Ask the Doc: What's up with all the computers?
Doc: Why are all my doctors now using computers instead of dictating? Seems like he looks more at the computer than me now.
A: The vast majority of physicians transitioned, or began their transition into electronic health records (EHR), after the passage of the Affordable Care Act (affectionately and unaffectionately called “ObamaCare”) in 2010. Some physicians embraced computers as a tool to help with their day while others also see it as a tool, albeit a hammer, they have been hit over the head with by well-intentioned pencil pushers.
The federal government’s Centers for Medicare and Medicaid Services is the entity that deals directly with physicians, medical corporations and hospitals in the matters of payment for services, fees, rates of fees and denials of payment. It is a massive and complicated area of governmental healthcare.
The Centers for Medicare and Medicaid Services dictates that physicians must use EHR or be penalized with lower reimbursements. It is the entity which doles out the money to physician groups to pay for the computers, computer software and training needed to transition physician offices into their EHR.
As with any government funding, there are requirements the government stipulates concerning how the computers are used and, more importantly, what data is collected and reported to the government.
“Meaningful Use” is the term used in the industry for the data collected and used by the system to justify the funding from the government. “Meaningful Use” is the reason medicines are reviewed with such scrutiny, demographic and insurance information data is carefully double checked, past medical histories are entered into the system and vital signs recorded every visit.
It is good medicine to make sure these things are correct in the computer. How they are entered, and what type of system is used, can be a huge variable.
A large percentage of physician offices were using paper charts prior to 2010. In order to hold onto that information, the charts were scanned into the computer system creating a sort of picture show of documents. The question of how much of the medical record is to be scanned in is up to the corporation managing the office — some scanned in all of the records, and some scanned in only a couple of years.
The difference in chart sizes for patients can be huge. Some patients measure their doctor visits in number per year. Others measure their doctor visits in inches of charts. It was not uncommon to work with a paper chart six to 12 inches in height. Deciding how much to scan in can be a crucial decision. Physicians generally want all the information they can keep on a patient.
Therefore, the vast majority of Americans, regardless of whether they have Medicaid, Medicare or private insurance, now have their medical records scanned into a computer, somewhere, and that computer is connected to the Internet so that Medicaid, Medicare and, yes, even private insurance can review the chart, the data collected, and have an oversight into the patient’s medical care.
The management of privacy is under the guidelines of the HIPPA, which is the medical information privacy act from the late 1990s. The assurance of privacy is also from the same government which guards national secrets and the still talked about breach by one individual at the NSA.
The problem a lot of physicians are having is that many are not typists or data entry wizards. Physicians train into their early 30s to think, diagnose and manage. The frustration has increased greatly in the past months and the physicians are beginning to push back on the requirements. Right. Organizing physicians is very similar to herding cats. Many have left the profession over this very thing.
Also, EHRs vary in functionality greatly. I have experienced this first hand.
EHRs are, in some ways, a lot like church buildings. If you have ever been in an older church which has had many additions by various architects over the years, and tried to navigate through the maze of hallways, varying entry doors, spotty signage, creaking floors, odd smells, potpourris of heating and air conditioners, weirdly functioning windows and countless colors of carpet, and then been in a church designed with modern architecture and planning, you will completely understand the difference in EHRs. They are that different.
This variance has therefore made life challenging for the physicians, nurses, and data entry personnel, in an area where timely delivery of care is desired, but hampered by the requirements, with a carrot and stick, by government.
Electronic health records (EHR) do have a vast potential for improving care, and vast potential for frustrating care. The theft of data by hackers is the massive elephant in the room that few are talking about. Until this week. Stay tuned.
Eric J. Littleton, M.D. is a Family Physician in Sevierville, Tenn. His new office is located at 958 Dolly Parton Parkway. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to firstname.lastname@example.org.