EHR Software Makes Doctors Secretaries

It all depends upon how the product is implemented. Doctors should expect to continue to document their interactions with the patients, physical findings, assessment and plan, anything they order that is not part of a standing order set but they should not expect to be entering data that others in the office are capable of doing. So in practices where they have not done a formal workflow self evaluation and planned for changing how workflow should change after implementation, one can see the burden falling on the physician to enter everything. So patients should complete online health histories when applicable, support staff should enter chief complaint, vitals, review meds, and allergies, collect the initial symptoms the patient may offer and these are available for physician review and editing if necessary. Standing orders should be created for routine preventive care like immunizations so they may be given by the nursing staff without physician input. Labs can be routed to a nurse/medical assistant for initial review and sending notification of normal results. Abnormal labs should be identified clearly in the physician in box so they can be managed separately from signing off on the normal results. E-prescribing refill requests can be routed to staff to triage whether the patient is current on appointments, etc so that the physician does not need to deal with those that would clearly be denied. All these are tasks that physicians are used to doing; they just need to evaluate how the process will change. Very few if any certified EHRs expect a physician to be a typist entering everything by typing. The key there is to get the system and hardware that support the data entry method the physician is most comfortable with. Tablets have excellent handwriting recognition and while one loses much of the benefit of structured fields with dictation, voice recognition is another option. It is not as good as handwriting recognition but many physicians are quite successful using it.

I haven’t come across any physicians as of yet who balk at EMR adoption because they feel it’s turning them into secretaries – although, having worked on several EMR implementations over the past few years, I can understand why.

For most of the past century, doctors were trained as medical practitioners, as they still are to this day. They rightly think of themselves as highly skilled profesionals, and the idea of documenting, recording, filing, and collating their patient records is a function that has always been left to secretaries, nurses, and CNA’s, allowing them to concentrate on practicing medicine. I’ve run into the same attitude among attorneys. It’s not so much a question of keeping track of documentation, it’s more a question of doctors not being specifically trained or particularly interested in doing so, whether their practice has implemented an EMR or is still using paper and filing cabinets.

I often make the comparison with other medical technology that’s been implemented over the past century – X-ray technology, EKG and EEC, new and more effective medications, etc. All these technological developments have permitted the physician to practice medicine more efficaciously and at greater profit than their forebearers coulod have dreamed – so, if the technology is a thing to be avoided, why are they prescribing Cipro when erythromycin would do just as well? Why implement a far more accurate digital blood-pressure monitor, when their old sphygmomanometer from 1975 would do just as well? Why send a patient out for an expensive MRI when a cheaper CT scan would suffice?

The answer, is, of course, that even a secretary uses a computer instead of an IBM Selectric, sends emails instead of letters, calls patients on the phone rather than send by carrier pigeon.

When you consider that the cost of implementing a comprehensive EMR system can cost as much to the physician as having a secretary, medical biller, and accountant on staff, it seems like a huge investment. However, if the implementation allows the physician to eliminate those now redundant positions, the cost-savings become obvious. Even if a physician determines that those positions should be retained, the cost savings in terms of more efficient processing of paperwork, reduction of prescribing errors, the cost of being compliant with third-party payer requirements, and the ability to track patient care more than outweigh the cost of investment.

A medical practice is a business, and a physician is a professional running a business at a profit. Any technology that allows him/her to do so should be a no-brainer.

(Disclaimer: I’m with an EMR vendor.) I’m familiar with this problem. Hospital Administrators want to cut costs (rightly so) by using EMRs to eliminate their transcription staff. Thus, doctors don’t get become secretaries, they become transcriptionists. Because many EMR products are hard to learn and use, the doctors are forced to slow down to do the data entry, meaning lower patient throughput and ipso facto fewer reimbursables.