Wednesday, March 07, 2012

EHR Musings From a Pediatrician

I am reproducing with the author's permission a post from The author is a pediatrician. Sermo is a physician-only online community.

Emphases mine:

EHR Musings
March 06, 2012
Author Specialties: Pediatrics

Let me preface my comments by saying that I LOVE TECHNOLOGY. I am a geek at heart and live to use all kinds of gadgets. I was actually looking forward to going EHR. These comments apply to someone with an existing mature practice that needs to be converted to EHR. For a doc starting out new, things are infinitely simpler. I am a Pediatrician in solo practice.

It has been 6 months since we started using [EHR name redacted - ed.] and dove all in to the EHR realm. They have not been a happy 6 months. I am working a lot more and enjoying it less. My days do not end with the last patient, far from it.

This is my opinion:

Pros: 1) You can always find the chart. 2) In the case of [EHR name redacted - ed.], since it is web based, I can work at home and access records from anywhere. It is also free and never has to be updated. 3) At the end of the day I remember the patients better. I can also send messages to the staff within the EHR for follow up calls, things I might have forgotten , etc.

That is pretty much it.

Cons: 1) Documenting will add 1-2 hrs to your day. Since a lot of the documenting consists of templates you or the EHR created, it results in charts that all look very similar and there is a tendency to overdocumenting. I daresay it gets in the way of patient care. 2) You will have to drastically change your workflow. If you walk in the room with a laptop or tablet, you will wind up interacting with the tablet and not the patient. If you jot down notes, and then go out of the room to chart or look up things in the chart you will walk 10 miles a day and take up precious minutes. 3) I actually find it harder to keep track of things as growth charts, immunization records, prior labs, previous medical diagnosis and things I need to follow up. Why? Because I now have 2 charts for each patient. The new electronic chart and the digital copy of the paper chart. In the case of newborns things are better because there is no old record. 4) Once you sign a chart it is often impossible to add a note to some parts of the chart to explain an error. For example if the MA switches the weight and the height and I do not notice prior to signing, the growth chart looks like a roller coaster and I can't change it.

Then there are the quality of life issues. I no longer have any time to do anything out of the office at lunch time. It is usually spent finishing the "documenting" from the AM so I don't have as much to do at the end of the day. I get frustrated by the inability to come up with a better workflow after 6 months. I have tried various different methods and none seem better than the other.

Then there is the issue of the e prescribing. Any of you that are doing this can "attest" ( nice play on words ) to the fact that you can write 5 paper prescriptions in the time you can do an e Rx. E prescribing would be a cinch in rural Arkansas, where your patients have only 4 Pharmacies to choose from. In Orlando with a 300 pharmacies or so, and dealing with young parents of kids it is a nightmare. They change pharmacies more often than I change clothes in a week. They tell you to send it to one pharmacy and later complain because they made a mistake and gave you the wrong pharmacy. It is such a hassle for the staff, that they beg me to give them paper scripts so they don't have to deal with the calls. Notice I have not said anything about the Rx's that never reach their destination !

BTW, if and when I receive the incentive money I will know that I have earned every penny of it and then some.

If you are still reading at this point, you can tell I AM PRETTY FRUSTRATED. And we all owe this to those wonderful folks in Washington DC whose lives are devoted to coming up with ideas to mess with our lives even more. ARGH !!!!!!!!!!!!!!!!!

I would love to hear comments. Just venting has made me feel better. Of course it is now 10:50 EST and I have 7 more charts to do.

I post this with no additional comments.

-- SS


Anonymous said...

Clearly, eRX is an experimental medical device according to the F D and C Act definition of such, that has not been vetted for safety, efficacy, and usability.

If you, as a physician, were to use an experimental medical device, you could not bill CMS for its use and you would need to obtain informed consent from the patients on whom it is being used.

Here is what I do not understand. How is it that CMS is penalizing doctors 1% fee reduction for not using an experimental device when it has policies that keep it from paying doctors for using an experimental medical device?

Just wonderin

southern doc said...

"Which pharmacy would you like me to send your prescription to?"

"The one next to the dry cleaners."

And it's downhill from there.

Anonymous said...

I work for a state court system that has gone paperless and where all work is done through "efiling." I can tell you that I could have written this post myself. The problems are identical, except for one crucial point. I am dealing with lawsuits, you are dealing with patients' lives.

InformaticsMD said...

Anonymous March 8, 2012 5:44:00 PM EST wrote:

I work for a state court system that has gone paperless and where all work is done through "efiling."

Let's see how EHR-like templates and checklists for generation of legal dockets would work out...turning them into legible gibberish, too.

Let's also see how computers could do at deciding if laws are constitutional or not. Child's play, eh?

-- SS