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EMRs costly to health system

A recent New York Times article caught my eye the other day.  The author focused on the seeming corruption of physicians bilking patients out of tons of money for unnecessary procedures and the havoc wreaked on the American public as we try to keep the rising costs of healthcare down.

The most interesting part of the piece was the amount of blame placed on doctors as the culprits (which in the extreme examples cited was probably warranted).  Of course, as an industry insider, I can tell you that there was so much under the surface that the writer either failed to comprehend, did not know about, or simply chose to ignore.  Judging by the comments from medical providers, I wasn’t alone in my thinking.

Although not her fault, the author bought into MGMA data that was grossly wrong, for example.  I can’t imaging too many dermatologists making just $175,000 annually in 1995.  From a wasted $800 fee that my clinic had to pay to gain access to a data set when we tried to offer a competitive salary to an endocrinologist in our clinic in 2011, I can tell anyone that the data we viewed grossly overestimated the average endocrinologist salary.  The MGMA data we bought was based on only 15 doctors in only 5 practices in the entire mid-Atlantic region who were apparently making an average of over $300,000 annually.  A Medscape survey quoted a more believable $168,000 annually for an endocrinologist.

I have to apologize for the rather longwinded intro to my EMR thought of the day, which is the cost of EMRs to the healthcare system in America. It seems that not too long ago it was much cheaper to use paper charts. Currently, most EMR systems are simply expensive recording tools. Some of them don’t even really generate insightful or easy to read medical notes, although what they do produce may be argued by some EMR vendor companies and end users to be some form of documentation that loosely qualifies for generating a bill for an office note or medical procedure (wide spectrum of quality here).

Some EMR systems are free but most are costly, either lump sum up front with ongoing annual maintenance fees, or pay-as-you-go monthly rentals of depository databases where data from medical notes is stored. Why is the medical establishment wasting all of this money when research has shown again and again that EMR systems do not produce more safety or efficiency of providing healthcare for anyone?

With incentive programs from the US government driving and pushing doctors to set up their own EMR systems for the past 4-5 years, unfortunately, this has been a horribly misguided, misplanned, and costly experiment by probably well meaning individuals who found it un-PC to admit their mistakes. Personally, I wish the government had stayed out of it and let the market forces do what they do best, provide cheaper and cheaper hardware and software options over time until the value of EMR systems eventually sunk or swam the market on their own.

I personally use a free version of an EMR system, which works fairly well (with various glitches here and there during periodic system upgrades). However, I am in the minority since most of my colleagues in the Washington, DC area are either still working on paper charts or have shelled out gazoomba bucks to use a costly EMR system. I am willing to wager that the DC market is not too different from everywhere else in America in that respect. Although I love my EMR system for its organization and ability to electronically prescribe medications with a few clicks of the mouse, I think it remains equally important to consider that the EMR experiment in America is largely failed to produce any significant tangible results and only costs the entire system more, which in the end will be passed on to the consumer.

No EMR system makes doctors more money. The carrot and stick incentive model that the U.S. government used to promote EMR use is small and will be short lived. With ongoing EMR costs to medical providers, this technology has already begun placing another money suck on the healthcare system. Paper and ink are far cheaper by simple math. The only way it makes fiscal sense to continue the EMR market as a cost saving measure is to make all EMR systems of zero cost to the medical providers who use them, which will probably never happen. This is the only way that additional costs cannot be passed on to patients (cleverly couched, of course by well meaning doctors who need to keep their own costs down). Challenging as it may seem, I am hoping that someday someone can think of a positive solution to this important problem.

January 21, 2014 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Electronic medical records with community health and the environment in mind

My thought for today focuses on how using electronic medical records helps us maintain the health of our communities by keeping the environment in mind, which ultimately promotes health for all.  Contrary to what some might think, you don’t have to write a prescription or perform a medical procedure to help keep patients healthy.

I recently stumbled upon a thought-provoking company, Toms Marketplace.  Toms purports itself to be “a different way to shop”.  Established just recently in 2013, Toms’ great philosophy is to use profits from the sale of their community-centered products to give back to local communities in multiple ways.  For example, some of their toy sales support reforestation.

