Posted on 06/18/2008 4:46:55 PM PDT by neverdem
A government-sponsored survey of the use of computerized patient records by physicians points to two seemingly contradictory conclusions, and a health care system at odds with itself.
The report, published online on Wednesday in The New England Journal of Medicine, found that doctors who use electronic health records say overwhelmingly that they have helped improve the quality and timeliness of care. Yet fewer than one in five of the nation’s physicians have started using such records.
Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care system. The bottleneck to the adoption of the technology is mainly economic. Most doctors in private practice, especially those in small practices, lack the financial incentive to invest in computerized records.
The national survey found that electronic health records were used in less than 9 percent of small offices with one to three physicians, where nearly half of the country’s doctors practice medicine.
Dr. Paul Feldan, one of three physicians in a primary care practice in Mt. Laurel, N.J., has looked at investing in electronic health records, and decided against it. The initial cost of upgrading the office’s personal computers, purchasing new software and obtaining technical support to shift to computerized patient records would be $15,000 to $20,000 a doctor, he estimated. Then, during the time-consuming conversion from paper to computer records, the practice would be able to see far fewer patients, perhaps doubling the cost.
“Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see patients, we don’t get paid. The economics of it just seem so daunting.”
Private and government insurers and hospitals can save money as a result of less paper handling, lower administration expenses and fewer unnecessary lab tests when...
(Excerpt) Read more at nytimes.com ...
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He may say this, but I think there's more to the story. I work in IT for a health care organization, and I've found that at least 90% of doctors HATE computers, especially when they have to incorporate them into their work.
I don’t WANT my records computerized. One click and they’re all over the world.
I’ll take my doctor’s nice fat manila folder any day.
You'd need the designers to work alongside docs actually in process of seeing patients--too much of these programs require a "yes/no" instead of "something else entirely"--protocols are fine to a point, but too many patients have too many things wrong with them at the same time--and they are not geared to the treatment of the complex elderly patient.
You are probably right. Our IT group uses precanned applications from software vendors. Chances are the stuff is already designed, outside of minor customization before being installed. I don't get into the clinical stuff very much, so I don't know for sure.
We have been EMR for a year and a half. It is a love hate relationship. Once you go EMR you have a new partner, your IT support company. It is great in that we have no paper records to lose or misfile. We have two different back up systems which cost about $400 a month. EMR is not cheap.
It started out that way where I work but they are gradually being brought around. It helps that we hired a full-time physician liaison who has worked wonders getting the docs online. They don't document online (yet) but have access to the old records and all current test results, notes, etc.
Zackly.
There are advantages and disadvantages to each.
Since everything on the computer is trackable, health care organizations/providers usually have stringent procedures on ensuring that access to charts is done only by those who have a specific reason to be in that chart. With paper charts, there is just no way to know who has looked at your chart, yet with an electronic record, there is.
As for “one click and they’re all over the world”, I don’t think that’s true, at least at this point in time. Each system is self-contained, so for Hospital A to send records to Hospital B, it most likely is done via paper records, or records placed on a CD/DVD. At least from what I’ve seen...
An EMR is definitely more time consuming, and many of the older docs can’t type well, which makes it even more cumbersome for them.
“Dr. Paul Feldan, one of three physicians in a primary care practice in Mt. Laurel, N.J., has looked at investing in electronic health records, and decided against it. The initial cost of upgrading the office’s personal computers, purchasing new software and obtaining technical support to shift to computerized patient records would be $15,000 to $20,000 a doctor, he estimated. Then, during the time-consuming conversion from paper to computer records, the practice would be able to see far fewer patients, perhaps doubling the cost.
“Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see patients, we don’t get paid. The economics of it just seem so daunting.”
The FP my wife worked for 30 years retired last year with a case of burnout. His replacement, a capable young female MD, didn’t last a year. One of her main reasons for quiting was the new electronic record system that was being forced on the group of individual MDS.
She was very computer oriented and had her own portable when she came into the practice. The new system is loaded with faults and has terrible design problems. It is a rare day that most things work. So she refused to even get in the program, and her partner, a computer expert suggested that she just leave the practice after he saw the mess the new system would create. She did and returned to a county clinic outpatient program where data entry people do the data entry, and she still only sees about 20 patients per day.
The older doctor returned 1 June after the new doctor left the practice. He likes computers, and is a Mac fan and his wife the office manager is a computer lover/nerd.
The time consuming bs daily data entry of the new medical record system program has cut their number of patients seen from 30 per day to barely 20. My wife, the doctor’s wife and doctor are going in to work at about 7:45 am, working through the lunch hour, and not leaving until about 7 pm. The doctor’s wife goes in a half day on her day off and so does my wife to try to get caught up with the data entry requirements.
Twenty patients per day isn’t even breakeven. The doctor and his wife are not drawing a salary during this phase in period. They need to see 30 to 35 patients per day to make it worth their time.
Of course if this continues, they will all burnout and close the practice. That will mean at least 3000 patients will have to try and find another doctor to cover them. New doctors don’t want this bs and are refusing to come into established practices.
IMHO, applying data processing techniques/IT to medicine is going to be a fool’s errand unless they follow KISS, Keep It Simple Stupid. It’s not a known problem like an engineering project. Medicine is a work in progress that demand constant learning. There are too many fields in it where the basic science is still unknown. Add in folks who can’t type, like me, confidential info and the threat of malpractice, it’s just begging for trouble.
ping
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