Friday, June 4, 2010

EMR Not a Rosy Picture Yet

The full implementation of an Electronic Medical Record can allow a physician to positively impact the continuum of a patient’s health care cycle, but it’s not an easy task to accomplish it.

An article published in the New York Department of Health Care Information Bulletin of March 2010, implies just the opposite. EMRs are promising health content management tools to organize medical offices and improve patients’ care. A vision pushed by the Obama administration which allocated about forty billion dollars in the Recovery Act through the federal government. This money is available to Physicians who implement an EMR and show Meaningful Use of the EMR to qualify for an incentive fund of about $63,000 from Medicare or Medicaid, not both. The funds are allocated to encourage and promote the implementation of EMRs.

The article published in the March bulletin called, “Working Together: Home Care in the South Bronx,” portrays Dr. Sahgal’s utter success transitioning his practice from paper to electronic medical records. It is absolutely possible that Dr. Sahgal now provides higher levels of care after fully implementing his EMR. However, the article fails to alert physicians to problems and difficult obstacles that will translate into higher costs for physicians and only paints a rosy picture of the process. The article gives EMR newcomers an unrealistic perspective of an EMR implementation, only emphasizing how in Dr. Sahgal’s practice telephone call efficiency was improved, how the doctor was able to develop a different model of care where some patients are visited at home in coordination with home nurses and social workers. It all sounded to me like a medical model I heard as a child implemented in the oppressive Cuban regime but that works. I am sure patients will love to get a health care visit from their primary doctors and not just a bill. The article also mentions ePrescribing medications, referrals are vaguely mentioned, as well as an increasing number of visits and other interesting facts that can be accomplished through an EMR; but fails to mention any logistics on how to accomplish these new work flows.

The article appears more like a sales pitch to physicians who want to purchase an EMR, without providing real and valuable information. An example of a feature that can be misleading is referrals. Referrals need to be tracked and this is a problem spot for a high percentage of EMRs. Let’s imagine that a referring physician gives a referral to a patient. The patient will go to the referred doctor, and once the visit is completed and the patient has the report, according to one of the rules of Meaningful Use, the referring physician needs to track the referral. But the doctors might have different EMR system that do not communicate with each other and even if they have the same system, often EMRs are not yet ready to electronically receive referrals as they ePrescribe or submit a claim. To track the referrals doctors will need to allocate new office resources and staff time to comply with the referral rule which will have a higher cost. The EMR alone will not track referrals.

Visiting patients at home presents also a similar situation where the practice needs to reach a higher level of coordination putting more stress especially on small practices that are already overwhelmed with work. The physician needs to search for patients with conditions that meet specific home visit criteria to generate a list of who needs a visit. This can be done through a searchable registry. The data needs to be available as structured data and not just as scanned documents. These details are completely overlooked in the article.

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