On a deeper level, aren’t we getting at some of the same grassroots issues by voluntarily using EMR systems that attempt, in their purest form, to be paperless?  Yes, EMRs can save trees and the environment in Honduras and elsewhere, and that has to be a good thing.

Trees should be a priority.  They are objects of beauty.  They provide oxygen for us to breath.  They provide shade on a hot day, which, depending on where you are in the world, can even save lives.  They help reduce atmospheric carbon dioxide and thus reduce global warming (yes, it probably does exist!) and all of its associated problems.  We are no longer living in the world of 1000 AD, and if people continue to use the world’s natural resources with abandon, then there can be consequences.

Thus, EMR users should revel and keep in mind a simple fact — that simply by getting away from the use of paper charts, they are touching the world for the better every day … keystroke by keystroke … tree by tree … and life by life.

child tree

January 5, 2014 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

EMRs Can Enhance Patient Engagement

The following is a guest post by Scott Zimmerman, President of TeleVox Software, Inc, whose bio appears below.

It’s well known that when EMRs are partnered with patient engagement technology, physicians can communicate more effectively and tailor their treatment plans to meet the needs of their patients.  For example, a patient who has diabetes can receive communications about monitoring blood sugar, while a patient who has high blood pressure can get daily reminders to exercise and take their medication.  This type of engagement can be highly beneficial, as TeleVox Healthy World research found that 83 percent of people across the nation admit they don’t follow treatment plans exactly as prescribed.

Though the use of EMRs is still debated among medical professionals, research has suggested that by transcending the in-office visit using digital technology to communicate with patients on a more regular basis, doctors may finally begin to achieve the amount of communication their patients desire.  It has been estimated that three in ten U.S. consumers would trust their provider more if they received text messages, voicemails or emails that provide patient care between visits.  Of the 66 percent of Americans who have received a voicemail, text or email from a healthcare provider, many report a variety of positive outcomes:

Fifty-one percent reported feeling more valued as a patient.
Thirty-five percent said digital communication improved their opinion of their provider.
Thirty-four percent reported feeling more certain about visiting that healthcare provider again.

When asked about how they felt about office visits in a virtual setting, an astounding 85 percent of patients in a study responded that communications such as email, text messages and voicemails are as helpful, if not even more helpful, than in-person or phone conversations with their healthcare provider.  And when it comes to patients giving consistent full disclosure when communicating digitally, TeleVox’s research showed the following:

Thirty-four percent of U.S. consumers said they would be more honest when talking about their medical needs through an automated call, email or text message than in person with a healthcare provider.
Twenty-eight percent said they would talk more frankly about nutritional habits.
Twenty-seven percent said they would be more open to discussing their fitness regimen.
Eighteen percent said they would talk more freely about their bad habits or personal vices through digital communication rather than in-person visits.

When healthcare providers link EMRs with notifications technology, engaging patients between visits becomes as easy as writing a prescription.  Physicians can use both to create and nurture that personal, human touch during the treatment process.

Scott Zimmerman is a regularly-published thought leader on engaging patients via ongoing communication between office visits. He is the President of TeleVox Software, Inc, a high-tech Engagement Communications company that provides automated voice, email, SMS and web solutions that activate positive patient behaviors by applying technology to deliver a human touch. Scott spearheads TeleVox’s Healthy World initiative, a program that leverages ethnographic research to uncover, understand and interpret both patient and provider points of view with the end goal of creating a healthy world–one person at a time. Zimmerman possesses 20 years of proven performance in the healthcare industry, with domain knowledge in the surgical, interventional and pharmaceutical arenas. Prior to joining TeleVox, Scott served for nine years at GE Healthcare in a variety of cross-functional and global leadership roles in sales, services, quality, marketing, pricing, finance and product development. Scott is a graduate of the John M. Olin School of Business at Washington University in St. Louis.
June 28, 2013 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

7 Tips to Help Improve EHR Etiquette

It’s been a while since I’ve written, but only because my practice has been booming lately and I’ve barely had a moment to breathe here in DC.  But I’m back now, and for who knows how long given the waves tossing on the sea of digital medical practice!

