All the laws have been passed and all the final rulings have been published. In the spirit of the times, you went out and got yourself an EHR. You did your due diligence and sat through many hours of vendor demonstrations. In the end they all started to blend together, so you talked to friends and colleagues and accepted the Hospital’s offer to pay a big chunk of your EHR costs if you picked the one they wanted you to pick.
Your biller quit in disgust, but other than that the implementation was uneventful and the Hospital folks helped a lot. After several hiccups, your Medicare payments are coming in regularly now and your office is adjusting well to the new software. The documentation templates leave a lot to be desired, but you type well and when you find some free time you may take a stab at customizing them a bit. Here and there you run into bugs and a couple of times the EHR was unavailable for a good two to three hours. Not sure exactly why. Maybe it was the Internet that was unavailable.
Anyway, if all goes according to plan, you will be retiring in 10 years and your much younger partner will be bringing in someone who is probably in Medical School right now. Everything seems under control. But today is different…
Today is January 2nd, 2011 and you are driving to work. Today has to be meaningfully different and your first patient is waiting in Exam Room 1.
Mrs. Kline is a pleasant 68 year old woman, who has been seeing you for ten years or so, for her hypertension (which is well managed), hyperlipidemia and a touch of arthritis. You bring up her chart on your EHR and begin your meaningful use (§ 495.6(d)(7)(i) – Record Demographics – Check). There is a little red sign on the screen saying that Mrs. Kline is overdue for a routine mammogram (§ 495.6(d)(11)(i) – Clinical Decision Support – Check). She says that she got a little postcard from your office the other day (§ 495.6(e)(4)(i) – Patient Reminders – Check) and will be making an appointment soon. You look at the BP recorded by the nurse and also notice that Mrs. Kline gained some weight and her BMI is now well over 30 (§ 495.6(d)(8)(i) – Record Vitals and BMI – Check). You chuckle as you notice that the nurse duly noted that Mrs. Kline does not smoke (§ 495.6(d)(9)(i) – Record Smoking Status – Check). As you listen to Mrs. Kline’s account of her knees “acting up” again and how it is now painful to walk Fluffy in the morning, you glance at her problem list (§ 495.6(d)(3)(i) – Maintain Problem List – Check) and medications (§ 495.6(d)(5)(i) – Maintain Med List – Check). She also mentioned some shortness of breath when walking Fluffy and you proceed to do an examination.
As you look over Mrs. Kline’s slightly swollen knees and check her wrists and elbows too, she tells you about her daughter Ellie and how she is now a third year Dermatology resident. Mrs. Kline is hesitantly wondering if her daughter could peek at her medical records once in a while. Sounds reasonable and you tell her to ask Mary at the front desk to set her up with access to the portal (§ 495.6(d)(12)(i) – Electronic Copy of Medical Records – Check). You explain to her that all her records are on the computer now and even today’s visit summary will be there before she gets home (§ 495.6(d)(13)(i) – Provide Visit Summaries – Check) and (§ 495.6(e)(5)(i) – Timely Access to Medical Records – Check). Her daughter in faraway California should be well informed from now on.
The exam was non eventful and the Lipid panel Mrs. Kline had last week looks good (§ 495.6(e)(2)(i) – Incorporate Lab Results – Check). You proceed to write a new prescription for Celebrex (§ 495.6(d)(1)(i) – CPOE for Meds – Check) and note that she is not allergic to anything (§ 495.6(d)(6)(i) – Maintain Allergy List – Check). The obligatory DDI pops up and you dismiss it as duly noted (§ 495.6(d)(2)(i) – Drug-Drug Interaction – Check). You adjust the BP meds and note that everything is on formulary (§ 495.6(e)(1)(i) – Formulary Check – Check). You ask Mrs. Klein which pharmacy she is using and promptly send all her scripts there (§ 495.6(d)(4)(i) – Electronic Prescribing – Check). On your way out you talk to Mrs. Kline about the need to monitor her blood pressure carefully now that she is on new meds and to call you if anything changes before her next appointment. You say good bye and good luck to her daughter. Mrs. Kline stops by the front desk and Mary sets her up with a portal account, makes an appointment for her and hands her the BP home monitoring education materials you ordered (§ 495.6(e)(6)(i) – Patient Education Materials – Check). Your next patient is in Exam Room 2.
As you walk over to your office, Mary mentions that the IT guy will be coming in later today to fill out some security survey (§ 495.6(d)(15)(i) – Protect Electronic Health Records – Check) and test the export function one more time (§ 495.6(d)(14)(i) – Capability to Exchange Clinical Data – Check) and he is certain that it will work this time. There is a new patient in the freshly cleaned Exam Room 1.
It’s after five o’clock and light snow is falling outside. You saw 20 patients today; some with chronic conditions, some very ill (one had to be admitted) and others with incidental scrapes and viruses, but pretty healthy otherwise. There was nothing unusual about today. On your way home you briefly consider that at this rate you should have plenty of data to report to CMS in 3 months (§ 495.6(d)(10)(i) – Report Quality Measures to CMS – Check) and Mary with the IT guy should figure out the rest when the time comes. That Christmas bonus was well deserved.
