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Need Point of Care EMR Documentation to Meet Future EMR Documentation Requirements

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As part of my ongoing writing about what people are starting to call the EHR Backlash, I started to think about the shifting tides of EMR documentation. One of the strongest parts of the EHR backlash from doctors surrounds the convoluted documentation that an EMR creates. There is no end to the doctors who are tired of getting a stack of EMR documentation where 2 lines in the middle mean anything to them.

Related to this is the physician backlash to “having to do SOOOO many clicks.” (emphasis theirs) I still love the analogy of EHR clicks compared to playing a piano, but unfortunately EHR vendors haven’t done a good job solving the two things described in that article: fast predictable response and training.

With so many doctors dissatisfied with all the clicking, I predict we’re going to see a shift of documentation requirements that are going to need a full keyboard as many doctors do away with the point and click craziness that makes up many doctors lives. Sure, transcription and voice recognition can play a role for many doctors and scribes or similar documentation methods will have their place, but I don’t see them taking over the documentation. The next generation of doctors type quickly and won’t have any problem typing their notes just like I don’t have any issue typing this blog post.

As I think about the need for the keyboard, it makes me think about the various point of care computing options out there. I really don’t see a virtual keyboard on a tablet ever becoming a regular typing instrument. At CES I saw a projected keyboard screen that was pretty cool, but still had a lot of development to go. This makes sense why the COWs that I saw demoed at HIMSS are so popular and likely will be for a long time to come.

Even if you subscribe to the scribe or other data input method, I still think most of that documentation is going to need to be available at the point of care. I’ve seen first hand the difference of having a full keyboard documentation tool in the room with you versus charting in some other location. There’s just so much efficiency lost when you’re not able to document in the EMR at the point of care.

I expect that as EMR documentation options change, the need to have EMR documentation at the point of care is going to become even more important.

April 12, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EHR and Malpractice Lawsuits

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Long time reader Carl recently pointed me to this excellent AHIMA article on EHR and Malpractice Lawsuits. It’s first section sums up the current state of EHR and lawsuits quite well:

Medical records are a vital part of any healthcare lawsuit because they document what happened during treatment. Paper medical records are relatively simple aspects of litigation. HIM staff pull the requested chart, track down additional information as necessary, and sometimes provide a deposition on the record’s accuracy.

The process is far more complex with an EHR. The record of a patient’s care that a clinician views on screen may not exist in that form anywhere else. When the information is taken out of the system and submitted into legal proceedings, the court has a very different view—one that often confuses the proceedings and, in the worst instances, raises suspicions about the record’s validity.

The challenges stem from the design of the systems, which were built for care—not court. If the provider struggles in providing documentation, a trial involving malpractice can easily shift its focus from an examination of care to a fault-finding mission with the recordkeeping system. At other times, the provider’s inability to put forward the information in a comprehensible format may raise suspicions that it is missing, withholding, or obscuring information.

I’d probably modify the sentence that says that EHR’s were “built for care-not court” to say that EHR’s were “built for billing-not court”, but the idea is still the same. The big issues for EHR in lawsuits is that there’s no really good precedent for how an EHR will be treated in court. We’re so early in the process of legal cases that use EHR documentation, that we just don’t know how the courts are going to deal with EHR documentation.

Plus, when you consider that there are 300+ EHR companies out there, I’m not sure that a legal case with one EHR software is going to be applied the same way to the other EHR software. Each EHR displays data differently. Each EHR audits users differently. Each EHR stores data differently. So, I expect that each EHR will be looked at in a different way.

The AHIMA article linked above is a good read for those interested in this topic and points out a lot of other issues that could face an HIM staff that’s dealing with a case involving documentation in an EHR. Although, one of the overriding messages is that HIM staff and healthcare organizations are going to need an expert of their EHR involved in the process. In fact, I can see many HIM departments getting trained up on EHR in order to fulfill this need.

What I also see coming is a new group of EHR expert witnesses. Again, I think that these expert witnesses will have to have specific knowledge of a particular EHR to be really effective. I’m sure they’ll come from the ranks of EHR consultants, former EHR employees, and some EHR users. Considering the millions of dollars on the line in these malpractice cases, these EHR expert witnesses stand to make a lot of money.

