A Family Physician’s EMR Experience

I have always looked at technology for opportunities to improve the quality of care and the efficiency of my family practice. For instance, nearly 20 years ago I started using speech recognition software to dictate all my patient notes. This eliminated the high cost of transcription and turnaround time too. However since introducing an Electronic Medical Records system (EMR) in my office about 7 months ago the quality of care and the efficiency of my practice have vastly improved. EMR immediately brings many benefits to mind. There is an obvious decrease in paper use. Even faxes such as physician correspondence and reports are now received in a digital file which can be saved to the patient’s record without printing. Prescription refill requests from pharmacies are now received, reviewed and filled electronically. Most of my patient lab test results too are now received electronically, reviewed and then saved into the patient’s record, again without printing. But perhaps one overlooked major advantage of EMR is that data is now more commonly stored on a server offsite on the internet, “the cloud” which provides tremendous advantages.

Over the years I have covered my solo family practice 24/7, essentially 12 months a year. Even when I took a brief vacation or extended weekend out of town I relied heavily on cellular phone and hospitalists for coverage. This has mostly worked well over the years except that when I returned to the office I was confronted with tall stacks of charts waiting for messages to be signed off, reports and specialist correspondence to be reviewed. In fact over the years my brief vacations have been mostly work deferred. I paid for it with extra work when I returned to the office.

Things are now much different over the last few months. A brief story is perhaps the best way to explain some of the benefits of my EMR. Recently I had to make a sudden trip to South America for a funeral. Besides the obvious emotional distress, I worried about my practice coverage while overseas. I still had a hospitalist covering me for hospital cases. However, I was anxious that a local family physician would not be able to effectively cover other routine issues with patients whom she was not acquainted.  The EMR circumvented many of my worries. Because the software and data storage are Internet-based, my laptop essentially provided me with all the functions as if I were in the office. The main thing lacking is that I cannot examine the patient in person. From the time I reached the departing airport I was able to start reviewing my prescription refill requests, all fax communications, lab reports and all phone call messages documented by my staff. While in South America I also logged into my EMR software in the morning and at night and performed those tasks. For emergency communications my office was able to contact me by text messaging. When I returned to the office after this ‘hurricane’ 5 day trip I was relieved to see that there were no stacks of charts waiting for my attention, and because of the ability to seamlessly perform work on the road, I did not have any backlog of work on my computer/EMR system. What was stunning is that even though a family physician was backing up my practice, she did not have to be contacted even once! My competent staff and the EMR system worked wonderfully.

A high-quality state-of-the-art EMR system is very expensive. However, I feel that the benefits outlined above do make the investment worthwhile. The American Recovery and Reinvestment Act (ARRA) in 2009 allocated roughly $20 billion to promote the adoption of Health Information Technology (HIT). The government does reimburse you for the cost of the system if meaningful use is demonstrated.  According to a recent bulletin from the American Academy of Family Physicians, “Eligible professionals participating in Medicare can receive as much as $44,000 during a five-year period and as much as $63,750 if they participate in Medicaid during the next six years. CMS expects to start issuing Medicare EHR incentive payments in May 2011.”

Sultan Rahaman graduated from the University of the West Indies Medical School in Kingston, Jamaica and completed his Internship and Residency in Family Medicine at the Jackson Memorial Hospital/University of Miami medical center in Miami, Florida. He is a full time Family Physician in solo private practice in Longwood, Florida. Dr. Rahaman has been a member of Doctors for America since 2008, where this post first appeared.

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9 replies »

  1. It is extremely encouraging when good stories are written. Physicians generally write only when they have bad experiences and the internet is flooded with such stories. Therefore, this is a breath of fresh air.

    Two important takeaways.

    1. This is not explicitly written or mentioned but behind the success is a lot of hard work; not just for the doctor, but for his entire staff, and the vendor. Of course, I don’t know Dr. Rahaman, but I cannot imagine this just worked like magic. I am fairly confident that there are a lot of good technologies and products out there, but success is in the attitude. The right attitude and right implementation strategies makes a successful EMR story like this one.

    2. The statement ‘A high-quality state-of-the-art EMR system is very expensive.’ I question the definition of ‘expensive’. So some, even Free is expensive. Why? If you don’t run the practice in an efficient manner, any technology is expensive if you just use technology to compound and expedite inefficiencies. Expensive is not a dollar term, it is the cost of efficiency, or lack thereof, it is the cost of peace of mind, it is the cost of lack of personal life, it is the cost of personal sacrifices. So, stop measuring cost of EMR in pure dollar terms.

