Over the last several weeks, I have heard a number of physicians tell me that either they or colleagues that they know will be retiring rather than adopt utilization of an electronic health record. The main reasons: cost and learning new skills.
Almost all of these physicians have been in practice many years and bring a high level of medical expertise. Their reluctance to this issue is more a reflection of a further decrease in time spent with the patient than an inability to utilize modern technology. In today’s medical practice, more time is spent with computers and paperwork then with patients. Computers in many practices have either prolonged the time necessary for a patient visit or have, at best, kept it the same. There has not been an improvement in efficiency and not necessarily a decrease in errors in dictation.
Be this as it may, all physicians are required to verify adoption (meaningful use) of a certified electronic health record (electronic medical record) by 2015. After that time there will be a gradual decrease in Medicare reimbursements. In 2015 this will be 1%, in 2016 2%, in 2017 3%, in 2018 4% and eventually up to 95%.
Physicians provide many free services to patients including answering emails, filling out insurance, family leave and disability forms, filling prescriptions, returning phone calls, patient support groups and performing sidebar consultations. We are expected to provide patients with a written record of their visit and recommendations at the end of their visit. This requires us to type or dictate our findings using a voice to text program either during the visit or immediately thereafter.
It is, therefore, not uncommon for a physician to be speaking with the patient and typing with his or her back to the patient. This, obviously, dramatically affects the doctor patient relationship. It also can lead to a decrease in time we spend evaluating the patient. It also has created a tendency to use templates or to “cut and paste” from other dictations. This can lead to errors.
During the auditing process, reviewers use software to look for these practices and penalize physicians. In the past, such tasks were performed by transcriptionists, secretaries, medical records staff, etc. Now they are performed by us. I will never forget being caught by an administrator faxing a document. She asked me what I was doing and then admonished me for using expensive physician time to do clerical work. She went on to explain that she employed much less expensive staff to do these functions so I could see more patients. If she could only see me now spending most of my time doing what used to be done by non-physicians.
Of course, there are significant benefits to these practices. Using an electronic health record can improve our ability to communicate with our colleagues in a timely and legible manner. It allows for rapid auditing of our practices therefore decreasing administrative costs and helping with compliance. It also allows patients potential online access to the medical records.
The bottom line however is that electronic records are here to stay. Fortunately, physicians are very smart and technology is always improving. These functions include utilizing voice to transcription software, electronic prescriptions, utilization of physician extenders and more efficient electronic health records. In the future, one would hope that evolving technologies will help us overcome the inherent current compromise of our time with patients.
It is everyone’s goal to allow physicians to spend more time with patients and less time with the ever-increasing administrative functions. After all, most physicians were not trained to be transcriptionists. Hopefully, this will allow more docs to remain in practice. Over time, the tools will become more affordable and more accurate. To my senior colleagues approaching this with trepidation — please hang on. Things will improve and your colleagues and patients need you.
Curtis T. Miyamoto, MD is President of the Philadelphia County Medical Society.