Overcoming Resistance to Electronic Medical Records


MAUI, HAWAII — Physicians are needlessly resisting the inevitability of electronic medical records, according to Dr. Martin J. Bergman.

As of 2005, about 23% of office-based physicians used electronic medical records (EMRs), said Dr. Bergman, citing statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics that were reported in 2006. In contrast, almost 80% of office-based physicians used billing software, he added.

Reasons for resistance include complaints that EMRs are difficult to complete, interrupt the office flow, and take too much time to administer and review, said Dr. Bergman of Taylor Hospital, Ridley Park, Pa.

“The first obstacle is cost,” he noted. The cost of getting EMR software can range from $5,000 to more than $30,000, although the better software doesn't necessarily cost more.

Once EMRs are established in the practice, physicians can expect significant savings associated with their use. The practice will save on transcription fees, and dictation will no longer be needed.

“My example is 12 years ago, when I went into electronic records, I was paying just under $20,000 a year for transcriptions,” he recalled. “I no longer use a transcriptionist. Over 12 years, I've saved close to $250,000 on transcription fees alone.”

As for time difficulties, there is a “steep learning curve” in getting used to using EMRs; it takes about 3 months to become familiar enough with the software that it no longer slows down the physician's practice.

“Those first 3 months are ugly,” he said. “After that, your productivity doubles.”

Dr. Bergman pointed out that EMRs can be used to track metrics—measures of patients' progress—which is difficult to do with paper files.

Metrics can quickly help gauge the success of the practice, and the news is not always good. “Until you start doing metrics, you think you are doing better than you are,” he said. “The majority of us are not using any form of metric.”

Other benefits of EMRs include:

An increase in productivity. Dr. Bergman observed that, now, paper records slow him down. EMRs give him instant access to entire histories, including lab tests and drugs used.

Easy creation of referral letters. Print them by pressing a couple of buttons, and upon leaving the computer, he said, “I'm done when I'm done.”

A tool for research. Patient data can be graphed to show results of treatment over time, which provides a good source of private practice research.

Access to databases. Data extracted from the EMR database can readily be shared with existing databases.

Patient data typically collected in an EMR include demographic information, active and comorbid diagnoses, currently and formerly used medications, and lab reports, he said during his presentation at a symposium sponsored by Excellence in Rheumatology Education.

EMR software offers two basic options: template software and database software. The choice might depend on whether the purchaser is in a solo practice or a group practice.

The solo practice will be better served by database software, which is flexible and can be altered on the fly to fit special information-gathering needs. But a group practice or hospital will more likely want template software, which is more rigid, and requires all users to fill in the same kinds of information in the same format.

Solo practitioners, Dr. Berman said, will probably not like working with rigid template software; they should look at flexible database software instead.

There are free, month-long demos of software available that allow determination of which one is appropriate for the practice.

Although patients can enter data directly into their EMRs at an office computer kiosk, some patients might find doing so difficult.

A personal digital assistant (PDA), which is often used by physicians to enter patient data in hospitals, also presents problems for some patients. A laptop is another option; however, because it may need to be replaced every few years, it may be a costly one.

Dr. Bergman gives his patients paper questionnaires; the answers are entered into the EMRs. His questionnaire comprises mostly check-off questions, which are easy for patients to fill it out quickly and for office staff to enter electronically.

After the patient's questionnaire information has been entered into an EMR at the office, Dr. Bergman can quickly open the patient's record, see the new information, and easily review information from the previous visit.

Dr. Bergman said that although he has been using EMR software from Stat Systems for 12 years, he is neither a spokesman for nor an owner of the company.

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