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  • EHR to become Mandatory

    The Economic Stimulus Package includes penalties if you don't have an EHR although we still have a few years to go.
    Bigdoc

  • #2
    The one hospital I work at has EMR- it took 45 minutes to write a progress note. They say I'll get faster once I get used to it.

    I remember when writers condemned the word processor- they felt that books written on a computer would lose the nuances of one written in pen and contemplated in pen. I feel the same way about EMR generated progress notes. But we shall see.
    HOT

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    • #3
      I do seem to be wired differently in the different modalities. Writing I can formulate. I can create diagnoses and plans. Dictating I must concentrate so hard on my words and including everything that I can't seem to formulate.

      New studies are finally addressing the issues of mistakes made on EMRs (sometimes in multiple). This notion that EMRs would eliminate error is absurd. Humans are still involved and so error still occurs.

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      • #4
        Well the errors and all are for every one to easily read! No confusion as to how to decipher the handwriting! It is a myth to think that we will not make mistakes, but EMR is expected to reduce the mistakes by misreading. If a patient claims allergy to Penicillin, this will stay for ever in the EMR. Though after questioning the patient you determine that the patient is not really allergic but had a side effect such as loose BM etc... Or in some cases, the parent of the patient told them that they are allergic to Penicillin. What I mean is that once an error creeps into the system it is impossible to get rid of it or correct it. Similar to your credit report. An error in it is not easily fixed!

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        • #5
          According to AMNews last month, only 1.5% of US hospitals currently have EHR. Our hospital is a shining example of one that does not, even though it just won an award for top 24 "most wired" rural hospitals in the US! What is lacking, in most cases is: order writing, progress notes, H & P, Op notes, Discharge, etc. Essentially, anything "physicians-generated". Apparently this upgrade is discouraged in most hospitals due to 1) concern re: physician frustration in the older, Luddite crowd, and 2) cost to upgrade.

          Stay tuned. This transition is going to be VERY painful!!!

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          • #6
            EHR is the only way Big Brother can keep you on a leash
            Bigdoc

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            • #7
              It is interesting that "they" keep on harping that only 17% of primary care doctors have EHR when a lesser percentage of hospitals do.

              Comment


              • #8
                Originally posted by Mac1 View Post
                Well the errors and all are for every one to easily read! No confusion as to how to decipher the handwriting! It is a myth to think that we will not make mistakes, but EMR is expected to reduce the mistakes by misreading. If a patient claims allergy to Penicillin, this will stay for ever in the EMR. Though after questioning the patient you determine that the patient is not really allergic but had a side effect such as loose BM etc... Or in some cases, the parent of the patient told them that they are allergic to Penicillin. What I mean is that once an error creeps into the system it is impossible to get rid of it or correct it. Similar to your credit report. An error in it is not easily fixed!
                Our EHR allows for both structured and unstructured annotation of allergies and problems. That way you can enter an allergy or an intolerance with an explanation; when you are alerted during ordering the annotations display with the warning. Best of all worlds - Mrs Smith doesn't ever want a beta blocker again cause it made pickles taste funny - you can get it on the list, explain why and at the same time get information that will allow you to use a beta blocker if life saving. An audit trail is maintained and available for all users so it is quite easy to edit allergies and problems (and see who did it) - if you want to do the right thing.

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                • #9
                  Originally posted by BigDoc View Post
                  EHR is the only way Big Brother can keep you on a leash
                  Ha! that's a good one!

                  The leash is called reimbursement, also known as Accounts Receivable!

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                  • #10
                    Originally posted by Phillip View Post

                    Stay tuned. This transition is going to be VERY painful!!!
                    I just got lobbied by our hospitalists - they are complaining quite loudly that they are much more inefficient in our long term care facility because we don't have the hospital EMR available there. Just had a conversation with our vascular surgeon - really likes EMR. Most of the staff = "I would never go back to paper".