This was just one of the 3,653 days until your retirement. The extra three are for leap years.
Congratulations, you are now a Meaningful User of EHR technology.
Margalit Gur-Arie blogs frequently at her website, On Healthcare Technology. She was COO at GenesysMD (Purkinje), an HIT company focusing on web based EHR/PMS and billing services for physicians. Prior to GenesysMD, Margalit was Director of Product Management at Essence/Purkinje and HIT Consultant for SSM Healthcare, a large non-profit hospital organization.
Filed Under: Meaningful Use, Uncategorized
Tagged: Clinical Decision Support, EHR, Margalit Gur-Arie, Meaningful Use, Patients Aug 17, 2010
What does EDI have to do with being liberal, or not?
I have no idea what you are trying to say. Is it that payers are better off on paper? Or are you just saying that providers benefit more than payers from EDI? Does this mean that the Government required EDI to help doctors out?
I don’t know who benefits more. I think both do, or should. If that’s not true, maybe we should ask UHC if they are interested in reverting to paper.
“I don’t know who benefits more.”
“Nate, regarding EDI, it is only fair that insurers pay most of the price since they realize most of the efficiencies of electronic claims.”
Before you were certain that it benefited insurers and thus they should pay for it, I think you intended and do build upon this to justify insurers, taxpayors, and others getting stuck with the tab for EHRs.
While still wrong I can respect and leave it at you don’t know. Maybe you just don’t beleive the math I showed you but it is pretty basic and indisputable. None the less I hope your initial inaccurate beleif doesn’t perpatrate into your EHRs arguemnt.
Doctors need to stop their whining and open their wallats like the rest of us do. They already live better then 95% of us, I’m getting tired of passing the hat to pay their expenses while they live in bigger houses, drive nicer cars, and have younger wives.
“Yes, but, again, information is not health care. To use all this newly accumulated information in a “meaningful” way will not be like sending out a bank statement; it will require the doc and her staff to use that information in a way that has a positive impact on an individual’s health. And that is very labor-intensive and expensive.”
In my experience this week at a leading childrens hospital, my wife and I were queried for relevant medical history information about our child, by various medical professionals in the context of a pre-op meeting – anesthesiologists, nurses, nurse practitioners, doctors. I assume they are engaging in this search for information to provide the best care. Neither my wife or I are medical professionals, we also don’t have perfect recall. I know our answers were incomplete. At one point we differed on our response to a question about how old our child was when a certain procedure was done – I wonder how the medical staff process this – do they take my wife’s estimate, or mine? on what basis, e.g. who sounded more confident? throw them both out? average them? For the record I trust my wife’s memory better than mine. One nurse had a big book of hardcopy records ( no automated search of course although she did spend a lot of time flipping through pages ). We did identify for her an error in her hardcopy which she acknowledged and promised to “send upstairs” to get it fixed. Seems to me its already labor intensive and expensive.
wonder how much time is spent taking redudenent medical histories? From my personal experience both in regards to medical and non medical digitliastion of data utilization of the data is far less labor entensive. Getting analog data to digital is tough, and the first few weeks of transtion from analog to digital takes som egetting use to but after that there is no question it saves time and is more efficient. I don’t see how using digital data can be more labor intensive then charts that get filed and passed around.
“Doctors need to stop their whining and open their wallats like the rest of us do. They already live better then 95% of us, I’m getting tired of passing the hat to pay their expenses while they live in bigger houses, drive nicer cars, and have younger wives. ”
That is not a very capitalist way of looking at things. Careful Nate, this sounds almost like a desire to “spread the wealth” around….
As to paper records, Rich’s story is very typical and there are very few questions in my mind regarding the need for digitizing clinical information. The cost should be born by the immediate beneficiaries, whoever they may be, not by those who happen to have enough money to pay out.
I have no desire to spread the wealth, I want as much of it right, points down to name, here as I can hold. The only time I want to spread the wealth is when my cup run overith I like a nice spread out spill instead of big puddles
And now ladies and gentlemen, how about a day in the life of a bunch of frustrated users?
http://hcrenewal.blogspot.com/2010/07/open-question-on-moral-authority-and.html
Propensity,
I just realized that you also posted here about your desire for a search engine feature within an EHR. Please see my comment in the “What’s in an EHR” posting if you want to see a working demo of such a feature: http://www.thehealthcareblog.com/the_health_care_blog/2010/08/whats-in-an-ehr.html My biggest frustration has always been that we not only need to search for answers about patient-specific questions (“Did this patient ever get the shingles vaccine?”), but we also need to search for clinical questions (“Can and should I give this patient who had shingles ten years ago a vaccine?” AND administrative questions (“Does this patient’s insurance cover the shingles vaccine?”). All of those questions end up wasting my time trying to find an answer. I don’t want to make this posting into a sales pitch, but that is exactly what my company does http://www.medsocket.com After we get our pilot up and running at the University of Missouri, I hope to share some more data on how much of an impact this type of search feature can have on satisfaction, improved patient care, time savings, etc… So, you don’t have to sell me on the idea of why we need better search tools for providers. Cheers. -Karl