ED Physician Executive Slams EHRs

Scott Mace, for HealthLeaders Media , January 28, 2014

"People often say, what can we do to get physicians to listen to their patients for longer? Actually, the question is, why does the average physician interrupt his patient after only 18 seconds? Because most of the information they're providing is not necessary."

Medical Record Documentation 'Primarily for Billing'
In his work with 2,000 emergency physicians, Tom has observed that the emergency physician looking at a patient's chief complaint knows 95 percent of the time, within 5 to 10 seconds, "what he is going to do with that patient. The rest of the time is going back and putting in place the documentation and studies that are required for him to do what he actually knew he wanted to do in the first ten seconds."

According to Tom, "medical record documentation is primarily for billing and to have a record in the rare event that there's a risk case." Doctors didn't insist on all this documentation, he says. "We didn't put them in place. The federal government did, and every insurance company copies them."

Fear of litigation is the real driver for all this documentation, Tom insists. But for an emergency physician, the chances of being sued are one in 25,000 cases, he says. "You might not be so willing to spend the time that it takes [documenting] for something that's a pretty rare event," he continued.

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8 comments on "ED Physician Executive Slams EHRs"

Dr. Cynic (2/7/2014 at 11:07 AM)
It is absolutely clear that electronic health records are good for medicine. 1. They eliminate the horrendous variability in handwriting as an obstacle to reading old notes. 2. They make it very easy to look up old labs, imaging, and notes by subject or date of service instead of wading through piles of paper. Now, which EHR is another question. The field is littered with products from the outstanding ED-Pulsecheck EHR, to the below average Meditech, to the absolutely horrendous Cerner. The problem is not that EHRs are bad, but that people who don't understand IT or medical practice are making these decisions for large organizations which then see suboptimal results.

steve jacobs (1/31/2014 at 4:39 PM)
I'm afraid that the speaker is looking at a conventional EHR as used in most hospitals. The reality for me at Kaiser Permanente is much different. We're using Epic like everyone else, but we're a complete group[INVALID] Inpatient and outpatient docs, labs, xr, etc. How would the speaker like to have instant access to the outpatient ecg done 2 wks ago when he sees a chest pain patient at 2AM? The problem isn't EHRs per se but rather the lack of interconnection. I can see all of my patients' records, even when they're admitted at tertiary centers far away. I can see all the labs, consults, etc. As for usability, Kaiser spent a lot of money and time customizing EPIC for each specialty. So at least for me as a pediatrician, it is far quicker than using paper. And readable. If you are practicing in a hospital ED with no data connections to the referring docs then his point about the documentation being primarily for billing has some merit. But if somehow EHRs can interconnect, then they will really show their promise.

Anne Creamer (1/31/2014 at 2:02 PM)
@cascadia, I don't understand your point. What was the physician's specialty? Did he have any training in workflow, documentation, user interface and functionality issues? And Dr, Geraci, your assumption that "an ideal product for Family Medicine would easily satisfy ER use" is not true. The ER needs documentation structure for all specialties, since we see it all. Do you have the need to document on OB/GYN, trauma, peds, psych, urology, just to name a few? The attendings and residents of all those specialties work in the ER on a regular basis and they need their specialty-specific terminologies and order sets in the ER module. That's what makes the ER unique among all the EHR modules: we need to be able to document for the universe of medical specialties. Therefore, it is very difficult to retrofit an outpatient system, or any other specialty unit for the ER; the ER needs to develop its own module and this needs to be done by ER doctors and nurses who understand its workflow and have at least a basic understanding of database design issues.




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