Patient engagement continues to be one of the most common complaints about EMR software.  There was even a mention of the frustrations in a previous post on Happy EMR Doctor.  Many physicians say that it interferes with patient interactions and that now most of their time is spent looking at a computer monitor and updating charts.  This causes frustration for all parties – patients and physicians – because doctors did not sign up for computer duty when they went to medical school and patients expect a doctor’s full attention during visits.

Software Advice, a website that reviews medical software, launched a survey on how to improve doctor-patient interactions in the EMR era and the results are finally in.  See below for the top seven tips received on maintaining quality relationships:

1. Position your computer between you and the patient:  No brainer here.  Face the patient during interactions.  Take the time to plan where your equipment will go so that this possible.

2. Invest in mobility:  Whether it’s a small rolling desk, small tablets or other lightweight tools, choose equipment that helps you move around.  A laptop may cost an extra buck but can be worth the investment.

3. Delegate as much as possible:  The objective is to interact with the patient as much as possible.  Have staff members enter the medical history, medications, prior procedures, etc. prior to the patient’s visit so you don’t have to during the appointment.

4. Dictate as much as possible:  Talk with the patient while scribes enter the information or use dictation software.  These allow you to focus more on the patient.

5. Ignore the computer when you first enter the room:  Chat with your patient for a few minute before you start recording information in the digital record.

6. Ask about previous complaints:  If the patient information is pre-loaded, look over it before entering the room. If they have open complaints, ask them about the issues to close them out in the emr. This reaffirms to the patient that you care.

7. Finish the chart in the room:  This can help to answer any other questions that might come up so patients feel like they have been listened to.

All in all, EMRs take some getting used to.  Once a physician develops a rhythm with the software, every patient interaction becomes easier.  Focus on the tasks as they come, and remember, practice makes perfect.

March 6, 2013 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Does Meaningful Use Destroy Doctors’ Skills?

About two weeks ago, I saw a patient who was referred for a new diagnosis of hypocalcemia (low blood calcium levels).  I ran a few additional appropriate lab tests and will be seeing him back this week or next.  This weekend, however, I had some spare time to read back through the sections of two medical textbooks dealing with a more detailed discussion of this issue.

How apropos, I thought, when reading a recent post on the Health Care Blog, titled The Destructiveness of Measures.  This post says such a powerful amount in such a short blog span, that I needed to highlight and share it.  It succinctly describes what the government is currently trying to do to a highly trained labor force who’s best asset is their ability to think about patients with complex medical problems.  Every minute spent filling out online forms to report meaningful use data to the government could be better spent in reviewing and updating their medical knowledge set.  Both tasks focus on patient’s and their medical problems, yet one is a much higher yield for patient care and physicians’ sharpness in providing higher quality care than the other, which could be completed by a person with a high school education.

Let’s not dumb down our physician’s knowledge levels by asking them to complete such inane tasks as generating Meaningful Use data sets.  Are the physicians the right personnel for such a clerical job?  Absolutely not.  Airline pilots can’t maintain their flying skills by running the beverage cart.  Doctors are no different.

July 23, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Oops, Practice Fusion Did It Again

What’s $6 million more amongst friends?  Practice Fusion recently released their latest meteoric-rise statistics in funds raised per the lovely venture capitalists of the world.  Check out Electronic Medical Records Service Practice Fusion Raises $6M From SV Angel, Founders Fund And Others.

On a side note, at my office here in DC, I saw an interesting patient this past week referred over from Bethesda Physicians, PC.  Not so interesting from the standpoint of her issue, but much more interesting from the standpoint that her records included a note from her PCP… wait for it… written in Practice Fusion!!!  I’ve been waiting for the day that, here in DC, I am now starting to get referrals from other offices using Practice Fusion.  So cool to see that familiar note formatting coming in from someone else for a change.  We get phone calls all the time from other offices, asking us how we like PF — and even have a visiting doctor and her practice manager coming over in person next week — but this is the first time to see another office right up the road using it.

Practice Fusion should be very proud.  They are starting to take off in the DC Metro area.  Quick, someone make a coverage map, like they do for cell phone companies!

