Wednesday, November 19, 2008

F = μkN (MD/EMR)

F = μkN (The Coefficient of friction as it relates to Doctors accepting Electronic Medical Records) Both McCain and Obama stouted that electronic medical records are a way to improve medical care and to decrease costs. Well we are in the middle of disproving this in our office.
Normally, when I meet a new patient, I go though the forms that they have filled out that describe their problem and their past medial history and then interview them about what is going on, examine them and then talk to them about what may be going on and what tests, medications or surgeries may be beneficial. I then step out of the room, write a brief short note and dictate the main note.

Now here is the EMR. The patient still fills out the forms but now the front desk person has to enter all the information into the system. (Takes 5 to 10 minutes and we need at least one extra persion) The nurse then puts the patient in the room and pulls them up in the computer and enters more stuff in. When I see the patient I have 2 choices, I can do the same thing as I used to do and then step out of the room and fill out the computer note which then sends the scripts and orders the tests, but it takes 5 to 10 minutes just to do the note. This means see fewer patients or spend less time with each patient. The other option is to do what the office manager wants and that is to do the note while you see the patient. This means that you are looking and trying to type while talking to the patient which so far has really ticked them off and spend less time actuall doing the doctoring. I guess we could always hire someone else to type the note while we see the patient. So far, the EMR has cost us extra money, allowed us to see fewer patients and in general, generate notes that no one can decipher.

The main benefit of the EMR has been that it automatically generates the pages of BS that are required by HIPPA, CMS and the insurance companies as well as other pages of drivel that are there for medical legal reasons.

What a great way to reform healthcare.


SeaSpray said...

I hear you Throckmorton.

I wouldn't be too concerned about typing in front of your patients. It will probably be more difficult for you but you will finesse it. Every patient brings something different to you in personality and you'll go with it just as always.

You're experienced and so you know what works. and with some patients it wouldn't matter if you rolled out a red carpet and catered to them...they'll be difficult anyway.

Just be yourself...firm handshake or hugs, eye contact, smile and they say if you sit down the patient perceives the visit to be longer. And if you parrot back some of what the patient says they feel you have heard them.

LOL! I didn't know it at the time but I think my PCP must have had an EMR or something for years now. I thought he just liked his computer!

He is gracious as always. I ALWAYS feel like I have his attention and he always gives me extended visits (not because of the system)... but admittedly we both chat a bit. No matter why I go in there...I can tell him anything and always leave feeling better... even if sick. :)

He is ALWAYS TYPING things in his computer. He asks me questions. And then parrots back my answer as he is typing it.

So, he greets me warmly, listens to my complaint/concern, examines me physically if needed, orders a test (rarely) with nurse if required then sits down and types whatever it is he types and asks me questions and types the answers.

Sometimes, he does come in and type first , does exam and goes back to typing.

I have never once felt put off by his working on the computer.

It is just hard for you guys I think.

He is the only doctor I have been to that does that.

I agree with your office is probably best for you to do it that way. Although... with today's job market...I am sure there would be a gazillion people wanting to do your typing. :)

I always wonder if they actually interview medical staff when they write these software programs because of the capabilities that are omitted that are important.

The independent Urologist seems to really like going electronic. See his older posts when he was setting up his practice. Also...there is another urologist who has frequented his blog and urostream, PPMD (hilarious)who LOVES and seems to live for this technology! He proudly explains all the perks and ways he has integrated these things into his practice...right down to pharmacy ordering. I believe he said his office is paperless.. not a 100% sure on this. i believe he commented that if his office was burning down across the street..that he could run his practice from his laptop. Something to that effect. and you probably already have the capability to order tests and check the hospital etc, from your laptop.

It's all so amazing and yet complicated.

Me.? I admit I am an old fashioned girl and can't help but to want a hard copy back up but that is becoming so passe. :)
I wrote something really long and deciding if should add it. If I do you can always delete it. :)

SeaSpray said...

One more thing and you probably know this. I read somewhere in the medblogs that the physician who LISTENS to his patients ...has the best chance of fending off lawsuits.

I don't recall why but guess it is because docs are less likely to miss something important to the diagnostic processes.

Then again... admittedly ...brevity with words is not my strong suit... so I am the patient you need to reign in a bit. :)

Using the motion of pulling back on the reigns, I reminded my orthopeadic doc once that he may need to "reign me in" a bit if I got off track and he laughed out loud... probably because he knew it was true. :)

So... I have great respect for ALL that doctors have to juggle. And they say men aren't good multi-taskers? Maybe with house chores... certainly not in medicine. :)

SeaSpray said...

Throckmorton, that other part of the post I wrote is so ridiculously long that I will put it up later in my blog as a post.

I basically just expressed my frustration with what I believe to be excessive documentation - things that prevent one regardless of what part of the patient process you work in... that hinder just doing the most IMPORTANT part of the job - helping the PATIENT.

I think Expediency in this process will become an archaic word of the past...replaced with the word REDUNDANCY!

Employer to potential new hire: "Are you proficient with redundancy? Yes? You're hired!" ;)