer connected to the web, have secure connection to meet HIPAA requirements, be reliably available through out work day, and full functionality must be available on the web.  Your practice must have a T1 line for reliable access, which costs about $500/month.

Questions: how reliable is your office’s connection to the web based soft ware? Who owns the data?  If the software company goes out of business, what happens to your charts?  What do you do when the server goes down, or you lose your connection to the net or some other snafu?

Benefits: cheaper initially.  Monthly fee per provider ranges between $350-750/month.  You are paying a monthly fee to the ASP who provides and maintains the software, the database, the server etc.  You still have to have work stations, but you do not have to keep and maintain a server, and don’t have to have a degree in IT to keep up.  Good for practices with multiple locations, may also be good choice for small practices that don’t have lots of up front cash.

Downers: security is left to the whim of the vendor, and software may be less customizable.

Client/server EMR: as noted, this is akin to owning a car.  Your practice buys the server, the software and other associated hardware. 

Requirements: your practice must buy and maintain the server, preform daily backs of the data base, up grade software and trouble shoot problems. May require that you have some one with IT experience on staff.

Questions: who will maintain the server and upgrade the software? How much will it cost to up grade software? How much will you pay someone to perform IT tasks?

Benefits: faster, likely more reliable with less “down time” than a web based system.  Usually more customizable for your practice.  Your practice is in charge of security.  (Could be a downer as well…)

Downers: Higher up front costs–your practice must buy a server, have space for the server, pay for software and installation, and pay a licensing fee for each provider who uses the EMR.  Costs run between $20,000-$40,000 per physician.  Can’t access the EMR remotely.

For a great comparison of multiple EMRs, check out this wiki.  The ACP has some info on EMRs but I didn’t find it helpful.  Last caveat: make sure what ever you purchase it qualifies for the CMS $40,000 “reimbursement” and that you qualify as a meaningful user!

So what EMR are you buying, and why?  And if you are waiting–why as well?

I’ve been slimed.  I just read the latest post from “The Health Care Blog” which talks about how patients view the use of EMRs, and what expectations they have.  Amongst the most ludicrous point from the post is the assertion that now, on top of meeting the demands on documentation for proper coding, we should use language in our records, particularly EMRs,  that patients can understand should they choose to read their record.  I can see it: patients don’t have a STEMI, they have a heart attack, and they don’t have CVAs, they have brain attacks.  Please, let’s use some common sense.  We in the profession use a very technical, specific vocabulary to describe to each other what we are diagnosing and treating.  Requiring we “dumb it down” shows a complete lack of understanding of what an EMR is for.

What if pilots were required to communicate with Air Traffic Control in ways passengers can understand?  How many more crashes and near misses would we have?

Mr. Kibbe, you  need to investigate your facts before you opine so wrongly.  I’m sorry, I’m ranting, but this sort of myth spreading propaganda does nothing to help health care, and shows no insight into health care management.

Oh, just in case I wasn’t clear enough, and  there is someone out there that doesn’t understand my intent: what a bunch of horse carp (deliberately misspelled)!