family practice issues and general life events

Posts tagged ‘meaningful use’

Busy days ahead…

Here it is the end of October- and I find myself, well not overwhelmed, but close.  Flu season has yet to begin, and yesterday, I saw 36 people.  Now some of it is caused by the fact that next week I am going to be in Orlando at the AOA convention for both CME and to give a speech.  A bit nerve racking really, that people would want to listen to something that I would have to say.  I am not a born speaker, and I have not discovered any great treatment for diabetes, hypertension or cancer.  Instead I just happened to with my husband receive the first electronic medical record incentive in the country.  Funny thing is that a year ago when we started the process to apply for the bonus, we didn’t actually believe that the Centers for Medicare and Medicaid services would actually follow through with their proposal.

So now next week, instead of seeing patients, I am speaking, obtaining CME hours, networking, connecting/reconnecting with friends and colleagues, going to Mickey’s Not So Scary Halloween, and who knows what else.  However, that talk remains in the back of my mind.  It has been there for about 5 months.  Since I first agreed to do it.  I have made two or three power point presentations, not happy with any of them- the basic knowledge is there, but I have a tremendous fear of being that boring monotone professor that no one wants to listen to.  That is probably why I can’t sleep, well tonight anyway.  But it is almost morning now- so I don’t plan on trying until after my day is done tonight.

It is funny how for the past several months, it has been there.  But it wasn’t until the first of this month that the talk hit me.  It was this month.  They want us to help to inspire other doctors, that the check is real.  And how we went about obtaining it.  Which I can tell, I was there.  I have the big check in my office to prove it.  But it seems funny all the same.  So the next two days at work will fly by.  Trying to get all of the routine appointments in before we leave town.  And then Saturday, the drive to DFW and the flight to Orlando.

Funny how public speaking can make some of us frightened out of our wits.  I am sure that they won’t tar and feather us- or at least I hope they won’t.  Though if they do- at least it is Halloween and I can pretend that it is my Halloween costume.  I could be a huge bird.  Sorry my attempt at bad humor.

It is however, important that I do this, mostly for my children.  So they can see the importance of presenting yourself calm and confident.  They need to see that despite fears, we can present a public appearance of knowledge and no how.  Maybe it will help them the following week at their science fair.  Maybe they will see everything that they can be, or what they can do if they have the desire to do so.  And maybe, I can give hope to other physicians who have no idea if they can even achieve what the government has decided is meaningful use.  Though I don’t know if they will all get a YouTube video of themselves produced by CMS


EMR and the family practice doctor

I am going to give my thoughts on the whole electronic health history debate.  It is probably worth about the same as most, less than some, and more than any of the politicians thinking that it is a good idea to implement.  All and all about 2 cents worth.  Why should you care what I think?  Because I am one of the people who are using it everyday, out in the office, and probably understand it more than those who are pushing for its requirements.


Back in 2005, when I opened my office with my husband, we decided to go ahead and “bite the bullet” and install the software.  The future was in front of us, and while in residency and in his moonlighting in ERs, neither had actually used an electronic medical record, we believed it to be the future and have been correct.  So we looked at all of the systems out on the market, well maybe not all.  We disregarded the “top of the line” due to their costs, and the fact we had just graduated residency and I was packed full of debt.  The less expensive ones just did not seem to do everything that we wanted, and soon narrowed it down to two.  And to be fully honest, the disrespect we received from eClinical works sold us on e-MDS as much if not more than their sales people.  Sometimes your competitor is your best friend, and your sales rep is your worst nightmare.  But this is not about the individual record keeping system, only a little background where I am coming from.  I have licensing for one, and use it on a daily basis.


First of all what EHRs are not.  They do not make you a better physician.  They do not make things easier to get your charting done, sorry it doesn’t.  There are functionality issues where you can enter templates, and preload, which do add to ease, but with all of the check marks that are now added to meet meaningful use guidelines, the ease of it, has been tempered by having to make sure that every box is checked. Which I guess is easier than hand scribing it out.  However, there is still significant time spent documenting after the patient leaves, that I would not call electronic medical records necessarily a time saver.


I would like to say that I look forward to the day when all of the consultants I use fully adapt an EMR.  At least those that handwrite rather than transcribe their notes.  Talk about terrible to read.  I usually see the faxed version of the note, integrated into the documentation.  I just hope that in some instances that the specialist does surgery, so I can know what they were thinking.  Then they have to use the hospitals dictation system.  And I can read typed information.  So for legibility reasons alone, there are definite benefits to the electronic health keeping system.


Drug interactions are a very beneficial part of the system. There have been times that rare interactions or interactions in disease states have popped up when I have entered a medication.  Sometimes this has helped me maintain a preferred medication due to potential side effects in and interactions and sometimes it has prevented potential complications.   Drug interactions don’t remain constant and new black box warnings seem to be increasing in frequency, so the back up is a nice feature.


The EMR can remind what tests are due, and if done right all of the test results are available at your finger tips and you can look at the trending.  These are all fabulous features of having it electronic.  Patients can see it, and if need to you can even print off the page at the visit.


Electronic medical records will probably be beneficial when they are fully integrated in the future.  However, they do not make better physicians. Patients are now heard to complain that the doctor spent the whole time typing into a computer.  How this is different from writing in the chart I don’t know.  Maybe those practices have not implemented the use of tablets, and the physician’s back is turned to the patient.  Costs of these systems remain high for software alone.  This does not include the constant need to upgrade current system.  Learning new aspects of the software and trying to implement needed aspects of the requirements.  The interface is ever fully functioning would be great, being able to pull down from a cloud visit notes from other providers, and what their documentation shows could help decrease costs.  However, risk from hackers and viruses remain a concern from both the patient and the provider.


The biggest difficulty with the implementation is that those that are creating the guidelines do not appear to be working with either the developers of the product or the providers and hospitals that must utilize the product.  It is easy for them to say that all prescriptions should go electronically, but not all pharmacies are ready to do so, or do even all state laws allow for all prescriptions to be transmitted that way.  Deciding that this is what constitutes meaningful use should take into consideration what is currently possible, and the time frame for it to become fully possible in the future.  Some of the requirements that are to take place in the near future seem to be almost impossible hurtles, especially when you consider that there is about to be a conversion in how everything is coded in 2013.  And any honest vendor, physician and insurance company can tell you that the conversion in itself may cause its own difficulties and meltdowns.

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