<p>Himom, is that a function of the electronic record keeping being burdensome, or just resistance to change from an older physician who doesn’t like the prospect of converting to (and learning) a new system? </p>
<p>I would think that long term, electronic records will be much more efficient and reduce paperwork – but I can see that there could be a steep learning curve for many. But I am thinking that when your allergist talks about not being able to keep up with paperwork, she is thinking of double entering data: first in her paper records and then online. But I think the idea of electronic record keeping is that ultimately the paperwork gets eliminated-- as it is all handled electronically. No more waiting around for paperwork to arrive in the mail, no more xeroxing, etc.</p>
<p>My understanding is that the people who purchase EHR systems are not end-users and have no idea how to evaluate usability. EHR is ripe for a couple of new CS graduates to write a decent interface to sit on top of the terrible systems that exist. </p>
<p>Also, the different EHR systems can’t talk to each other (because it’s unheard-of for a patient to see one doctor and then be referred to a different doctor in a different practice?). This is again inexcusable, and there’s a nice opportunity for someone to write software to knit two systems together.</p>
<p>EHR should work. And it will work eventually. This is not a difficult technical problem.</p>
<p>I sat with my dad in his doctor’s office last year after surgery. Doctor was inputting info for appt., and basically said that based on Medicare rules and the code he should implement for that visit, he would not be compensated for the visit. It fell outside of window for when primary doc could see patient after surgery to bill Medicare. Not sure if he was confused or lying or somewhere in between, but he had no problem with filling out the online data. Just frustrated that he wasn’t getting paid for seeing a patient. Many docs might not have mentioned it, but he has a gruff bedside manner so I don’t think he realized how it sounded. </p>
<p>Some docs are better at jotting down notes while interacting with patients. This is double work, but really most docs do not get into field to input data, but to listen to patients and try to help them. It is not always that they are technophobes, either. It is hard to concentrate on a patient when looking at an ipad or computer screen at same time. </p>
<p>I find when I have a smartphone or iphone in hand, I am less attentive to the world around me. We become zombies.</p>
<p>I know I have to be careful when on ipad with clients that I do not zone out and stop listening. It is easy to do, even when writing notes and transcribing what they just said!</p>
<p>But doctors need to keep records, whether those records are on paper or in silicon. Are doctors less attentive looking at a screen than looking at a chart?</p>
<p>There should be no "paper"work. Doctors should have switched to electronic record keeping without being told to do so. Now whether that electronic data is compatible with EHR needs is another issue, but a practice still doing paper charts is just outdated.</p>
<p>Go take a document and start typing it into computer or ipad. Now, answer your phone at same time. </p>
<p>Are you just as efficient without making mistakes? I know I am not. When I am simply typing, I can do 75-85 words per minute. Not so, when doing multiple things at once. Your brain shifts between activities, and sometimes lags. </p>
<p>We all multi-task, but sometimes the efficiency of doing many things at the same time leads to errors. There are even studies that say women better at multi-tasking than men.</p>
<p>This can lead to errors in billing, notating the wrong meds or a host of other issues.</p>
<p>This study found good and bad - more typos, sometimes notating in wrong patient’s charts - but also reduced cognitive load making other things easier for docs.</p>
<p>AIUI, from talking to a doctor who is a close friend, the EMR system she has is a pain in the neck. There are multiple screens with redundant questions that she has to fill out every visit, such as “did you counsel the patient on smoking cessation” etc. She says she spends the visit looking at the dam computer instead of the patient. Of all the trials of practicing medicine, the EMR requirement was the one that almost pushed her over into early retirement.</p>
<p>What is your point? A doctor has to keep records. They have to either write things down on a piece of paper, or they have to enter things on a computer screen. So how is it different if a doctor answers the phone while entering data on a screen, than if a doctor answers the phone while writing something down on a piece of paper?</p>
<p>If it is more work to enter data on a screen than write on a piece of paper, that is a symptom that the interface is bad. For everyone else in the world, it’s easier to enter data on a screen.</p>
<p>Sryrstress, has the mom priced the cost of buying a policy for the baby in her state (either on exchange or off)? The premium might not be that high – kids are relatively cheap to insure. It might seem high to a young father whose own policy is heavily subsidized by his employer – but in term of actual out-of-pocket to the family it might really be affordable. At $42K per year, “affordable” would equate to $332/month. It may be that when you add a full cost premium for baby to the the dad’s costs, they will find they aren’t paying much more than that, given that the mom has a parent-subsidized policy. </p>
<p>Of course they will have to confront this issue again when the mom reaches age 26, but for now their situation may not be as difficult as it seems.</p>
<p>That’s the way I feel too. Are these doctors stuck in 1980? Why has this not happened already? How can they still be using pieces of paper? It’s as if they were chiseling my records in cuneiform. Come on, folks. Get those records online, and make them available to me on my smartphone.</p>
<p>As a former medical malpractice attorney, I still have nightmares about trying to read medical records. We had to hire nurses to read them. My d’s cardiologist records his notes after the visit in front of the patient, encouraging the patient to stop him if he hears something wrong. That means he hires someone to do the data input but he can well afford to do that.</p>
<p>The EMR issue may be a generational thing – I tend to be more comfortable using a keyboard to type notes from a phone conversation than handwriting (with the phone on speaker) – but prefer writing in a notebook when attending a meeting with a lot of give and take. I can listen and type at the same time, but I can’t talk and type. </p>
<p>But if I don’t later on enter my notes into the computer… they get lost. And no one else can read my handwriting. There are electronic dictation systems that a doctor can use to help with the transcription issues. My smart phone is pretty good at getting the words I dictate for text messages correct as long as I restrict my vocabulary for dictated messages – so I don’t think it’s at all difficult to program a voice-to-text system for doctors (which would recognize common medical terminology). </p>
<p>Somehow I don’t think that this will be a barrier at all for my daughter’s generation – (the ones who have grown up texting).</p>
<p>At some point, we’ll just have chips implanted in our brains and what we think will be transcribed. Those thoughts will of course have to be edited by a trusted source.</p>
<p>If EHR systems allowed doctors to just dictate the notes. Have them typed up and then scanned into an electronic system, they’d likely be fine with it. It’s the required fields that have to be clicked through each visit. The doc has to check off boxes before the next page loads before the record is complete. I don’t know if this is some govt requirement or just one crappy system. But this is the complaint I heard.</p>
<p>I had an emergency appt. with my gynecologist yesterday morning and called my internist’s office to let them know the afternoon before to send everything. All my tests and my internist’s notes were sent electronically to the other doctor. It was nice not having to go through step by step what the first doctor did or have to have the same tests repeated. He did ask me to describe my symptoms from onset and asked some questions, did and exams and two tests not done by the internist. He also came up with a preliminary diagnosis and it’s likely I will have to see a specialist. But the appt was so much easier and quicker since he had so much of my info already.</p>
<p>EHR systems are very expensive and designed by non physicians. What works for an internist may not work well for a surgeon or a floor nurse. That is why, from what I recall, more than 50% of the EHR expenditures are to replace existing systems. Also, if you practice at several hospitals, you have to learn multiple passwords, accounts, and systems. Doctors love the thought of working exclusively with EHRs. But the enthusiasm fizzles as soon as the “system is down”. We are a long way away from making it work.</p>