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine and opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

September 23, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Realities of Drug Ads in Free EHR, EMR

A while back, John Lynn wrote an interesting post considering drug ads and their part in free EMR business models, e-Detailing and Pharmacy Ads and Free EHR Software.  As a practicing provider who sees and treats around 20 patients daily, I have never had time to, and generally don’t care to, read the pharmaceutical ads in my EMR system (Practice Fusion).  There is really no chance of educating me about drug specifics, and probably 99% of doctors, this way.  Most doctors nowadays either Google search or search an online medical reference such as UpToDate.com for a drug that they want to know more about, typically as a patient visit unfolds or shortly thereafter.  I do my searches when the patient is right in the room with me in order to save time, and they seem to enjoy knowing that I’m being thorough in making sure I’m giving them the right information.

Now:

Do I admit to occasionally seeing the name of the drugs flashed ever so briefly before my eyes when the ads first appear peripherally in the screen margins?

Yes.

Could I name a few such drugs now, upon thinking back?

Sure.

Have they influenced my prescribing patterns?

Nope, not at all.

So how do I get my information about new drugs otherwise?  In the same old-fashi0ned, traditional way that doctors have been getting their drug information for years.  It’s those beloved, unauditable, private conversations over lunches, which are always on the drug company reps.  Let me tell you, free food goes an awful long way for a hungry doctor and his hard-working staff.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine and opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

September 20, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

International EMR, EHR — Insider’s Perspective on NeHTA

A recent reader recently commented on my earlier post, Government Sponsored E-health Initiatives, and brought my attention to his blog, Australian Health Information Technology, which focuses on the Australian government’s EMR initiative NeHTA.

David More MB, PhD, FACHI, describes himself as a ‘dissident’ who is a bit worried about this organisation.  Have to say that he sounds like a fun guy (and certainly very interesting guy) already.  You may want to poke around his site to get more information about NeHTA in general.  He posts interesting tid-bits such as noting the number of weeks late that NeHTA is in delivering their plans for what sounds like stage I of their version of the US Meaningful Use plan.  Dr. More also cites breaking news articles regarding government EHR plans from both Australia and the US.  Bon apetite!

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

September 6, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

First Study to Show EMRs, EHRs Lead to Better Outcomes in Diabetes

A great post over at the Doctors LoungeElectronic Records Tied to Better Diabetes Care — cites a new study published in the New England Journal of Medicine today, Sept 1.  The study, Electronic Health Records and Quality of Diabetes Care by Cebul et al,  is a fairly big one considering the place where it was published and the naysayers out there citing past studies that failed to show significant improvements in health outcomes in the setting of implementing EMR and EHR use.

However, as a previous insider to the academic, ivory-tower world, I have a hunch that some major liberal politicking is likely involved at least a bit here.  After all, the HITECH Act is the initiative of a democratic administration that desperately wants to be vindicated as being right and not wasting money in a downtrodden economic time.  But nevertheless, once a study like this — from reputable centers such as The Cleveland Clinic and Case Western Reserve University — is through the strict hurdles of getting published in a journal with the magnitude of the New England Journal of Medicine, the message will be quite powerful.  A new king-of-the-hill in studies of EMR efficacy may be afoot.

ADDENDUM:  Since posted this, a lot of other news sites, including the Bangor Daily News and the Minneapolis Star Tribune, have now come out with even more coverage on this big news

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

September 1, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Latest Practice Fusion Stats Continue to Skyrocket

Just thought I would share with my readers the continued phenomenal climb in users and patients served by my EMR, EHR provider, Practice Fusion.  They continue to impress the heck out of me in terms of their user number, which is now over 100,000 users strong.  They reportedly add to this over 500 per day and 10,000 per month.  The patient count is now up to 16,000,000 apparently.  Considering there are about 312,000,000 citizens in the US population, that’s about 5.1%.  Quoting from the above link, “the company started the year with 55,000 users (82% increase) and 6 million patients (166% increase).”

Just remember that a while ago I predicted that Practice Fusion would be the next Gmail and that eventually every doctor would eventually have an account.  Looks like my prediction may be coming true.  No wonder venture capitalists like Peter Thiel have been pumping in the dollars.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

August 26, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.