NCMS Seeks Physician/PA Feedback on Electronic Health Records

The NCMS is interested in learning about your experiences and perspective regarding electronic health records (EHR), both good and bad. Please share your experiences with us and encourage your colleagues to do the same. Your feedback will help us understand the best way to organize our advocacy efforts on behalf of our member physicians and physician assistants. Your NCMS and the NCMS Foundation are involved in numerous physician-oriented projects designed to make the best use of EHR and related technology. Help us push in the right direction! Enter your feedback in the comment section, below, or contact us directly by email at kfreeman@ncmedsoc.org.
 
 

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4 Comments

  • John G. Wagnitz, MD

    As we move into the realm of EMR we need to be cognizant of the importance of a protected narrative section to better “introduce” the person written about to the reader. The recorded session with also seem more personal to the person seeking services than watching an interviewer typing into a computer, watching the screen and rarely making eye contact.

    http://www.psychiatrictimes.com/forensic-psych/content/article/10168/2007443

  • EHR is an appealing idea. However, do all of us have to participate in the excruciating pain of the birth effort?

    To my understanding, the primary purpose was to allow intercommunicability between various health care entities. This might be hospitals, doctor’s office, labs, radiology facilities, nursing homes, etc. etc. None that I have heard of starts at this point. Some of the larger ones allow communication within the various entities under their umbrella, but each seems to value having their own proprietary system. There are supposed to be cost savings by not duplicating testing, patient care improvement by allowing access to current accurate records, and more effective and efficient referrals of patients for additional services at other sites. Some of these may be happening, in an almost accidentally haphazard way. We cannot even get our practice management and EMR, from the same company, to talk to each other, and to get the EMR to import CT scans from our own scanner in our own office took an act of God! I have heard that various entities (insurance carriers, government) are hoping to “mine” the data contained in the charts if it is entered in acceptable formats. This seems a very much lesser priority for the average practicing physician, and certainly not a justification for excessive time required to complete records, or inadequate quality of records.

    As to “going paperless”, our system requires that we receive a fax on paper, then scan it in to the EHR!

    As to saving money on fewer employees, can’t see that this will ever happen.

    As to the “bonus” money promised by the government, can’t see that we haven’t spent far time doing records than we’ll ever be reimbursed for. Were it not for the eventual mandate to do records in electronic format, I guarantee that a dictaphone, and a decent transcriptionist will produce more efficient and accurate records, and save money both!

    We (5 Otolaryngologists, surgical subspecialty practice) are using NextGen software for EHR and practice management, which we purchased through TSI. We were misled into a lengthy and exorbitantly expensive contract, for a product that can only be (mercifully) described as woefully inadequate. In order to generate an approximately accurate record, text dictation is required at most points. If the “bullets” are checked, an abomination of English, and a fictional misrepresentation of the patient’s actual story is generated. One of the TSI customer liaison people herself told me she didn’t think the check box generated history was adequate for taking care of the patient, and clearly not adequate for legal defense!! In order to generate an adequate minor surgical report, well,… you can’t! There is no way to start a clinical chart ahead of time, such as an ER patient coming for follow up,a phone contact, a neighbor, to ensure continuity of care. The program seems to have a plethora of options, but good luck figuring them out without any substantial training, which is how this product is delivered. I tried explaining to the company (TSI) that we doctors were in essence their free Beta testers. They didn’t seem to understand, or to appreciate how valuable this expert input could be if put into practice by someone who understood at least a little about how medicine is practiced and how charts should be.

    On the (dimly lit) plus side, at least the charts are legible, but you still have to sort through pages of irrelevant or duplicate material to attempt to determine what portion of each visit might be new or salient. Also, there is value in being able to access the record remotely to see if a patient is legitimate in their request for medication, or to assist with advice on a partner’s patient.

    E-prescribing is a mixed blessing, since controlled substances cannot, thus far, be sent, refill requests that were not initially sent electronically require new prescriptions to be sent, and prescriptions that were made out to the patients nickname, or middle name, or however they are routinely addressed are just plain lost without a chart. 20% of the time, the patient doesn’t know what their drug store is, or what street it is on. Not to mention prescriptions that were supplied in non-office settings (ER, surgical center, hospital).

    I could go on and on. The technology exists to make this a useful, efficient and viable option. The multiple independent iterations of similar products are at present competing and counter productive. The industry needs a shaking out like VHS vs Beta, only moreso. As the ACA will bring more patients into the system, with no increase in manpower to serve them, more time spent on poor documentation seems like the wrong way to go!

  • Debb McRoberts

    I am a hospitalist at a 150 bed hospital in central NC, and our group is at the mercy of the hospital administration in the choice of EHR. They went with an update to Meditech, which does not have electronic progress notes, nor as yet physician order entries, or e-prescribing. It does allow for dictated H&P’s, Op notes, and D/C summaries to be scribed in and annoted which in my mind is an advantage, as it takes away the bland gibberish that we see in so many outpatient EHR’s where the chart is padded to fit the DRG. It will eventually happen in the inpatient services as well, however.

  • Sandra Brown MD

    EHR may reduce cost by preventing duplication of services. However this will not occur as long as individual medical offices or major health care systems are using stand-alone software that is not cross-platform accessible. For example, WFU does not talk to CHS so when patients take themselves to WFU for a second opinion exhaustive imaging and other tests are repeated unnecessarily.

    EHR has been well shown to permanently reduce provider productivity by 15 – 25%. Supposedly we have a medical manpower shortage. So does it make sense to reduce the efficiency of what we do have by 15-25%?

    EHR severely inhibits effective provider communication. The typical EHR medical encounter contains vast amounts of irrelevant information (noise to signal ratio incredibly high). Mistakes in the EHR are perpetuated essentially forever. We do not have EHR and we hate getting EHR notes from other offices because we can never figure out what is going on with the patient, particularly longitudinal changes and physician reasoning.