Monday, October 13, 2014

Why the Government Prejudice regarding Specialty Electronic Medical Records

The past decade saw the development of electronic medical records, both in number and level of sophistication During this decade there was a steep learning curve by vendors with frequent and arbitrary regulations regarding EHRs.

Successfully Choosing Your EMR: 15 Crucial Decisions 

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EHR development has been overly influenced not by it's functionality but by parameters of HHS and CMS in regard to data structure and interoperability.

The regulations included a mandate for interoperability and items called 'meaningful use'.. The term 'meaningful use' is a misnomer.  Meaningful use in their terms only had to do with it's utility in garnering information from an EMR which may or may not be useful for it's designed purpose.

The following statement from Ophthalmology Management specifies some items:

"Switching electronic medical records (EMR) systems is a big decision, even if you feel like throwing your existing system against a wall. So don't ditch your EMR system before you download the paper that includes an eight-question assessment to help you decide - and to protect you from making the same mistake twice.  (this statement is from Ophthalmology Management and is a quote from EMA, a specialty EHR for ophthalmology.)"

In many specialties there are fields and specific information unique to that specialty. Clinical work flow must be considered, since a poorly designed software can radically alter efficiency and disrupt the clinic volume and income. Numerous studies have revealed that efficiency can be reduced for several months by a factor of 20-30%.

Medical practices chose to accept incentive payments for consenting to meet meaningful use criteria with their EHR.  This occured by an angst of 'not being left behind' despite serious reservations and advice for HHS and ONCHIT. Several deadlines have been delayed and doubts remain about the implementation of MU Stage III.

Many medical practices have invested in EHRs. Some installations were obsolete at the time of purchase.

Some medical practices decide to purchase a new system despite the added costs, preferring to write off an older system with accelerated depreciation. These decisions are supported by a record of decreased patient volume.  Most physicians report an additional hour of work each day and a reduction in patient volume.

Many physicians have expressed their extreme unhappiness with their electronic health records. Management surveys continuously confirm dissatisfaction. Despite this, EHR use has grown.  Imagine using a defective hammer to drive in a nail. Regulators have taken their eyes "off the ball" ignoring patient care, and equating paperwork with 'quality of care'.  This has become a fundamental failure of the entire American health care system.  Poor patient care can easily be disguised if all the information which is entered is designed to thwart the 'required entries' to proceed, or satisfy an algorithm for a complete medical record.

There are several certifying standards, the most onerous are those mandated by CMS and regulated by  

Adding to this frustration is that many large organizations will select a vendor whose reputation has been built upon usability for primary care and/or internal medicine/pediatrics.  Population Health has become a new 'buzzword" in the HIT workspace.  A large or medium sized multispecialty group may select a system which their specialists can not use.  Interoperability has become a deserved design requirement.

When designing or selecting an EHR, every department must have input on decision making. Some IPAs and loosely organized primary care groups have offered to 'give' an EHR to their specialists t
o encourage acceptance of a group EMR.  This in many instances has been disastrous.

Their are other choices.

1. Utilize a specialty specific EHR based upon:

     User testimonials
     Site visits
     Demonstrated user functionality and efficiency in actual operations.

2. The requirement for interoperability are clearly defined by ONCHIT which should make disparate systems interoperable.

3. The realities however are quite different from a vendor point of view, leaving users holding the proverbial 'bag'.

Does your EHR need a tweak or a trashing?

How to tell if your system is already in need of a major goose.


Need an EHR plan?

Whether it’s your practice’s first foray into EHRs or your practice is upgrading to a new version of the software or a new system, the HealthIT.govwebsite provides ophthalmology practices valuable insight. This includes these six steps:
    1. Assess your practice readiness
    2. Plan your approach
    3. Select or upgrade to a certified EHR
    4. Conduct training and implement an EHR system
    5. Achieve Meaningful Use
    6. Continue quality improvement

On the website, each step is a link that users may click on for a detailed explanation.

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