Friday, January 11, 2013

EMR Savings Fall Short

Well, well, well.  This is entirely unsurprising.  The NY Times this morning reports on a new assessment from the RAND Corp regarding implementation of electronic health records:
The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.
This is the same RAND Corp whose analysis back in 2005 predicting $81 billion in health care savings triggered the mad rush by practices and hospitals to adopt EMR.  That report was sponsored by the very same corporate conglomerates who stood to benefit the most from mass implementation (GE, Cerner, AllScripts, etc).  So this is not some fringe Luddite organization drumming up data to support an anti-EMR creed.

Anyone with half a brain could see this from a million miles away.  EMR makes it too easy to "up-code" a patient encounter simply by mindlessly checking boxes.  So in larger health care conglomerates, armies of professional coders can pore through charts and make sure documentation is such that hospital profits are optimized.  I get a call once a week from one of these disarmingly sweet natured people about the need to revisit Mr X's record to indicate whether "excisional debridement" was done vs "incisional".   Or if so and so met the criteria for "sepsis".  These minor contrivances add billions to accounts payable  receivable over the long haul.

The other main problem with EMR is that it was rushed into practice far too quickly before they were really ready for mass use.  Basically a wild west of competing EMR providers flooded the market with user-unfriendly, early prototypes.  Instead of a standardized, integrated national system that would allow easy electronic communication between doctors in, say, Idaho and NY City about common patients, we have a mish mash of unrelated software programs.  I cover three hospitals.  All three use entirely different EMR systems that I had to learn.  And this is in one city. 

Further, the actual "medical record" that is constructed using current EMR is a linguistic and stylistic travesty.  The awkwardness of note/consult construction makes it hard to sign one's name to these blocky, information-inundated four page progress notes marred by rote, balky, technical jargon and syntax.  No one actually talks like an EMR record.

At one of the hospitals, the traditional SOAP note format has been reversed so that the Assessment and Plan appear at the top of the note, followed by the Subjective/Objective sections.  This is because they found that doctors got tired of scrolling down through reams of useless, unpersonalized data and cookbook exam findings in order to get to the part where one could get a sense of what the consultant doctor actually was thinking because the Assessment template is essentially blank, requiring the physician to write out a clinical determination.  Sort of like what we used to do with pen and paper.     


Joseph Sucher, MD FACS said...

So many of us "in the business" have been saying this for over a decade. But not only has it fallen on deaf ears... we became persona-non-grata and were no longer invited to the playground.

EMR can be a good thing. But, just as you have detailed, it is not. We are saddled with a massive amount of horrible software that just doesn't help us take care of patients. In fact, it is even worse on the nursing staff, who now spend much more time clicking boxes that no one will ever see.

Anonymous said...

It's accounts receivable not accounts payable the additional up-coding effects. You always ask yourself if technology has made things better at all. It's great to hear your opinion on EMR. Thanks