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ED Physician Executive Slams EHRs

Scott Mace, for HealthLeaders Media, January 28, 2014

Tom even cites a January 2014 study that 40 percent of healthcare dollars spent do nothing to improve patient lives. "Why do people do these types of things? Well, because we're risk-averse, it's a rare event, costs are transferable to the patient, so we practice for the exception. We do a bunch of unnecessary testing. [And] there's a lot of unnecessary documentation that goes along with it."

Yet, particularly in the ED, even if doctors have medical records in front of them, they are not going to pore through them when they can just query the patient and get what they need much more quickly, Tom says.

Billable Hours is Not the Model
He contrasts physicians, who get paid more if they see more patients, to attorneys, who bill for the time they spend in any kind of documentation. The more they document the more they can bill. "It's just the opposite for us," he said. "The more time we spend documenting, the less we get paid."

For a significant majority of patients, physicians have no need to spend any significant amounts of time in the medical record. Only relatively few complex patients require such scrutiny, Tom says.

In Tom's ideal world, medical records would be completely mobile and have significant voice recognition capabilities. In a hypothetical scenario, a patient presenting with chest pains would prompt the emergency physician to request a standard chest pain macro, enter appropriate variations, be notified of EKG results, and send those results to the on-call cardiologist.

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8 comments on "ED Physician Executive Slams EHRs"


Dr. Cynic (2/7/2014 at 11:07 AM)
It is absolutely clear that electronic health records are good for medicine. 1. They eliminate the horrendous variability in handwriting as an obstacle to reading old notes. 2. They make it very easy to look up old labs, imaging, and notes by subject or date of service instead of wading through piles of paper. Now, which EHR is another question. The field is littered with products from the outstanding ED-Pulsecheck EHR, to the below average Meditech, to the absolutely horrendous Cerner. The problem is not that EHRs are bad, but that people who don't understand IT or medical practice are making these decisions for large organizations which then see suboptimal results.

steve jacobs (1/31/2014 at 4:39 PM)
I'm afraid that the speaker is looking at a conventional EHR as used in most hospitals. The reality for me at Kaiser Permanente is much different. We're using Epic like everyone else, but we're a complete group[INVALID] Inpatient and outpatient docs, labs, xr, etc. How would the speaker like to have instant access to the outpatient ecg done 2 wks ago when he sees a chest pain patient at 2AM? The problem isn't EHRs per se but rather the lack of interconnection. I can see all of my patients' records, even when they're admitted at tertiary centers far away. I can see all the labs, consults, etc. As for usability, Kaiser spent a lot of money and time customizing EPIC for each specialty. So at least for me as a pediatrician, it is far quicker than using paper. And readable. If you are practicing in a hospital ED with no data connections to the referring docs then his point about the documentation being primarily for billing has some merit. But if somehow EHRs can interconnect, then they will really show their promise.

Anne Creamer (1/31/2014 at 2:02 PM)
@cascadia, I don't understand your point. What was the physician's specialty? Did he have any training in workflow, documentation, user interface and functionality issues? And Dr, Geraci, your assumption that "an ideal product for Family Medicine would easily satisfy ER use" is not true. The ER needs documentation structure for all specialties, since we see it all. Do you have the need to document on OB/GYN, trauma, peds, psych, urology, just to name a few? The attendings and residents of all those specialties work in the ER on a regular basis and they need their specialty-specific terminologies and order sets in the ER module. That's what makes the ER unique among all the EHR modules: we need to be able to document for the universe of medical specialties. Therefore, it is very difficult to retrofit an outpatient system, or any other specialty unit for the ER; the ER needs to develop its own module and this needs to be done by ER doctors and nurses who understand its workflow and have at least a basic understanding of database design issues.