<p>Flossy, where do you get that? Actually, what do you mean? </p>
<p><a href=“Why Doctors Don’t Like Electronic Health Records – The Health Care Blog”>http://thehealthcareblog.com/blog/2011/10/07/why-doctors-dont-like-electronic-health-records/</a></p>
<p>Try this.</p>
<p>Edit to add - There’s also this thing called “meaningful use”. Last I checked all the rules had not been written, yet. But, I would bet the time stamps are part of it. It affects reimbursements.</p>
<p>So it is ok to hand write, during the OV or later, that doesn’t interrupt patient interaction and you can look a piece of paper “in the eye?” Apples and oranges. This is about appropriate record-keeping, which is part of a doctor’s responsibilities, like it or not. Student training includes the face to face, the oral summaries and the written documentation. He quotes some guy who doesn’t look at EHR? What, he’ll only read what’s hand written or he counts on a patient to remember all the details, in medical jargon and shorthand? Silly. </p>
<p>The article first dates to 2011 and he is a retired pathologist who blogs. We already know how use of EHR has increased over the past few years.</p>
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<p>“Meaningful use” is simple. It means that the practice can’t just HAVE the record system; that would be meaningless symbolism. They have to use it. </p>
<p>Now, there may be some required reports in order to demonstrate “meaningful use.” The practice has to demonstrate that when patients come in for visits, their information is recorded in the system, not chiseled into stone slabs, and so forth. But those reports are either going to be generated automatically (if the software is good) or some database administrator is going to print them. </p>
<p>Doctors seeing patients are not database administrators, so their job is merely to put the information from the patient visit into the system.</p>
<p>Flossy, according to the link you posted, doctors have been dragging their feet about EHRs since long before ACA came into being: </p>
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<p>LasMa, I have no idea what point you are trying to make. Actually, I am not trying to make any point about EHR.except to explain that most doctors are likely not luddites who can’t type. So, the government passed an order 10 years ago and the system still sucks. So what?</p>
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“may” doesn’t belong anywhere in that sentence, Fang.</p>
<p>When I posted that link (thanks for the attribution, btw) I also pointed out that time wasted being led around by the regulatory nose ring is time spent not being a doctor. The writer of the op/ed that kicked off this conversation stated he lost 2 hours of his day, which would be a pretty substantial drag on the healthcare system as a whole if he’s typical. </p>
<p>I’ll repeat: anyone that can read through that link (and the ones embedded in it) and still defend it as a good thing has the soul of a apparatchik.</p>
<p>I think a number of you folks have no idea what docs have been responsible for reporting, for as long as we personally can look back. The estimate is that 60-70% are currently using EHR, that small practices are growing at the fastest rate. This argument is just not productive. </p>
<p>Flossy, the point is that you posted that link on a thread about ACA. I’m pointing out that this problem was not brought on by ACA. </p>
<p>It is a problem for sure, though. Toward the end of the article, the author says that what’s needed is some software that’s developed by doctors, from the ground up. That makes sense to me. But again, it’s not an ACA issue, so I’m not sure why it’s on an ACA thread</p>
<p>First, I didn’t bring it up. Second, to participate in Obamacare a practice is required to use the EHR system. That’s probably why it’s here. But, it’s not my issue. We agree, it’s a problem. One of many. None of which you think were caused by ACA. I get it. I really do. Yup.</p>
<p>^ No wonder some are confused. As of January 1, 2014, all public and private healthcare providers and other eligible professionals (EP) must have adopted and demonstrated “meaningful use” of electronic medical records (EMR) in order to maintain their existing Medicaid and Medicare reimbursement levels.</p>
<p>Not “to participate.”</p>
<p>And I caution everyone not to jump to conclusions based on what was what two years ago or what one guy insists. Of course that includes a retired pathologist blogger. In the electronic info age, things change fast.</p>
<p>What is the distinction between participate and get reimbursed? Just curious.</p>
<p>I sincerely hope you know the difference between “to participate” and “in order to maintain their existing Medicaid and Medicare reimbursement levels.”</p>
<p>And that folks can distinguish between a blog or a conversation and a study. Or how relevant- or not- something from two years ago may be.</p>
