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I’ve performed analysis of a lot of family physician practices that have EMR and while most have said that the first few months on the EMR were a trial, almost every one of them that have used it for at least a year prefer it. Yes, I believe if the physician buys a Walmart priced EMR that they are going to have more difficulty than those that spend the money to get the right one. More than in anything else, I’m a believer that in EMR’s you get what you pay for. Now, don’t get me wrong as I’m not saying that you need to spend $100,000 on a system – because I also believe that there are a few that are completely over-priced – but spending $50,000 on a truly excellent system for a 1 to 3 doctor practice is not spending too much, in my opinion. In fact, some of the people on this listserv have heard me remark in my seminars or in my newsletter that “A good EMR will pay for itself in increased income twice within the first year – regardless if you’re spending $35,000 or $55,000 for it, and not for the reasons that most think about. In fact, I think the majority of people selling, installing and training the good EMR systems are not even promoting it for the main reason they should.
The majority of physicians, it seems to me, have completely missed the real benefit of EMRs. I believe most are looking for something to eliminate the paper, or the cumbersome charts and filing cabinets. Some, listening to their billing department, are looking for something to “pick the codes” for them. Others, listening to their office manager, are looking for something to help them not get behind in their documentation. Still, there are a few that believe that getting an EMR today will ascertain their chances of qualifying for the EMR bonus money in 2011-2015. While those are benefits to the EMR, in my mind, they are minor benefits (including the $44K – which is not very much of a bonus to those family doctors truly running their practices the right way, in my opinion). The true benefit to the practice, to the patient and to their income (again – this is my opinion) is how it helps them to change their practice from practicing mediocre medicine to practicing good medicine to get better than average medical outcomes and an increase in their income of $150,000 to $450,000 a year (for a solo family physician seeing 25 patients a day).
George, physicians are human and as such, they are going to make mistakes, miss things, forget things, have their mind on other things and the vast majority (again – in my opinion) do not practice good medicine when they are relying solely on their own memory, intuition, instinct and “on-the-spot” decisions. When a physician is seeing a patient, they are still thinking about the last patient that just walked out, whether they’ve made the hotel arrangements for the convention in 2 weeks, whether they should pick up the mower on the way home, whether their son practiced enough for this week’s game, whether they should start looking for a mid level for the upcoming winter when they’ll double the number of Medicare patients, whether the supply of flu vaccines arrived yet, how they’re going to pay for the increase in the malpractice coverage, whether Obama is going to screw them to the wall to make himself look good, etc. etc. etc… Only 2 men ever walked on water and one sank – so the thought of “making mistakes” is going through their mind also.
On the diabetic patient they’re about to walk in and see, if they have a good EMR, it will help flag them when they walk in to see that patient that since 22% of asymptomatic diabetics have silent ischemia – that maybe they should be doing a holter, and it may be time for him to do an ABI (since 1 out of every 3 diabetics over 50 have P.A.D), and we need to ask whether the patient has restless leg syndrome, burning or numb feet, burning in their legs, cramps in their legs, sores or wounds taking a long time to heal, or the patient is overdue for a foot exam, and it’s time to do an A1C (every quarter) and an LDL (6 times a year and we need to do Apo Lipo A & B as well) and a CBC (since Medicare says everyone on long term chronic meds should get a CBC on each visit), and twice a year, we need to check the patient for autonomic dysfunction before that leads to DAN or CAN, and an eye exam, and when was the last time I did an Orthostatic Blood Pressure on this patient since 11% to 14% of American adults suffer from Orthostatic Hypotension and the 3rd PQRI wants us to ROUTINELY do Orthostatic BPs on diabetic, or perhaps the patient needs diabetic patient education, etc. etc. etc. etc. etc. Yet – if you look at the exam that most doctors do on their 3 month diabetic patient – they are doing ONE to TWO of these 16 things.
If the patient is your family member, George, how many of these would you want their doctor doing? Yes – I’m sure some FPs are going to be upset when I say that the insurance carriers have trained them (IN THE PAST) to do mediocre medicine because they did not tell the doctors to do these things or they gave them trouble getting paid – but that’s in the past. Today – EVERY one of these things should be flagged, considered and a good EMR will help them do that. This is just one disease management area. Now – multiply that times however many for hypertension, hyperlipidemia, hypercholesteremia, sleep disorders, breathing difficulties (20% of American adults have pulmonary dysfunction), CHF, etc. etc. etc. etc. and you’re starting to see how the pay for performance of PQRI (instead of the pennies in Pay For Reporting) combined with a GOOD EMR easily helps family physicians increase their income by $250,000 a year. More importantly – it helps them be better doctors so they are not contributing to the number of diabetics that are being hospitalized to have an amputation because their family doc missed the P.A.D. or they’re not contributing to the number of diabetics suffering from instant death because their family doc missed the silent ischemia caused by a lack of sympathetic or parasympathetic protection – which is so easy to detect if the doctors are doing good medicine.
Yes – I’ve written a book here – but EMR is a good thing when used properly and if that means the Family Physician can only see 22 patients a day instead of 25 for the first few months when they are getting used to – it will be worth it if those 22 are getting better medical care than they would with the doctor relying on their own limited memory. By teaching the family physicians (that are not too arrogant to learn) what PQRI can really do for them, we’ve found that almost every physician can achieve this better care and increase their net income by that $150K to $450K (per physician). So – EMR can be a good thing, my friend.
Don
Don Self & Associates, Inc
PO Box 2610, Lindale, TX 75771
http://www.donself.com
http://www.medicalsource.biz
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