I don’t want to make it all sound doom and gloom. I expect that there will be many cases involving EHR where a doctor or institution is covered better by an EHR than they were in the paper world. This will be even more true as EHR vendors continue to shore up their EHR audit logs and processes. There’s new legal risks with EHR, but there are also old risks that are removed by using an EHR. We just need to make sure we’re ready for the new risks.

January 23, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

First Hand EMR User Experiences, Slaying the Paper Dragon, and EMR GUIs

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Time again for a quick look around some of the EHR and Health IT topics being discussed on Twitter. It’s an interesting time for healthcare IT on Twitter. They’ve started accepting nominations for what they’re calling the #HIT100. A number of people have already nominated my @techguy and my @ehrandhit Twitter accounts as a #HIT100 nomination. I’m honored that people would consider me in that group. I’ll be interested to see who ends up making it on the list. Those lists aren’t perfect, but I enjoy them for discovering new people I didn’t know about.

Also, before I go through some tweets, be sure you check out the Around Healthcare Scene post on EMR and EHR.


I love Inga from HIStalk and I love these first person perspectives and comments on EMR software. We need more doctors, practice managers, nurses, etc talking about their experience. Props to Inga for putting that together.


I love the concept of the “paper beast.” Such a perfect description and something that so many people forget about when their planning their EHR implementation. Dealing with the existing and future paper (yes, paperless is a myth) is an absolute must in a good EHR implementation.


This is a topic we’ve discussed many times before. Although, I think we need to keep pointing it out so that physicians take a good hard look at the documentation method of EHR software. There are so many options out there that doctors shouldn’t settle for something less than optimal.

July 1, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Paper Has Healthcare Spoiled

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As I was thinking about the radical invention of something called paper, I realized that we’re really quite spoiled by paper and its amazing benefits. Let me just list a few of the radical benefits that paper provides a doctor using a paper chart.

* Immediate response to pen – Yes, tablets and styluses are getting better, but there’s nothing like the instant satisfaction of putting pen to paper and seeing the ink spread across the page. Sure, the pen runs out every once in a while, but that’s generally pretty rare. A nice pen just flat out works with an immediate response in the exact location you want something written. There’s no calibration needed. You just pick it up and start using it. It’s beautiful.

* Never a delay when flipping pages – Think about the beauty of paper’s ability to flip between pages. When I turn a page I get an immediate response to that flip and see the desired result (a new page) immediately. I’ve never seen an hour glass when flipping between pieces of paper. I’ve never had a page partially load and need to refresh. Paper has the unique ability to flip pages with instant display of the next page.

* Instant On – Speaking of instant, paper charts are the true epitome of “Instant On” technology. Computers are getting better at making boot times fast and computers turning on quickly. However, anyone who regularly uses a computer knows all the screens you have to see as your computer boots up. A paper chart is beautiful in its ability to immediately be available for you to work. It has true Instant On capabilities.

* No training needed – Ok, maybe this is a stretch of a title. There is no training needed for paper, because since elementary school we’ve been taught how to write with pen and paper. The ability to write is near universal thanks to training in doing so since we were children. You hand a new doctor some pen and paper and they can start documenting their visit. No login or password required. No needing to know how to access Citrix so you can open the chart. Just hand them the chart and a pen and they start charting.

* Multiple page view – The display area of paper is so expandable. If you need a dual monitor dual page view of the paper you just slide it open. If you need a quad page view, you’re only limited by the amount of desk space you have or you could even move to the floor if needed. This easy to manage multi page view is powerful since it’s quite often that you want to see multiple pages at the same time.

* Fast page switching – Take a paper chart and watch how fast you can switch back and forth between pages of the chart. I call this “thumb in chart mode.” With 5 fingers you can even instantly “bookmark” up to 5 locations in the chart which you can switch to and back very quickly with zero load time.

* Flexible to an infinite number of documentation methods – Does paper support the SOAP format? Yes! Does it support every specialty? Yes! Paper has the ability to morph to every medical specialty’s documentation needs. In fact, it can easily be adapted to a different documentation method for every doctor within every specialty. It’s designed so flexibly that there really are an infinite number of documentation methods it can support.

