<p>When I go to the emergency room, I’m going to be glad that they have my electronic health records.</p>
<p>Doctors are going to have to do paperwork, whether electronic or handwritten. Having to do paperwork is not something new. </p>
<p>
Do I believe this? Wait, no, not for one tiny millisecond. Cite? I would believe that at some particular hospital, when some particular software had just been introduced, doctors took a while to get used to it. It takes time to get used to a new piece of software. But that ER docs in general now are half as fast as they used to be? Hahahahaha.</p>
<p>The pen hasn’t been used in decades. Before EMR, doctors just dictate and medical transcribers type it all out. Now the doctor has to input every single word describing your visit, your complaints, drugs prescribed and any other issues that were discussed in the visit. It is very complete because of legal issues. They also have to input specifically item correctly or payments are not issued. For a 15 minute appt, the doctor spends 5-10 minutes on EMR. Is this the best use of his time? I don’t know where you live, but when I call to make an appt,the next appt is on average one month’s wait. No wonder the ER or urgent care clinics are swamped.</p>
<p>I’ve been to see younger doctors now who come in the room not to check me out, but goes directly to the computer and starts typing away. On a few visits, the doctor never touched me. Among my friends, we are always joking about the “no touch” medical visits. One friend even said she had a “no touch” physical exam. Is this the type of care you want?</p>
<p>Cbreeze, they took notes during the OV. They didn’t record something while examining you, nor try to retain it all in memory, til they got back to their dictaphones. </p>
<p>“In the past, the numbers often quoted were 2.3 to 2.8 patients per hour. We are now living the new reality of patient complexity, acuity, customer service expectations, skilled workforce shortages, crowding, boarders, and risk management,” he said. “To the extent that a range can be established, it would be 1.8 to 2.8 patients per provider per hour.”
That was dated 2009. Again, lots you can look at that offers current info about how staffing, time of day, demand and complexity affect patients per hour. </p>
<p>Again, note it was Bush who started pushing this, in 2004.</p>
<p>The ACA paid tons of money to doctors for EMR. The ACA has also changed Medicare reimbursements. Now, if a antediluvian doctor doesn’t use EMR, they get something like 95% of the reimbursement of normal doctors who use modern recordkeeping.</p>
<p>I’m not going to shed a tear for doctors who “have to input specific items correctly or payments are not issued.” Isn’t this the same for everyone else who uses a computer for business- they’re expected to do it right?</p>
<p>My doctors have been using electronic records for a while now. It’s great. Now I can see my records and test results myself when I log in to their system. I can look back on all my appointments, see what I was seen for, see what my weight was each time.</p>
<p>“Before EMR, doctors just dictate and medical transcribers type it all out. Now the doctor has to input every single word.” Oh my goodness gracious, doctors actually have to use keyboards like every other professional? No wonder there is a generational divide here. The older stodgy doctors are saying “What? I have to put my precious medical-school-trained fingers on a keyboard?” and the just now being trained young doctors are saying “Of course we have to input the data into the computer. I wonder if there’s a way I can use my phone instead of a keyboard.”</p>
<p>Just received a letter from our internist for the past 15 years. As of July 1 he is converting his practice to a premium care model (concierge). He is charging between two and two and a half thousand dollars a year per patient. He is an excellent doctor so I guess I shouldn’t be surprised. </p>
<p>I’d say that was his decision, under his control, made by him, for his own reasons. Add that to your premium costs, deductible and etc. And complain to that doctor. If you choose to remain with him, it’s your decision, based on his his conditions for service. </p>
<p>CF, if you wish your doctor to be spending time typing several pages per patient instead of using the time to see patients, no wonder you promote inefficiency. As I said, if you have an acute problem with severe pain and discomfort, I’d like to see you be told, “There will be a long wait, your doctor is typing.”</p>
<p>So how do concierge doctors do record-keeping? And let’s say I go to a concierge doctor who refers me to a specialist in my insurance network. How will my records transfer, so that the specialist can follow up my care?</p>
<p>Frankly I find it sad that most of the physicians in the links above talk about the EMR in terms of its inconvenience to them. The physicians I have a lot of sympathy for are the docs who complain they can’t spend as much time talking to their patients. The fact is, however, that they could if they chose to. </p>
<p>As most have pointed out, the Electronic Medical Record pre-dated ACA. I know several large organizations which started implementing or preparing for implementation as early as 1992. </p>
<p>But in any case if so many docs are against it, the question you need to ask is, why are people moving to the EMR? There are many reasons, but here’s a few: </p>
<p>People used to laugh about doctors’ handwriting. Do you realize how many people died because of that handwriting? A nationally known healthcare guy was telling me that he was involved in one med mal trial where the doctor on the stand had to admit he had no idea what his own handwritten discharge instructions said, or even when the patient was discharged. </p>
<p>Pharmaceutical interactions killed thousands of people every year. The EMR flags those, as well as patient allergies. Before the EMR, you had to rely on the doc remembering what else you were taking and what you were allergic to; or on the pharmacist to flag the fact that a patient on X drug would sustain injury if they also took Y drug. </p>
<p>I’ll mention one last significant benefit. With the computerized record, physicians and hospitals are working together to analyze data. If a researcher is trying to monitor or identify trends, you just can’t deal with reading through thousands of handwritten notes. </p>
<p>The EMR will significantly reduce medical errors and allow us to improve care. I appreciate the dislocation to physicians, particularly older but excellent practitioners. But I’m afraid I think it’s worth it. </p>
<p>Warning CF: “whining” doctors will appear in the following…</p>
<p>Results of a survey of 100,000 physicians…a white paper on the effects of the aca…by Merritt Hawkins - a physician placement service :</p>
<p>
[quote]
Key findings of the survey include:
The majority of physicians responded unfavorably to passage of health reform.
