Tuesday, July 28, 2009

Health Reform....is Health IT mandatory?

One of the greatest discoveries a man makes, one of his great surprises, is to find he can do what he was afraid he couldn't do.

Henry Ford


[Shades of the Past!


Jeff Marion of  EHR watch .com shares this commentary from Shahid Shah.

Guest Article: Why do Doctors Hate EMRs???

There is also an audio cast on the web site, for those who like to multi-task, listening and /or reading content.

Some interesting quotes regarding the appraisal of typical EMR software.

How do we know doctors hate EMRs? Look at anemic adoption rates.

When such features as e-prescribing, e-visit, and PHR integration are considered, it is likely than less than half of physicians use their EMR for little more than their own templates and a few favorite features. The majority of physicians have voted with their feet.

In the business community it is common to hear doctors referred to as computer-phobic and “in denial” about the benefits of computing. That is wonderfully ironic when heard alongside chronic complaints that doctors are overly eager to use expensive technology: lasers, cryro-probes, fiber optics, MRI and PET scanners, stents, and implants. The fact is that doctors love high-tech.

They have reason to hate EMRs but not computers and iPhones.

Most physicians receive their first scars at the hands of hospital software. The truly unlucky have experienced a software installation with conversion from paper to EHR.

Physicians know that better exists. They have experienced Google, Amazon and e-Bay. Game lovers know that Electronic Arts’ “Tiberium,” now 15 years old, exceeds the capabilities of their professional health care software. They know from Yahoo and MSN the value of configuring a home page suited to delivering niche-information of their own preference. They know from using Word and Word Perfect that they can create precision documents merely by tweaking a template. They know they can use voice commands to make a phone call on their Blackberry.

They know that they can find drug information more easily on Google than proprietary software. They suspect that if their EHRs and EMRs had physician-specific home page functionality, that they could drop and drag orders, answer FAQs, dictate letters, and save time with templates with many fewer clicks. Ordering medications should be as safe and uncomplicated as using E*Trade.

Today most EHRs and EMRs are invasive both to workflow and finances. While high cost is a significant barrier to physician adoption, workflow disruption remains the killer deterrent.

An example demo patient, a return visit for an office visit, was typical enough: an obese, diabetic female smoker with a pulmonary problem. Everything was point and click: select, enter, click, read, post—again and again, over and over. The visit timed out at 30 minutes (their calculation, not mine) not including the time spent by a nurse’s clicks and front-office clicks. Allowing for physicians’ differing styles and based on difficulty, I’d expect this visit to take half that time. The record created was excellent. In private practice, at two patients per hour, and at this level of complexity—say 12 to 14 patients per day—one should expect bankruptcy. One would make a better living running a Dairy Queen.

A sign at a dry-cleaner’s shop reads: Low Prices, High Quality, Fast Service: Pick One. The point of EMR design is not to “pick one.” And, I am not advocating modeling medical practice after that in a remote mission clinic where the only record is a toe-tag, although I should recognize that mission outcomes are remarkably good. In the real world you get what you measure. If the metric is the chart, and you are willing to sacrifice time, then have at it. Also, in the real world, physicians are not usually on salary with no increment of production payment. Physicians do not hate high-tech and they do not hate computers. They hate wasting time; they cannot afford it, and neither can our health care system.

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