* Easily supports text and graphic input – Oh the beauty of paper. In the same input area you can easily add text or graphics. In fact you can easily link the text and graphics in whatever way you see fit. Some might prefer to write male or others might prefer to draw the universal symbol for male. It’s completely extensible to text or graphics in every area of the page.

I’m sure there are other areas where paper spoils us that I’ve missed, but this is a good start. Hopefully you’ll add any areas I’ve missed in the comments.

Watch for future posts in my “Healthcare Spoiled” series.

March 16, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

EPOWERdoc and Unique Features of ED EMR Software

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As many of you know, when an EMR or EHR vendor wants to show me their system, instead of getting a full demo of their EMR I instead ask them to show me the unique features of their EMR. Basically, I’m interested in seeing the features, functions, approach, etc that makes an EMR or EHR vendor unique from the 300+ other EMR companies in the market today. This was my approach when EPOWERdoc approached me with a request to take a look at what they’ve created with their EMRDoc software.

Turns out that EPOWERdoc has been around for 12 years and is already in 250 hospitals in 40 states. That’s a pretty good footprint for an Emergency Department comnpany. In fact, I read that they’ve done 17 million Emergency Department visits in North America in their 12 year ED EHR history. Of course, these numbers come from EPOWERdoc and we know how good EMR install counts are from EMR vendors. However, even if that numbers bloated it’s a decent sized install base. Update from EPOWERdoc: The client numbers and ED visits are correct, we started out as a Paper Template system from software printing and that is where the large client base is predominantly. We are 36 months into the EDIS market with the product you looked at and have 18 live and another 9 by first qtr 2012.

During the short demo, EPOWERdoc showed me 3 or 4 interesting things about their Drummond Group modularly certified EHR. However, the feature that hit me most was the EMRDoc prose generator. In fact, this demo was one of the reasons that I’ve started predicting an EMR documentation revolution against hard to read, bulky, clinical notes.

I wish EPOWERdoc had a video of their EMR notes prose generator to demo it. If they create a video, I’ll post it to my EMR, EHR and Healthcare IT videos website. Until then, here are before and after screenshots of the EPOWERdoc interface which shows the granular data entry and the note that was created (click on the image to see the full image).

And now the image of the outputted documentation:

We could certainly debate the finer points of the user interface for inputting the data. Plus, a screenshot doesn’t show some of the other elements they’ve created to be able to quickly handle the input of the granular data elements. What hit me was how much the second image read like a clinical note. To be honest, as I read it I felt like I was hearing someone dictating a clinical note. Are their subtle differences where dictation is better, definitely. However, they seem to have done a good job of taking the granular data and turning it into clinical prose. I’ll be interested to hear some doctors thoughts on the above to see if they agree or disagree.

There were a few other interesting EMRDoc features that stood out to me in my short EMR demo.
-As an ED EMR, you have a different workflow than an ambulatory practice. As such, you need the ability to manage multiple open records at the same time. What I think EMRDoc does really well is switching between patients, but then also tracking your last documentation location for that patient.
-Related to seeing multiple patients, EMRDoc documentation feedback tool provides the user (doctor, nurse, etc) with a real time feedback as to the status of the level of documentation for medical coding as well as what has been completed in the note. In the ED where you’re regularly pulled away to deal with a pressing problem, the feedback statuses are a great little feature.
-EMRDoc has a feature that forwards clinical information and data from the Nursing Record to the Physician Record and from various sections of the Physician Record to other sections. Pretty slick implementation that reduces having to document that same thing multiple times.
-One of the big questions for an ED EHR like EPOWERdoc is how they deal with the hospitals large HIS system. EPOWERdoc’s answer was a partnership with Iatric who uses technology allowing data insertion into non accepting systems such as Epic, Cerner, McKesson or Meditech. I’d seen Iatric (They had the amazing trick shot pool table guy at HIMSS), but it sound like I should get to know them a little more. Maybe I can get Katherine Rourke to cover them over on Hospital EMR and EHR as well.

