ED Physician Executive Slams EHRs

Scott Mace, for HealthLeaders Media , January 28, 2014

"That would be it," Tom says. "Now people have developed a system that greatly improves my lifestyle, still has all the documentation, actually improves my ability to communicate with everyone else, and actually allows me to spend more time with patients or seeing more patients or doing the things I need to do, versus going to some fixed station where I have to put in a lot of unnecessary data, except for the fact that I have to bill out."

Too Busy to Innovate
CEP America already uses scribes to try to improve physician productivity. The company bills hospitals for its physicians' services, but must eat the cost of the scribes itself, Tom said. "If we can develop systems that allow us to somehow circumvent our need to put in place all this documentation, that's the type of systems that we're looking for," he said.

I did say Tom is a self-avowed optimist. "I don't mean to sound pessimistic," he told the HIMSS chapter. "What I mean to do is provide you with some understanding of why things have taken the length of time that they've taken in the healthcare industry… every physician, every person, every citizen, is in favor of us being able to extract information [in a short period of time]."

As Tom points out, the changes brought about by healthcare information technology can be threatening. Vendors with little knowledge of what physicians actually do can bring ill-advised solutions to healthcare. Busy clinicians simply may be too busy, or too set in their ways, to explore innovation.

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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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