<p>That’s why I’ve long thought a big part of this thread is nothing more than venting: “I think it so it must be true.” Its newest family member: “I can post it, so it must be so.”</p>
<p>Well, I suppose they could participate without getting paid. But who would do that?</p>
<p>Funny, eh? “without getting paid” versus “maintain their existing Medicaid and Medicare reimbursement levels.”</p>
<p>Flossy, please show me where I said there are no problems with ACA. OTOH many people are blaming every problem with modern medicine on ACA, whether it’s related or not.</p>
<p>The retired pathologist says “EHRs won’t be useful and physician-friendly until physicians themselves have more input into their design.” Well, why don’t physicians have input into their design? EHR systems are products developed and sold by the private marketplace. It’s been ten years since Bush started the ball rolling requiring them. In that time, not one person has prevented a bunch of doctors from getting together with a bunch of programmers and coming up with a system they liked. If they want input, why don’t they provide input ?</p>
<p>“You cannot look a computer in the eye. You cannot read its body language. You cannot talk to an algorithm. You cannot sympathize or empathize with it.” But apparently you can do all those things with a piece of paper.</p>
<p>They are involved. The med organizations are involved- etc. It’s just something the older, retired pathologist didn’t realize, back in 2011. </p>
<p>My internist, who is my primary doctor and whom I see four times a year due to a chronic condition, has been grumbling about EHR for about 7 or 8 years, ever since his practice group began switching over to this form of recordkeeping (long before the ACA, mind you). They did it for efficiency reasons–and because the insurance companies were demanding it so they could process claims more efficiently and more accurately. It probably does still take my doc longer to enter the data electronically than it took him to jot down a few notes longhand or to dictate into a machine because the online interface is more demanding about the information he records at each visit. The trade-off is that he’s required to enter more information, less is left to human memory or lost in transcription, and as a consequence he has instant access to more complete records at the next visit; trends can be more easily (and almost costlessly) charted; the insurance company has instant access to more complete and more accurate information; his practice spends a lot less on clericals to record, maintain, retrieve, reproduce, and transfer paper files; other providers–like the surgeon who recently performed surgery on me and the hospital where the surgery was done–have instant access to my complete recent medical history; and my doc has instant access to lab results or other diagnostic tests or procedures performed outside his office. </p>
<p>In short, the information gains and transactional efficiencies overwhelm the inconvenience to my doc. I think he knows this, but he grumbles anyway, mostly because when he decided to become a doc he didn’t imagine it would involve as much data entry as it now does, and data entry seems beneath his dignity. And because before EHR what he did write down was mainly diagnoses and orders, not data; he was the kingpin calling the shots, not just a cog in a well-oiled machine (and a machine that can more easily second-guess him even on diagnoses and orders, based on the data). I can understand that as a professional he feels demeaned and degraded by these developments. But as a patient with substantial medical needs, I wouldn’t go back to the old system of casual paper records for anything.</p>
<p>And I can perfectly well understand why the federal government, as the primary insurer for virtually all older Americans and the insurer by default for the lowest-income Americans, would demand just the same kinds of electronic data that my private insurer began to demand long before the ACA was enacted. Efficiency, accuracy, and well-informed decisions are virtues in the public sector no less than in the private sector.</p>
<p>To attribute EHR to the ACA is nonsense–and I say this as both an avid fan of EHR and a lukewarm supporter of the ACA. To credit all of doctors’ grumbling about EHR without considering its countervailing benefits, and then to attribute all of that to the ACA, is (to quote Bentham) “nonsense on stilts.”</p>
<p>Excellent, bclintonk. I do think you nailed it about many doctors feeling that data entry is simply beneath them. That, plus resistance to change, probably accounts for most of the grumbling. </p>
<p>A generation from now, when most doctors will be millennials who will have grown up with computers, both docs and patients will have a hard time believing that medical records were ever kept by hand. </p>