As I said, I didn’t do a full scale top to bottom demo of the EMRDoc ED EHR system, but I thought these were some interesting features of their EHR that were worth sharing. I’d love to hear some first hand experiences from any EPOWERdoc users. Let’s hear what you think in the comments.

October 11, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Shareable Ink

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Ever since HIMSS (still seems like yesterday, but was really a month and a half ago), I’ve been wanting to do a writeup about the company Shareable Ink. A number of people asked me at the show what the most innovative thing I’d seen at HIMSS was and my most common answer was Shareable Ink.

The interesting thing about Shareable Ink is that they provide such an interesting middle ground between a technical solution and continuation of paper. I remember about 5 years ago when I heard someone describe the perfect clinical documentation system. It was completely flexible. Required little to no training. Supported every possible documentation style. etc etc etc. Then, they acknowledged that what was being described was the paper chart. It was then that I recognized that while EMR can provide some benefits that paper charts can’t provide, paper charts also had some advantages that would be difficult to provide using an EMR. (See also this post about EMR’s being designed as more than a paper chart).

I think this background is why I found the Shareable Ink approach to documentation so fascinating. I really see it as an interesting way to try and capture the benefits of granular data elements and electronic capture of the data while still enjoying the benefits of paper.

My simplified explanation of the Shareable Ink technology is as follows. You print out a form that you want to use for the patient visit. Each page that’s printed out has a unique background (although it just looks like a colored page to the naked eye). When you use the Shareable Ink pen to write on the printed out page, the pen uses a camera to record what you wrote on that page and where you wrote it. Then, once you sync the pen it recreates the document you wrote on in the system.

It also has some really interesting advanced functionality as far as being able to do check boxes on the printed out form and even will convert your handwriting into text on the electronic document if you wish. I’m certainly not doing all of the features justice in this description, but I think you get the general idea. It’s a pretty cool demo if you get a chance to see it. I wish they had some videos on their website of it in action so I could show you. (UPDATE: Stephen from Shareable Ink sent my this link to a YouTube video of it in action. I’d like to see a few more specific examples of it in action like I saw at HIMSS, but it does do a pretty good job of showing some of what I described above.)

I think they’re also taking a smart approach to the market. Their strategy was to focus on areas of healthcare that were slow to go electronic: Anestheiologists, Emergency Room, Hospitalists and ambulatory Physicians. A smart plan since this hybrid paper/electronic system might get those that love their paper off the fence and into the digital world.

I do have some concern about how well this would do over the arc of the day. How often would there be issues with a pen that frustrates the providers? How much work is it to print off the sheets for each patient? How well could this integrate with an EMR (although, I’d love to see it used with a number of the “Hybrid” EHR vendors out there)? Not to mention, how will the syncing of the pen work? Will it sync flawlessly every time or will you have a bunch of doctors wondering where the documents are/were since the pen didn’t synch for some reason?

I’ll be keeping an eye on Shareable Ink and how well they do. There’s certainly an existing market of users that love their paper and so I’ll be interested to see how these doctors like Shareable Ink’s technology.

An interesting side note is that I find it interesting that Shareable Ink left the Boston area and moved their headquarters to Nashville, TN. Very interesting move I think.

April 13, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Doctors’ Training vs. Transcriptionists’ Training

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This will be a bit simplified, but I think you’ll get the idea. If you consider a doctor’s training. Doctors are trained in an incredible volume of information and then how to use that information along with a lot of other variables to be able to evaluate patients conditions, provide care and at the end of the day solve problems.

On the other hand, transcriptionists are trained to do repetitive tasks very well with high accuracy. Certainly they have to have some skills with the medical terminology. Also, many have moved beyond transcription into helping with the clinical documentation and ensuring that it’s documented properly.

None of this should be news to anyone. Now for the big finish…

Which training is more suited for someone doing a million clicks on an EMR?

Is it any wonder that scribes and other creative models for documenting a patient visit in an EMR are becoming an important part of the discussion? Watch for many more creative models using people to come out in the next year.

April 12, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Complaints of EMR Documentation Aren’t Completely the EMR Vendors’ Fault

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One of the biggest complaints surrounding the implementation of an EMR is the way the EMR software handles the documentation method. Beyond just the learning curve, there are plenty of EMR software that have a terrible user experience.