  2. I would be curious to know what software you have chosen among all those on the market. You are obviously satisfied with your choice.

  3. The value of EMR/AMR is situational. If you are in private practice and are using your system to conform to your and your patients needs then there is some value albeit limited by system design. If like most physicians who are now employed the system will be set up to benefit corporate needs which rarely include what is important to the physician . Unforunately for myself I am involved in the launce of Allscripts at my practice. All I can say is that this is the worst system I have ever used. A pen and paper has never looked so goo.

  4. Great I totally agree with Dr. Rahaman, electronic medical records is to make patient emr better and reduce the medical errors. Now we can store the medical records online and can access it anytime from anywhere. It is helpful for both patient and physicians.

  5. MD as Hell – thank you for point A – it definitely must not be true and must be completely meaningless, now that you have said that you do not believe it.
    Determined MD – everything you said was unwarranted – the doc was talking about how in a situation of unplanned absence, his patients were still taken care of, without external help and without backlogs, due to his ability to access information remotely. I am sure Dr Rahaman would also prefer being left alone when he steps out of his office, but lets also consider for a moment that his patients might just value a doctor who makes a sincere attempt to ensure continuity for his patients even when dealing with an unforeseen travel.

  6. eMR Ethics
    Interesting post! But, the fields of medicine and information technology (IT) each have separate and related ethical considerations. Ethics may prohibit technology, for example, when using a specific application that would make a security breach likely. However, ethics may also demand technology.
    For example, let us suppose that a new surveillance application would improve public health — is it not ethically imperative to utilize it to save countless lives? But suppose it also almost guarantees a security breach — what does the ethical position on use of the application become then? This is an extreme example, though not completely unrealistic.
    Complicating the picture is the fact that IT in the healthcare arena has so many and varied uses. For instance, office, clinic, and hospital-based medical enterprise resource planning (ERP) is based on the same back-end functions that a company requires, including manufacturing, logistics, distribution, inventory, shipping, invoicing, and accounting. ERP software can also aid in the control of many business activities, like sales, delivery, billing, production, inventory management, quality management, and human resources management.
    However, other applications particular to the medical setting include the following:
    • The EMR, which has the potential to replace medical charts in the future, is feasible.
    • Healthcare application service providers (ASPs) are available via Internet portals.
    • Custom software production may produce more solution-specific applications.
    • Medical speech recognition systems and implementation are replacing dictation systems.
    • Healthcare local area networks (LANs), wide area networks (WANs), voice-over Internet protocol (IP) networks, Web and ATM file servers are ubiquitous.
    • The use of barcodes to monitor pharmaceuticals is decreasing the chance of medication errors and warns providers of potential adverse reactions.
    • Telemedicine and real-time video conferencing are already a reality.
    • Biometrics will be used more often for data access.
    • Personal digital assistants (PDAx) wireless smart-phone connectivity, which relies on digital or broadband technology including satellites, and radio-wave communications are increasingly common.
    • The use of wireless technology in medical devices will be increasing.
    All of these applications offer advantages, but the security of these IT methods and devices is not yet fully standardized or familiar to health professionals. They all involve inherent security and privacy risks, and the prudent healthcare organization will want to ensure that these risks are identified and contained.
    Dr. David Edward Marcinko MBA CMP™

  7. Wow, a doctor making an argument to be on call 24 hours a day 365 days a year! Thank you so much, Dr Rahaman, another nail in the coffin being crafted by politicians behind this montrosity of PPACA!
    Hey, I just want readers to know that I am a human being with realistic and proper needs, so when I have to leave my practice, I do so with the overt agenda that I will not be available to my patients for that time period. I also think that probably 80% of my colleagues share this perspective to a fair degree, so what this doctor has written above is not a template for what should be expected of doctors.
    By the way, thank you, Dr Rahaman for the validation of why I despise people who claim they are on vacation or other distraction from their job responsibilities and then both complain and distract others in their puruit to “be in the office” while away from it. I’m sure the mourners appreciated your full attention to grieving while you were checking your computer several times a day.
    This is why I do not like this faux acceptance that technology will improve our lives to a sizeable degree. It justs ups the ante of accountability, especially for physicians. But, hear the lie enough and it becomes the truth, eh, Americans? WHEN the lawsuit finds a physician culpable of neglect or substandard care by failure to act via computer, will all you advocate docs be just saying “just an exception”. Yeah, our profession is the exception to these false rules!!!

  8. A. I don;t believe this drivel.
    B. Matthew, is this the best you have this week?

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