Government interference in the process will be an ongoing concern, as the feds are riding this horse very hard.
Government bureaucrats are anathema to the KISS (Keep It Simple, Stupid) concept. They are involving groups like
CCHIT (mentioned earlier) and others to try to make up for their lack of understanding of the total picture. And
I suspect they will make it very difficult to qualifY for the Stimulus money.
I am familiar with a 50-doctor multispecialty clinic that adopted an EMR that forced the providers to
completely change their daily routines. That formerly 50-doctor clinic is now a 39-doctor clinic, and according
to its currently unemployed prior administrator, it is now
having serious financial difficulties.
In my opinion, in order to satisfY the government's requirement that HIT be used "in a meaningful way," the
following elements are the Big Three:
- The visit notes comprise the basic
elements of the medical record. It has been estimated that the notes of the encounters between the provider and
the patient contain 70% of the patient information and are the basis for the coding to get paid. As alluded to
earlier, templating just doesn't cut it. If the patient's visits are documented thoroughly in these notes, they
will contain most of the essential medical information on the patient, including medical history, physical
examination findings, lab and other test results, diagnoses, prescribed drugs and other treatments, etc.
An electronic record of the patient encounter with the provider.
- Words scribbled on a prescription pad in undecipherable
handwriting has for years been fodder for comedians. But it is no joking matter when an incorrect medication is
dispensed from the pharmacy as a result. In its most rudimentary form, an e-prescribing system could render a
legible prescription from a printer. Ideally, it would be interconnected with area pharmacies and transmit the
prescription via HL7 or some secure mechanism rather than a piece of paper.
Electronic prescribing of medications.
- Having a two-way HL7 link with
your reference laboratories would eliminate the need to manually scan or otherwise input lab results into the
patient's electronic record. And though it may be easy enough to fill in the check-boxes on a lab
Electronically ordering laboratory tests and receiving the results.
requisition, electronic ordering not only could automatically populatethe patient's demographics (as
well as the requested tests), it could also, if linked to the patient's insurance information, assure that the
lab work getssent to the correct lab. Too often a patient is sent to "Lab A" for a blood test, etc., only to
find out too late that the insurance company will not cover the cost of the test because its clients must use
"Lab B." In addition to the electronic order, a facsimile paper requisition can also be generated for the
patient to take to the lab.
Now for my idea of a practical EMR solution involving minimal cost and very little disruption to your practice:
Assuming that your preference is to avoid the pitfalls that befell the 50-doctor clinic discussed earlier, you
might desire a relationship with a password-protected, Web-based medical transcription company with full VPN,
FTP, and HL7 capabilities. That company should archive your records permanently and offer easy search capability.
In addition, your page on the transcription company's Web site ideally should provide you with the ability to
e-prescribe as well as order tests from your reference labs and access the results, all of which would be linked
with the patient record.
As simple as it seems, this solution offers you the three main components of an EMR at very little additional
cost beyond that for your normal transcription. The records and capabilities are maintained on one Web site for
easy access, and your providers can continue to interact with their patients with little or no disruption of
their daily routines. Instead of waiting until October 2011 to apply for Stimulus money to help defray the cost
of implementing an expensive EMR that requires routines to change significantly, and results in seeing fewer
patients and generating less revenue, it may be more practical to go with a simpler solution now.
Then, if at some future point you wish to transition to a full-blown EMR, all of your digital records can be
easily imported into any system you might choose, as opposed to having to scan in non-digital records, which can
be costly as well as cumbersome. Perhaps the federal bureaucracy, in its infinite wisdom, will someday even come
to appreciate the beauty of a "KISS" EMR and ultimately agree that a simple solution, such as described herein,
is all you really need.
Steele E. No use = no "meaningful use." EMR Straight Talk. May 12,2009;
Steele E. The risk of automated EMR coding. EMR Straight Talk. April 29, 2009;