While I don’t want to totally let EMR vendors off the hook, I do think it’s worth noting that EMR vendors aren’t completely to blame for the unwieldy interfaces. I believe one of the biggest reasons that the EMR documentation interfaces are so terrible is thanks to the crazy insurance billing and documentation requirements.

Seriously, it’s a total mess. Everyone that’s involved with insurance billing in healthcare knows what I’m talking about. Trying to code an application that’s easy to use, works well for the doctors and still handles all the insurance billing and documentation requirements is a serious challenge and so it’s not surprising why so many EMR software fails to deliver a great user experience.

That’s not to say that all EMR software have terrible user experiences. Although, let’s be honest that they’re taking on a nearly impossible task. I guess I compare the insurance documentation and billing requirements to cleaning a toilet. Nobody really likes to do either. Yet, they’re absolutely necessary jobs. Certainly there are some tools that can make cleaning a toilet easier (gloves, wands, cleaning solutions, etc). However, it’s still a task that isn’t fun to do no matter how you slice it (unless you pay someone else to do it, but the pain of the expense is still there). The billing and documentation parts of an EMR software are trying to do the same thing: make a task that no one likes easier. Unfortunately, using an EMR isn’t going to change a task that no one likes into something fun.

I hope that EMR vendors don’t use this as an excuse to not focus on creating usable software. It’s NOT! However, I think it’s important to consider the true impact of the EMR. Is it really the EMR software that is so bad or did you hate these parts of practicing medicine before having an EMR as well?

If you find that it’s the EMR software that’s so bad, then hopefully you were smart in the contract you signed with your EMR vendor (see the EMR contract section of my Free EMR Selection e-Book). You won’t be the first or the last practice to switch EMR vendors.

Of course, if the complicated insurance billing and documentation is the problem. Maybe Obamacare’s single payer insurance plan will help to solve that issue. At least there would only be one organization to deal with.

November 24, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

“The Impossible Day” Issue with EMR Software

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In continuation of my posts about RAC auditors and other audit issues that EMR software can help or hurt, the following comment was sent to me by an EMR and HIPAA reader. Maybe all of you have heard of “The Impossible Day” but I found the concept interesting and it seems like EMR software could be well positioned to control this issue. Is this a major problem or only a problem for a few people that like to code too high?

The RAC audits are an interesting and mindful subject. Some practices have been getting into trouble with the “impossible day” which their EMR’s seem to help perpetuate. Some seem to end up with more documentation in files, but when RAC auditors do the math on how long the docs are supposed to be legitemately spending, its not adding up… Thereby “The Impossible Day” emerges.

I’ve asked some EMR vendors if there is some sort of a control feature with a warning on the total time based on visits/notes for a day. Most are not familiar with this. Just like anything else, if we hear more about it from the RAC audits, more will pay attention.

November 11, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Medicare RAC Auditors and EMR

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Yesterday I addressed the possible caustic demeanor of insurance companies towards template based EMR documentation methods. Definitely something worth considering when you choose an EMR. How they document and the type of note that it creates matters to the insurance company, matters to you reading the note later, and to some extent the doctors who receive your notes on a referral.

Today let’s look at another possible problem with the ugly template note that many EMR systems like to employ (Note: The Jabba the Hut EMR vendors LOVE this type of note). This was sent to me by another reader (Yes, I have the best readers).

I know that Medicare RAC auditors apparently love the EMR systems as practices seem to be hanging themselves with poorly maintained patient notes; (ie. “sutures healing nicely “ in a current note for a surgery that is 2 years old). I guess some insurance payers are jumping on that same wagon of EMR note distrust as the RAC auditors.

Now I’m sure that none of those reading this blog would have poorly maintained patient notes. At least not intentionally. The problem with many of the template approaches to EMR documentation is that the above scenario easily happens in a busy clinical practice. Luckily there are a number of EMR software which don’t use this poorly designed template note systems.

As they say, Buyer Beware. It’s never been more true than when selecting and purchasing an EMR.

November 2, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.