Saturday, December 24, 2011

Reluctance to Change Into EMR

"I don't want to sit in front of a patient looking into a laptop," says a Denver doctor. "I'd rather look into the patients' eyes". You can still continue to give that "personal" care when you are in front of the patient. They need that from you, and nothing in this world can replace that. You don't need to stare into a computer, if you were to just review her digital history, even before the visit, just as you would flip through a bunch of papers in a file folder medical record. But imagine if you were to order a test for the same patient, after the visit, with a click of a button, and get access to the results instantaneously, once the tests are completed. Wouldn't it mean better and quicker care?

Resistance to Change. Doctors have got used to a particular methodology and workflow. A patient walks in. The Doctor's assistant pulls out a physical file folder containing the patient's medical history, a record of his/her visits to the doctor, his/her lab and other diagnostic test results, and the handwritten notes about the patient's history. As the doctor begins consultation, it's easy for him/her to quickly thumb through the pages and get up to speed on the patient's medical history.

About a year back, we made a decision to move from NY to NJ. My 8 year old daughter, a chronic Asthma patient, had one of her usual attacks. We took her to a local doctor in NJ, who requested that we physically bring in and hand over her past medical records from her Pediatrician in NY. She said, we could have them fax the records, or have them even mail the records. There was no way of her receiving or viewing a digital version of her past medical history with a few secure access codes instantaneously, nor was there a way for the NY practice to digitally transmit the records and avoid valuable time lost, or even loss of confidential patient history, in the course of this physical transfer. The doctor gave her some temporary medication, based on our relaying her history, and had to wait for the physical records to be released from the NY practice after a bunch of red-tape processes and signatures, to get a detailed grasp on her history.

Today doctor's are under increasing pressure to scan these paper files and convert them to electronic medical records (EMRs). In fact, the Federal Govt. has set a goal for every American to have an EHR by 2014. However, despite nearly $17 billion in economic stimulus money that is dedicated to medical records scanning, many small practices are reluctant to make the change.

Why are doctors so reluctant to change. In course of a recent visit to a major practice in NY, I realized that they had implemented Allscripts EMR. This is one of the most acclaimed electronic health application available today. It not only makes the doctor's workflow much easier and convenient, but its plethora of mobile features, including its well known e-prescription and CPOE, improves quality of care, and raises patient safety to new heights. Inspite of this, an insider mentioned that at an astonishing number of doctors within the practice, are not very happy to work with AllScripts or any EMR for that matter.

Why this reluctance? It is not that they are averse to computers. Most doctors today have depended on digital information and computers, to secure their Medical Degrees. So what is it? It may be for multiple reasons. Maybe they did try an EMR, in the days that EMR was newly introduced, but were left with a "not so comfortable" experience due to lack of information or customer support, or the vendors were not trained in how and which system works best for that specific clinic. Therefore, those doctors must have even gone back to using paper after spending thousands of dollars on a system that either was not customizable or did not integrate well with the other practice management or billing programs. Or, maybe, they feel that the modern day EMR, and other e-Health applications are going to gradually undermine their capabilities of efficiently and effectively handling the Patient Care workflow, by themselves. Though, this definitely is not the case; since the e-health applications are just tools for them to use, in order to improve patient care and safety.

Then why this reluctance to change? Why do we have to think that we need to literally drag a doctor, kicking and screaming, into this digital IT world to make everyone's life and efforts more meaningful?