2)The majority of physicians believe health reform will increase their patient loads while
decreasing the financial viability of their practices.
3)The majority of physicians plan to alter their practices patterns in ways that will reduce
patient access to their practices, by retiring, working part-time or taking other steps.
4)Physician practice styles will be increasingly less homogenous. The full-time, independent
practitioner accepting third party payment will largely be supplanted by employed,
part-time, locum tenens, and concierge practitioners. </p>
<p>We are moving toward a more corporate structure for healthcare. It seems like there will be less competition. The model support the Sutter Health approach - large providers taking over an area and having a monopoly. Hospitals buying dr. practices and eliminating independents. </p>
<p>cbreeze, I would say If you want your doctor to dictate some text, instead of producing useful records that can be searched, cross-referenced and related to the other care given to this patient and others, then no wonder you promote inefficiency. I would say that, except can we stop with the insults and agree that we both want to promote efficiency and we disagree on how to do it?</p>
<p>Doctors are not producing pages of text. If they were, they could continue to use dictation. Rather, they are filling out online forms. Online forms can be poorly designed, and they can be annoying, but there’s a reason that you fill out some online forms when you order from Amazon instead of writing a letter, and the reason is, it’s easier for you and it’s easier for Amazon. </p>
<p>dietz, doctors say they don’t like the ACA, and they make various predictions that may or may not be right. And I should care because why?</p>
<p>Doctors are always saying they’re going to retire. And then they don’t. That prediction is one I don’t believe. Doctors like being doctors, no matter their whining. They like the job, they like the prestige, they like the money.</p>
<p>CF; Did you read any of the 116 pages? The statements are support by the other 114 pages of information. This is predictive, it is what is happening. I may not want to believe in the effects of gravity…but it has it’s effect anyway. My ‘belief’ doesn’t alter it’s effect.</p>
<p>CF, since when are you an expert on electronic medical recordkeeping? If this is similar to your knowledge of the individual market in Ca prior to Obamacare, I would be very skeptical.</p>
<p>I am suppose to believe you, whose only hands-on experience with the system is googling the internet as opposed to my doctor who is dealing with this day in and day out.</p>
<p>I believe the doctors said what they said. I just have little interest in a survey of doctors, and little belief in the accuracy of their predictions about the health business.</p>
<p>LOL!!! Your right CF!! What possible value could a survey of doctors have in this area. It is the newly insured and those who feel morally knighted in their support who should be surveyed. That is all that matters.</p>
<p>But I can see you point…I feel the same way about those danged whining teachers…I don’t care about their complaints either! If you don’t like your 4 months vacation, your pensions, your free trainings, your status…then just quit. We can save communal $$$ by not gathering your input. After all WTH would you know and why would we care. Yup, got it. </p>
<p>Of course, we could ask: since when is GP some expert? We are equally skeptical about his experiences being representative. </p>
<p>And the 116 pages date to 2010 and uses the term “likely.” And states it is “initial.” I’d like to see something more current that explains recent experiences. Plus, they didn’t even contact 100,000, not even close. And got 2400 responses. So, let’s see if this dissatisfaction (and the reasons claimed) still hold. Eh? Watch for calling someone pompous when the post implied a greater indicator than the report presents.</p>
<p>And for heaven’s sake, someone is complaining electronic records input takes more time than handwritten? So much your doc can’t see you? As if they didn’t have to stop and record in the past? Who here has seen the faces of these screens, besides me? </p>
<p>Teachers, btw, are increasingly being steered toward electronic records- some do daily reports for kids. </p>
sorry…tha’st pompous. Especially reading ‘them’ the riot act about electronic records. And declaring never, NEVER wanting to hear any docs whining.Check that particular paper and you’ll find it addresses the concerns SOME physicians have about electronic records. The concerns differ based on the size of the practice.</p>
<p>The second article to which I linked was from last month - so quite recent. It references the white paper and highlights both the pros (doc as part of hospitals might bring down certain costs) and the cons (shortages and increased costs possible in the near term). Either way, both sources point to a trend away from smaller physicians practices to larger conglomerates. And from personal experience with Sutter - one of the prime examples of eating up small practices, squelching competition and increasing prices - it makes for a less balanced market.</p>
<p>I had my annual visit with the PCP yesterday. So, yes, this is an anecdote. He’s been in practice since the 70’s. Very knowledgeable dude, name known on certain lecture circuits. He loves his electronic records but frankly he’s the only one of my docs who’s figured out how to use them to his advantage. Actually reviews before visit so he remembers what happened in the past. I had to wait for some X-Ray results and his next appointment had cancelled so I had the rare opportunity to chat. Giving a line item account of the bullet points we addressed would just lead to another nuuuu uhhhhh…your wrong…that’s stupid…I don’t care/believe etc…he should quit…I’ll simply say…it will not be business as usual for small, by today’s standard, practice.</p>
<p>
No, really? I hadn’t gotten that vibe from this thread at all (okay sarcasm off). There are a majority of participants that would jump on GP if he posted an article showing that gravity has an effect on life on earth. They’d declare the source invalid, the personal experiences a non issue and then cue the violins.</p>
<p>The paper says they had a response rate of 2.4% to their survey. That’s too small to make any conclusions. So we can stop right there and ignore the whole thing.</p>
<p>But if we want some humor, we can look at their predictions and laugh. Among the predictions that we should dismiss with a giggle: “The Survey of Physicians and Health Reform included in this White Paper indicates that 16% of physicians plan to switch to a concierge practice in the next one to three years.” Yeah, right. The survey was in 2010. It’s 2014 now, and the one to three years have passed. Time’s up. Are 16% of doctors in concierge practices? Bzzzt, no, but thank you for playing.</p>