Talking to doctors about an EMR makes them run the other way or just simply tune out the speaker even with all of the government incentives and impending penalties by Medicare and Medicaid.
This reaction by most doctors is truly not hard to understand. EMR's to most doctors simply means scanning in paper records or playing with a PC or tablet that is going to slow down their production while seeing patients. The problem is truly simple. Give doctors an application on a gadget like the iPad that will take the repetition out of their daily work and you will see EMR adoption by physicians take place faster than a tornado or hurricane. As they say, "the devil is in the details" and it truly is.
Take a close look at what doctors do: chief complaint, present illness, review of systems, medications, allergies, past medical history, family history, social history, vital signs, exam, diagnoses and recommendations. Standardized work flow by specialty is the starting point of any adoptable EMR, followed by standardized nomenclature or verbiage. Eighty percent or more of what physicians do and document is repetition. If you want to see physicians adopt EMR's like a whirlwind, standardize not only the workflow by specialty but also the description of the normal findings so that doctors only need to document the exceptions or the abnormal findings. What is normal is the same for everyone of the same gender. A physician spends at least 20% of their time documenting the same normal descriptions, day in and day out 30 to 50 times per day. Eliminating repetition is the number one rule of any automation and this is no different for doctors. In fact even the description of the abnormal findings can also be standardized on drop down pick lists to further eliminate repetition and save the doctors' time.
Transcriptionists long ago figured out how to standardize word processing templates for dictation by physicians. When a physician dictates a record, the transcriptionist already knows how the doctor is going to describe the normal findings and she templates it on a word processor but still charges by the line as if she had typed the entire report. No wonder the transcription business has been so lucrative for so many years. Many current EMR's are nothing more than glorified, word processing, templates that arose from medical transcription. A template based system has been designed backwards. The physician enters data into a template selected by diagnosis or presenting problem then the application pushes the data into the backend database. No wonder doctors don't want to adopt the EMR. It is much more time consuming to enter data into a template than to just handwrite or dictate, so why change?
Provide physicians with a standardized database that follows the workflow for their specialty where the doctor only has to document the 20% of abnormal findings and watch EMR adoption go through the roof. You will not have to convince a doctor very hard to eliminate 80% of their repetitious documentation. Now place this EMR application on an iPad or similar mobile platform that runs on the cloud and the biggest problem with be filling back orders.
Furthermore, the standardization of the normal nomenclature by specialty goes beyond saving a doctor time. The EMR now becomes a clinical tracking tool. The separation of the normal descriptions from the abnormal descriptions allows tracking of the abnormal findings. For example, a standardized EMR rather than a template based EMR will allow the physician to track symptoms like chest pains, black stools, dizziness, etc as well as abnormal exam findings such as wheezing, cardiac arrhythmias, ankle edema, etc from visit to visit until resolved or stabilized. Now a physician is provided with an EMR that not only eliminates repetition and saves time but more importantly tracks medical problems from visit to visit until resolved. A functionality that the physician currently does manually if at all. A standardized, normalized database EMR will not allow medical problems to fall through the cracks. Imagine the implications for lowering medical malpractice insurance premiums by improving quality of care.
Dr. Angel Garcia is a practicing internal medicine physician with more than twenty-five years of clinical practice and over fifteen years of research and development of electronic medical records. Dr. Garcia was a five-time guest speaker at the National Medical Records Institute annual scientific meetings. In 2001, Dr. Garcia was selected as a finalist for the Ernst and Your Entrepreneur of the Year Award and was a guest speaker of President George Bush at the White House for the High-Tech Leaders Forum and the Economic Leaders Forum. Dr. Garcia recently published a book entitled "Do No Harm-Saving Our Health Care System" which highlights the EMR at the core future US healthcare. www.DoNoHarmDrs.com
