Many Older Physicians May Just Say "No" to EMR
Unhappy Camper (Vol. 1, Issue 4)
By now most of you know that while I have embraced EMR, I remain unconvinced of many, if not most, of the claims as to how EMR improves the quality of medical care. Today, I worry about those many, many physicians that will fail to adapt to the coming change.
Most attention to this issue so far has been has focused solely on the timing of a ROI on EMR considerations for older physicians (see http://www.ihealthbeat.org/articles/2010/8/16/physicians-approaching-retirement-weigh-pros-cons-of-adopting-ehrs.aspx). But for many others the concept of becoming disoriented in the EMR documentation of medical care is too daunting a prospect to undertake.
Most of our ‘physician champions’ of EMR are all very well versed in computer use, and they may give too-brief consideration to many hapless physicians that have practiced good medicine for years but who remain computer-phobic. These physicians have often adopted cutting edge technology within their medical and/or surgical roles, yet they preferred not to computerize their medical records—until forced to do so now. Our overzealous physician champions might ask, “What’s the difference in using medical technology and EMR technology?” Well, medical technology is used by highly skilled physicians in complex human disease cases, whereas EMR works to capture payment and meaningful use data for digestion by the bureaucracies. It’s the surgeon using a gamma knife to skillfully cut away a cancerous tumor versus a computerized data-collecting EMR. It’s apples to oranges.
While our physician champions were still playing Mario Brothers in their bedrooms, many skilled physicians eschewed computers, e-mail, the Internet, and video games to play in the real world rather than the virtual. Something so mind-numbing as computerized billing was left to the office staff, so these doctors never needed to learn computers. They dictated their op notes into a Dictaphone, or nowadays Dragon Naturally Speaking, but they really never wanted or needed to get into the guts of database operations such as used in an EMR. And these same highly-sophisticated doctors may become quickly overwhelmed by the disorientation of adopting EMR in their offices. As much as our physician champions would have you believe that learning EMR is as simple as learning to send off an e-mail, it’s not. My practice been doing this for over three years and we’re still disoriented on occasion.
So what are the options for a doctor in the retirement red zone? Perhaps the best choice is to get a new, younger partner than can gradually ease the practice into utilizing EMR. But for many of these physicians, they’d really rather spend their time golfing, teaching their grandchildren to play catch, or enjoying a well earned retirement life rather than entering the virtual gloom of EMR.
Some may choose to pay and train a medical assistant as an EMR scribe, but available training in EMR use is costly and not readily available in nearby places like community colleges. Without such training the trusted medical assistant will likely be as disoriented in EMR use as the physician. And it is the critical EMR adoption period were horrible mistakes in EMR use will likely take place. If and when the EMR trained medical assistant/scribe completes their training they instantly become a valuable commodity, who can just as easily jump ship to another employer who would more willingly pay the outrageous salary they will now command. This leaves the soon to retire doctor the choice to start the whole process again, or to simply pull the plug on their practice.
For these physicians there may not be any practical choice they can make. They have paid their dues, and are proud of their contributions made over many years of their career to the health of their patients. They don’t need or deserve this aggravation. They will instead await the phase-in of the penalties for not adopting EMR under ‘ObamaCare’, and quickly retire. In droves. Soon. Real soon. And I don’t really know how well the American health care system will function without them.
Whenever there is a new requirement, my first thought is how I can customize the EMR to accomplish it in an automated, efficient manner. Our aim is to always have the providers focus on patient care. We set up templates for most things and monitor for appropriate use so we are documenting appropriately. There are also billing/coding links, and admin support/reporting to accomplish the administrative work behind the scenes. I agree that a lot of this can be distracting, but I hope that many will look to utilize the technology to streamline their work rather than add to it.
Using an EHR? Yes - eClinicalWorks
Disclosure: Owner/practicing partner of Aquidneck Medical Associates, Inc. Contracted as the Case Management Physician Advisor at Newport Hospital (a Lifespan affiliate) and as an advisor for BCBS of RI to help facilitate HIT integration in community practices
I'm an old guy, but I enjoy computers as long as they are of use to me. And there's part of the problem.
The government expects two things. First, that I will use an EHR. OK, might be useful, I'll give it a try. Second, that I will demonstrate to the relevant bureaucracy that I am using an EHR. Not fun, not the practice of medicine, makes my heart sink just to think of it, not going to try.
I know this because I am using an e-prescribing program, which has been useful and well worth the cost in money and learning time. But I can never remember to enter the special billing codes on Medicare patients that would allow me to collect the little bonus (or avoid the little punishments to come).
Using an EHR? No