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                    • #11
                      Originally posted by Kursk View Post
                      I just got lobbied by our hospitalists - they are complaining quite loudly that they are much more inefficient in our long term care facility because we don't have the hospital EMR available there. Just had a conversation with our vascular surgeon - really likes EMR. Most of the staff = "I would never go back to paper".
                      Do you dictate the free text fields, type, or drop down lists?
                      Which EHR is this if you dot mind me asking?
                      Bigdoc

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                      • #12
                        Originally posted by BigDoc View Post
                        Do you dictate the free text fields, type, or drop down lists?
                        Which EHR is this if you dot mind me asking?
                        All of the above.
                        Dictation policy - dictate anything you have dictated in past if you want (H&P, op notes, consults). Progress notes have to be done with EHR tools (free text type, user customizable templates with drop downs, documentation links that bring in structured data like vital signs when the template opens, combo, your choice). Some small VR pilots - less than 1/2 that try use VR consistently or extensively.

                        Without trying to force a reduction in dictation by policy, our hospitalists voluntarily decreased use of the dictation service. They still use it for complex H&P but for the most part they have almost completely migrated to customized templates and free text typing. I think I have convinced administration to be happy with this result and avoided a 'ban' on dictation which would be counterproductive.

                        To me the success and happiness of this group of very busy clinicians that see a wide variety of problems is the most potent argument I can offer in support of EHR. It was a major transition and it took them several months - but in the end they will tell you that they would never go back to paper.

                        Comment


                        • #13
                          >>> It was a major transition and it took them several months - but in the end they will tell you that they would never go back to paper.

                          The average rate of EMR installation failure is about 50%. Many of those physicians do go back to paper, or at least to a more primitive EMR.

                          In one study, 19% admitted to a past deinstallation or to a current process of deinstalling an EMR. Of those, 8% went back to paper. As HITECH tries to force docs into EMR, you'll see both the number of deinstallations rise as well as the number of those going back to paper. This happened in Phoenix, AZ when doctors were forced into EMR later ended up ripping them out.

                          The best way to successfully have an EMR rollout is to offer inexpensive, functional, easy-to-use systems that doctors really WANT to use. Forcing a horse to drink will never work...

                          Al

                          Comment


                          • #14
                            Originally posted by alborg View Post
                            The best way to successfully have an EMR rollout is to offer inexpensive, functional, easy-to-use systems that doctors really WANT to use. Forcing a horse to drink will never work...

                            Al
                            Uncle Sam ain't gonna do that
                            Bigdoc

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                            • #15
                              Ahhh... but BigDoc, Uncle Sam can be forced to listen to our needs. Remember big government is there for us, not vice versa.

                              Cases in point:
                              1) CCHIT was wrong, and last year after much bashing from various blogs the HHS finally "saw the light" and distanced itself from its multimillion dollar relationship with CCHIT.
                              2) In 2007 then President Bush tried to force his version of HITECH on physicians; it got enacted, but at the same time defunded... i.e. it was DOA.
                              3) In 2009 Assemblyman Conaway of NJ wanted to ban non-CCHIT EMRs from his state. The law got shelved after it was disclosed that he took payouts and actively participated in HIMSS events.
                              4) On 12/2009 the CDC came out with it's HIT data- after almost a year, HITECH has only convinced 6.3% of physicians to get ready to do "meaningful use" to get the promised $44000.00 per physician grant.
                              5) Come to the present day- last year I published my calculations that EHR "meaningful use" was going to cost conservatively upwards of $60000.00 per physician per year, dwarfting the $44000.00 grant for full HITECH participatioin. I was told through the grapevine that this and other reports of EHRs NOT saving money, NOT decreasing errors (and actually adding new errors), and EHRs NOT increasing quality got up to the likes of Congressman Pete Stark. I'm currently in the process of setting up an interview with my local Congressman who is interested...

                              All of these small wins were partly due to blogging activities... you can see more in the "Carousel of Progress" in detail.

                              It's just a matter of all of us becoming more active in politics for not only what is best for ourselves (self-survival), but also for what is best for our patients and for the future of healthcare. We're the ones that know best what needs to be done, not President Obama's golf partner and HIT consultant, Glen Tullman (CEO of Alscripts) nor the 5 other HIT lobbyists that surround him.

                              Since 2004, in my more than 5000 blogs throughout the 'net, my target audience wasn't those brainless politicians in power- it was the 780000 physicians out there. It is WE who are "Uncle Sam." If we don't play along with the increasing bureaucracy en block, then these poorly thought out mandates will die out... it just takes time, patience, preserverance with an active presence in websites s.a. docsboard. We all need to fight, and if we do, these politicians will eventually have to listen. They are supposed to represent us, not HIMSS and other quid quo pro lobbyist groups.

                              Al

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