EMR was supposed to be the answer to comprehensive, coordinated medical care in the 21st century.
In this column, I’d like to change gears and discuss what’s going on with your doctor. Yes, I understand that you are the patient. You’re the one with acute crystal-induced arthopathy (gout), pityriasis rosea (a rash that, like most rashes, has no known cause and no known treatment) and onychomycosis (that dreaded toenail fungus). Heck, you might even have “retro-bulbar micturalgia” (an inside joke, but if you must know: If you claim that your eyeballs hurt when you urinate, your doctor will know you’re faking symptoms). Never mind, back to your doctor. We need to talk: Your doc is having a tough time and is singing the blues.
What’s going on? In short, it’s about electronic medical records (EMR) and so-called “Meaningful Use.” EMR was supposed to be the answer to comprehensive, coordinated medical care in the 21st century. Originally touted as the high-tech vehicle that was supposed to modernize and streamline care in the digital information age, EMR became a thundering steam engine that’s careening off the rails.
Computerized records were supposed to simplify and integrate health information so your medical records would be current, legible and available wherever you need care. That hasn’t happened. Instead, EMR systems today really aren’t much more than fancy filing systems that hold massive amounts of data required by insurers and government payers. The problem is, much of the information your doctor is required to input in the EMR doesn’t really help you receive better care. This ever-growing bureaucratic burden placed on providers is having a profound effect on the practice of medicine as well as on doctor/patient relationships.
Medicare is driving much of this with a steady stream of onerous regulations under the guise of the Meaningful Use program. You might be wondering how all this required information gets into your record—and therein lies the problem. It’s largely a low-tech data entry process and believe it or not, many medical providers now spend nearly as much time typing and clicking data into your electronic record as they spend providing patient care. Of course, some of this work can be shared with staff or automated by using dictation or voice recognition software, but it’s still a laborious, manual process performed by doctors who must cram the data entry into your office visit if they have any chance of keeping up.
“So you’ve had trouble breathing for five days? Hold on a second…” click, click, tap, tap, click, click, click, clack, clack.
“…OK now, any cough?”
If your doctors expect to be reimbursed for the care they provide, your simple visit for an acute upper respiratory infection will likely require a detailed two-page report. This tedious and unproductive activity has many medical providers frustrated and discouraged. Let’s explore this theme a little further to the melancholy strains of that new blues hit, “My Doc Took a Hike Cause He Don’t Know How to Type.” Twang!
Here’s another classic example of the inefficiencies involved in the EMR documentation and billing process. Let’s say you have Medicare and just want to be seen for your “yearly physical.” The following is a partial list of some of the things that are mandatory and must be clearly documented during the visit: All your medical problems, your entire past medical history, your family history, a screening test for depression, a “cognitive functional assessment,” an assessment of your risk of falling, home safety, how well you can get dressed and bathe, a discussion about alcohol misuse and illicit drugs, documentation and counseling on tobacco use, an update of all your immunizations, obesity and nutritional counseling, a discussion about end-of-life care (advance directives) and screening for sexually transmitted diseases. Of course, many of these are important and appropriate, but does that 72-year-old, retired schoolteacher who has been happily married for 48 years really need to be checked for sexually transmitted diseases? Oh and by the way, an actual physical exam and an evaluation of any of the things bothering you are specifically excluded. You need to make another appointment for that.
OK, I’m done for now. I feel better having vented. For my next column, I’ll be back to talking about your health—perhaps we’ll delve into the common malady known as post-prandial borborygmi (look it up). In the meantime, you have the inside scoop. I’m not suggesting that you send your physician a sympathy card, but the next time you hear a disconsolate tune and the clacking of a keyboard coming from your doctor’s office, you’ll know what’s going on. It’s the soulful lament of your physician entering data and singing the blues: “The thrill is gone, the thrill has gone away.”
Dr. James DeVore has been a full-time family physician in Santa Rosa since 1980. He’s medical director of St. Joseph Health’s Annadel Medical Group.
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