It’s a nightmare. I’m not sure how I’m still getting paid, but I haven’t switch over yet. When forced to, I’ll retire or go do some locus tenens rent-a-doc work.
I’m in a small, solo, end of career psychiatric private practice. This sort of system is anathema to the sort of patient-centered practice I conduct. I really don’t care much that others think this is a great leap forward. It will not work well for what I do, and I resent the idea that I should go along with forced into this model.
I frequently hear my patients complain about the sort of impact this has on their time with their doctors in other specialties. The doctor spends their whole time looking at a computer screen and making data entries on the keyboard, rather than discussing matters face to face with eye contact as any human being might.
From my side, when I get records from other doctors, for instance a progress note from a recent visit, it used to be a succinct one or two pages. Now I get 6-10 page tomes with so much useless info that I seldom even bother to take the time to review it unless it is essential to do so. The darned things are full of errors because no one has the time to go back and proofread their typing and dictation and use the system to make corrections.
On occasion I will go do some locus tenens work at a hospital or clinic who uses one of these things. It is a nightmare.
RecentlyI got an ad from a VA hospital looking for a locus tenens shrink to come fill in for a while. Among the non-requirements to go there and work were board certification, a license in that state, and certification in either advanced or even basic life support - but the one requirement for the doc was the ability to type 30 words per minute! I kid you not. That’s the focus. Data entry. The science and art of medicine be damned. No thank you.
One of my M.D. clients who is also a psychiatrist in private practice decided in the summer of 2013 to only see private patients, not only because of the mandated EMR issue but because we were at the point of having to add another full-time employee just to deal with all the managed care and internet generated paper. Computerized programs do not decrease paper and increase staff time when you consider EMR plus the electronic payments, electronic remittances and trying to keep the checking account in agreement with payments that are supposed to be deposited.
He does negotiate fees with patients, fees are always paid or he doesn’t see that patient any more, he has a lot more money in the bank, there is so much less hassle and patients love the total attention he is able to give them. Said he wished he’d done it sooner.
I have drawn a line in the sand and no longer will no longer seek medical treatment from a physician who uses EMR’s. I want a doctor to see and talk to me, not a person who only has time to do data input.
“It’s a nightmare. I’m not sure how I’m still getting paid, but I haven’t switch over yet. When forced to, I’ll retire or go do some locus tenens rent-a-doc work.”
You’ve hit all the necessary points in your post. Doctors, rather than being able to be patient-centric, are being forced to be system-centric. I have had several instances where I felt I received sub-standard care. but when you try to redress these issues with the now mega-medical services providers, you run right up against the bean counters and the backup lawyers.
I went to my doctor last week. He’s changing my BP medication so he decided since I hadn’t had one for better than a year, he’d run and EKG. Which took the nurse all of five minutes, but before she hooked me up, she gave me a form to sign agreeing to pay $83.00 for the service should my insurance (Medicare+ a Supplement) refuse to pay the bill. You go to the ER in your own car, and the whole process is all about your ability to pay, not in rendering treatment. My doctor is a good Internist. I value him, but he’s increasingly harried by the medical records system as opposed to spending time with me. I will wager that he now spends more than 50% of my visits pounding away on his terminal. He has even written down conditions with respect to my health that he has yet to discuss with me. I hate to think that he is now down to kiting the bill, but it has crossed my mind.