EMR: Promises Unfulfilled

Welcome to my nightmare.

My practice is limited to consultative ultrasound in Obstetrics and Gynecology. It's been that way since the mid 1980's. My routine used to be simple. A medical assistant or sonographer would escort a patient into the exam room and take a history, inserting pertinent information on a report form. Patient identifiers would then be entered into the name and data fields on the ultrasound screen. After seeing that the patient was properly set up and doing some preliminary scanning, I would be called in. After asking the patient a few questions and a little small talk, I would then perform the ultrasound exam. I would give the patient a synopsis of my findings sans medicalese and then leave to write a preliminary report. The chart would then go to for transcription and from there to billing. Life was good.

Then I joined a large health system which had incorporated all the 21st century technology, including both an EMR and Ultrasound Reporting software as well, neither of which talk to each other. My routine is considerably different.

Now I am either handed a stack of demographic info or obtain my own demographic info off a computer screen. I then enter this data into another computer screen. This is invariably incomplete as it's usually unclear who referred the patient and to whom the report will be sent. A medical assistant fetches the patient and escorts her into the exam room, but usually I am the one to enter the info into the data field in the ultrasound machine. I am most often the one now who takes patient's history. I also figure what needs to be done and in what order. I then leave the room so the patient can change. After an appropriate interlude, I return and perform the ultrasound examination. I again give the patient a synopsis of my findings and then leave to write my report.

I return to the computer and then finish entering the demographics and some historical data. Because the images are usually not incorporated with a patient's demographics (remember, I couldn't enter that until I spoke with the patient,) I have to "attach the images" to a patient. Then I am ready to write my report. I pull up an image and input data from it into the appropriate field in the report page. I find some fields arranged in a nonintuitive fashion. I entered descriptive information by keyboard now rather than pen as I am now the transcriptionist.

Periodically, I have to launch an additional program to find the appropriate diagnosis codes so the examination I performed can be justified. The present diagnosis code system of about 14,000 codes is set to switch to a whole new system featuring 70,000 codes, which will not make my life any easier. After completing the report and seeing that the exams are entered, the indications are entered and they all are coded, I electronically sign the report and then send it to a network fax driver. Unfortunately, because many of these reports find themselves mysteriously transferred to Altair 4, I also print the report and then walk over to a fax machine to do that myself. In some cases, when the patient's physician is in the same group of offices, I will leave the report with the office staff to be scanned into the EMR. (Remember, I told you the EMR and the reporting software don't talk to each other.

Looking at the two practice systems, I ask myself which system enhances productivity? I used to be a doctor. Now I not only see patients, but I'm a transcriptionist, a biller and a coder as well. And this in a health system with an army of billers and coders. I am not the only practioner with these issues. I can tell you that the increased time subsequent patients wait for their exam because I am dealing with tech issues is not boosting my patient satisfaction scores. But that's a topic for another day.

Think Your Doctor Is In A Funk? Your Doctor Would Agree With You

While most doctors are satisfied with their job, most agree the stress levels have increased in recent years, with one out of five admitting to feeling just plain burnt out. In an AMA commissioned study, doctors offered that the EMR was the number one negative factor impacting doctors' morale.

• "What we've created is a monster, when really what we were shooting for was good patient care," said a physician about the government's program to promote "meaningful use" of EHRs with bonuses and penalties. The extra time spent "working the chart" to satisfy meaningful use requirements, the physician said, takes away from face time with the patient.
• "I am not a clerk," added a cardiologist who complained how the technology increased data entry responsibilities. Sixty-one percent of physicians surveyed are like-minded, saying that EHRs require them to perform tasks others could handle.
• "The EHR is not just a one-time investment," said a physician with practice management duties. "It's a hugely expensive, ongoing, every-freaking-day investment."

Other complaints including information's being lost in a maze of data, confusing dropdown menus, and lack of a standard for interoperability. Doctors' offices still rely on faxing hard copy and then having to scan information back into the record.

The electronic record isn't the only stressor. Having to jump over multiple and ever-increasing regulatory hurdles compounds the difficulties doctors face. Struggling to meet government's "Meaningful Use" requirements may be the most prominent hurdle. While striving to provide better patient care by adhering to regulation, office visits take longer. Struggling to keep to the schedule shortens the time actually spent with the patient. Not only does this result in a less than satisfactory doctor-patient relationship but increases the likelihood that an error may occur, potentially, a serious error.

Additionally, some large groups base pay incentives on "productivity." This also impacts adversely on the time spent with the patient and the quality of that time. Finally, in an era of declining payment from third party payors, doctors feel it's not about profitability anymore - it's about viability.

So next time you think your doctor is stressed and rushing, he is. Why not take his hand and offer some encouragement? He'll thank you for it.

You can read the study here.