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VISION — EMR: Keeping it Simple
From The Journal of Medical Practice Management
Volume 25, Number 3, November/December 2009


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:

  1. An electronic record of the patient encounter with the provider. 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.

  2. Electronic prescribing of medications. 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.

  3. Electronically ordering laboratory tests and receiving the results. 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


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.


  1. Steele E. No use = no "meaningful use." EMR Straight Talk. May 12,2009; http://blog.srssoft.com/blog/?paged=3.

  2. Steele E. The risk of automated EMR coding. EMR Straight Talk. April 29, 2009; http://blog.srssoft.com/blog/?paged=3.



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