This post was originally published on 4/25/2012
Implementing an EMR is not supposed to be easy, but after you implement and learn, your clinical life is supposed to be easier. At least that’s the hope. I’ve talked to several providers who have found, and continue to find after a long time, that documentation is harder, takes more time, and gets in the way of care, rather than improving it.
So whose fault is it? And why do we put up with it?
In my innocence starting a solo practice in early 1998, I selected an EMR because my handwriting was legendarily hard to read, and my major justification for the additional expense was that my notes would be legible and that the EMR would support good documentation. I gave little thought to reports. I wanted to be able to populate a problem list, medication list, and flow charts without double entry- tasks that I hated in paper charts but I considered essential to good care.
Meaningful Use did not exist. I just needed a tool that would facilitate care, and not get in the way. I found one.
I found after implementation that data could be extracted. Even better, since I am not the brightest doc in the world, I found that there were modifiable templates for notes that reminded me of clinical guidelines, guided me in clinical decision making, and reminded me unobtrusively of things that otherwise may have slipped by. Reminder to check something every visit like diabetic patient’s feet? Check!
I got to participate in a research network that extracted my data periodically and gave me back information. I did a really good job taking care of hyperlipidemia and CAD. I did all the right things and was above the norm across the network. But I did pretty poorly identifying hypertensive patients. Too many times I accepted my own excuses like, “Oh, the blood pressure must be up because…” Once that was pointed out, we fixed it.
By national standards, we practiced near the top on quality measures.
Starting out with some simple goals, I got lots more. And it improved my care. By the way, my notes were done when I was done seeing a patient, and no one ever had to search for a chart because they were accessible in every exam room and office, and even remotely via the web. It was faster than writing or even dictating a note.
Are things worse now?
What I hear from you are things like: “In order to update and enter all the information, it takes multiple clicks, and if I make a mistake, it takes longer to correct it than entering the whole note.” Whose fault? Workflow? Bad choice of EMR? “We’ve worked with the vendor, and they don’t have a solution.” “Our staff is having to take 20 percent more time than before implementation to document a note.”
Wait a minute! Have we let a goal — better reporting of quality and meeting MU requirements — supersede what we’re expecting from EMR? Back to basics, folks. Go back to the beginning. What do you need from the EMR? Improved documentation, better reporting, clinical decision support, and FASTER workflow for physicians.
Twenty percent slower seeing patients represents a GIANT cost, and asking docs to complete charts after “normal” hours so they can keep up their documentation is NOT the answer.
There are satisfied users out there, there are good solutions out there. Are you happy with your system? Please comment below!
Not to do better after finding where the fault lies is inexcusable, even if it is difficult.
If you’re in a small office and love your EMR, tell me. If you’re in a large group with multiple offices and love your EMR, comment below. If you’re stuck with something that isn’t working for you, comment below! Let’s get the word out. I want names of good systems and systems that aren’t working for you!