Thursday, April 16, 2009

DIY EMR vs The Big Boys

Here are some of my thoughts on this whole EMR business , now that I have "upgraded" to one of those products worthy of a government seal of approval.

EMRs do some things really well. Some of these things benefit the doctor. Others benefit bean counters. Other's benefit patients. A few of these things benefit doctor, payer, and patient simultaneously. I think this is an unintended consequence of an EMR, to be honest.
  1. EMR's handle prescriptions really, really well, and that is regardless of an eRx module or not. The good EMR's have built in prescription writing software--actually the software is from a third party vendor--that simplifies the new and refill process so much that a medical assistant with a little bit of training can do it without mistake. This helps doctor, payer, and patient through efficiency and accuracy. My little DIY EMR was terrible at this.
  2. EMR's handle coding very well. The good products have CMS coding rules pre-programmed. When the doctor sees an encounter, the system can suggest an accurate level of coding that reflects the documentation. This helps doctor and bean counter at the same time, though it does not help the patient at all. My DIY EMR was not sufficient in this regard, but I could have made it so if I had the knowledge then that I have now.
  3. EMR's handle documentation extremely well. Notes are well written and chock-full of information and free from handwriting issues. This helps the bean counter though not the doctor or the patient as much as you might expect. You see the notes seem to lack the essence of what was on the doctor's mind. I find them difficult to sift through, to be honest. In fact I just got documentation faxed from a local urologist to whom I referred a patient. The computer note was difficult to interpret, albeit beautiful. Had the urologist not called me in addition to the fax, I'd have not known what he was planning. I found that quick, short, scribbled notes (typed even better) provided the best form of documentation from a pure patient care perspective. Ironically, my little DIY EMR was superior in this capacity.
  4. EMR's enhance billing processes. Good EMR's can seamlessly merge EMR data with billing data and facilitate claim generation and turn-around time. Coding, ie programming, requirements for this were light-years ahead of my little DIY EMR. This feature of an EMR helps doctors only.
  5. Correspondence: Good EMR's facilitate correspondence with providers. Ironically, this might not really help the receiver, since these systems tend to inundate them with paper. I have had a number doctors mention this to me with regard to my system and other popular systems. Perhaps this is just a customization issue. In this regard, looking back, my little DIY EMR was superior.
  6. Document management: When properly interfacted with participating labs and radiology centers, document management with a good EMR is a snap. These interfaces don't come cheap, however, and if your EMR and local lab/radiologist etc cannot work together, you are screwed. My little DIY EMR was vastly superior in this regard since it worked with everyone, cheaply. There were no interface issues.
  7. Intra-office communication: Good EMRs, though probably even cheap ones, have secure email features for intra-office communications. I have found this feature, even in my small office, to be a huge improvement over my previous way of doing business. If I was a better software designer, I could have configured my little DIY EMR to do the same thing. But I didn't.
  8. Customization: Good EMR's can be customized and programmed to reflect "best practice" guidelines. My little DIY EMR did not do this. I actually see a sinister motive in the government's and industries pushing this "best practice"agenda. Ultimately, the powers-to-be will use this to empower midlevels and pay doctors less.
All in all, my little DIY EMR was damn good. Not perfect, but nothing is. If I was cash only practice, I'd still be using it. But in the RAC, HIPAA, P4P era, it no longer was sufficient for my needs.

Still, not bad at all.

Dr Schoor MD FACS

Urologist and Owner of iLabTQM, a CLIA compliance software company.