Author Topic: What are the promises and realities of an EHR  (Read 4910 times)

Ango_mark03

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What are the promises and realities of an EHR
« on: July 08, 2014, 05:33:23 AM »
The EHR is a giant leap towards interoperability. But what about its impact on doctors, is it taking the time which is meant for patient visits or the error in the workflow? How about its benefits? How should the adoption improve?

PMRNC

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Re: What are the promises and realities of an EHR
« Reply #1 on: July 08, 2014, 08:17:04 AM »
IMHO, I believe we will see this date pushed back AT least one more year but my guess is 2 years. They have not ironed out nearly have the kinks of privacy, security, etc. Then like you mentioned is the time factor. The other day, we took my grandaughter to the pediatricians office and I hadn't been in this office before and was completly flabbergasted as to the kaos in the office with the nurses trying to juggle their mini laptops, meds, and anything else they need. Then you could hear of course as in all pediatricians offices a child crying loudly and the doctor had to speak over him because he had to type away on his laptop, when the doctor got to us, my grandaughter was happy and she was yelling a bit.. and he stoof off to the side of the room with his little tablet in hand and would do nothing but look at the tablet, ask questions w/out looking up, then at one point he went to examine her (most of the visit was spent with him looking at his tablet) his tablet beeped or something so he picked it up and then said, Oh I'll be right back. Comes back into the room 10 min later apologizes that we have to go through the  questions again !!! I wanted to grab my daugther and grandaughter out of there so fast..but I'm just the grammy.

My own experinece was not good with EHR either so I now have a legal OPT out I give to my physicians. Of course they look at me like I have two heads but my attorney's name/number are on it and they can do their homework.  I don't like EHR's and I don't believe they will be private at all. I think they are going to frustrate doctors that are indeed USED to hands on with their patients and then they will be more of a toy to those who like them, patient communications will diminish.

According to CMS these are the guidelines for establishing EHR / and pentalies for not doing so.

f Medicare eligible professionals, or EPs, do not adopt and successfully demonstrate meaningful use of a certified electronic health record (EHR) technology by 2015, the EP’s Medicare physician fee schedule amount for covered professional services will be adjusted down by 1% each year. The adjustment schedule is as follows:

    2015—99% of Medicare physician fee schedule covered amount
    2016—98 % of Medicare physician fee schedule covered amount
    2017 and each subsequent year—97% of Medicare physician fee schedule covered amount

If less than 75% of EPs have become meaningful users of EHRs by 2018, the adjustment will change by 1% point each year to a maximum of 5%(95% of Medicare covered amount).

The Recovery Act allows for hardship exception from the payment adjustment in certain instances. The exemption must be renewed each year and will not be given for more than 5 years. More information on payment adjustments and the requirements to qualify for a hardship exemption will be provided in future rulemaking between now and the 2015 effective date.

Linda Walker
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Anand

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Re: What are the promises and realities of an EHR
« Reply #2 on: July 08, 2014, 08:23:12 AM »
Any new technological inferences has its own +ves& -ves & EHR is no difference. The idealogy is to extend the best possible service and enable good health care to pt's. With that being said - certain practices still working or unsure about the effectiveness of EHR and the reason behind such requirements, on the flip side we do have great pool of practice and office's have already been set and the changes are up & running . With the Mobile first/Cloud first advancement, such changes would certainly align the healthcare into the next level as the constant change has become inevitable. However what I forsee and required at this point in time is the fact that both the Dr's & Pt's should get continous education and importance of EHR . In a broader prespective I think this would certainly change the way healthcare opertaes for all good reasons.. JMO

DMK

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Re: What are the promises and realities of an EHR
« Reply #3 on: July 08, 2014, 10:32:04 AM »
I can tell you first hand that EHR is a NIGHTMARE for the providers.  Although it was well intentioned, and should have made record keeping better, it doesn't.  The doctors are stressed out because they can't doctor.  Most of them are not computer savvy, and yet they are FORCED to participate or get their reimbursement cut even further than it has been.  Add to that the cost of the computers, the software (horribly expensive for the really good ones, but there are free ones) and the WASTED time trying to learn the software, keeping up with meaningful use measures (and the gobbledy gook way that's written up) and then throw in the ACA stuff, and you have a HOT HOT MESS! 

Care will continue to get less and less personal, less and less efficient.  Prescriptions will be messed up and delayed, studies will take longer to order and get done, referrals will be delayed worse than they already are.  The staffs in all offices will get crabbier and crabbier, and more doctors will quit private practice and go to the hospital groups because the HOSPITAL has to take on the expense and see to it that the work gets done. 

In a perfect scenario you could go to any doctor or hospital with your name and insurance information and they could pull up your entire history and CORRECT information.  Not gonna happen.  It's still data being punched in based on what the patient tells each doctor (and sometimes they don't tell the whole truth, or can't remember).  So...garbage in, garbage out.

There is my unvarnished opinion.  And our EHR is going pretty well!  Our scope of practice means that there is NO WAY for us to meet meaningful use.  We're hoping to meet just enough to not get dinged on our payments.

rdmoore2003

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Re: What are the promises and realities of an EHR
« Reply #4 on: July 08, 2014, 11:20:27 AM »
I have worked with EHR for the past 9 years.  I like it much more than papercharts.  It really is up to the providers office on how smooth or rough it goes.  I have seen providers offices that still use paper charts, lose the charts, cant read handwriting (even dr cant read own handwriting), papers not in correct part of charts, etc.   Depending on which EHR system you purchase, it can be very helpful.   Paper charts and EHR both have good & bad aspects.  However, if you have a provider that is not very detailed or is very messy, no matter what system you have it will always be the same.   If your provider is opposite of that and has his staff correctly trained on a new EHR, then there should not be any major problems....this is all just my opinion.
Regina

PMRNC

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Re: What are the promises and realities of an EHR
« Reply #5 on: July 08, 2014, 12:24:56 PM »
Cumbersome is one word.. clumsy is another and adjustment is another.. but all of that is on the Practice's side. When do we hear about the privacy issues on the side of the patient? that's my whole deal.. they don't get a vote, physicians are going to be OBLIGATED to educate them and so far that's not working out too well. Patients must know their state privacy laws in addition to federal privacy rights.. I've not seen ONE physician with a hand out on privacy for the patient.
Linda Walker
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RichardP

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Re: What are the promises and realities of an EHR
« Reply #6 on: July 08, 2014, 01:32:33 PM »
... is it taking the time which is meant for patient visits or the error in the workflow?

A couple of our clients adopted an EHR about four years ago.  Once they got up to speed, they were spending about 30% of their workday putting data into the computer/EHR.  Much of what they were using their very expensive time to do was what we used to do for them as their Practice Management company, using much cheaper labor.  Time that they previously used to generate income with by seeing patients.  I have since read articles in Medical Journals, and the related comments, where many other EHR adopters were reporting about that same 30% of their workday - doing data input rather than seeing patients.

... How about its benefits?

The Federal government has a goal to develop best practices for as many medical conditions as possible.  The changeover to using EHRs will allow them to collect the data - illness definition; treatment(s); outcome - that will allow these best practices to be discovered (what range of treatments generated the best outcomes for a given medical condition?).  In that respect, the changeover to EHRs is not for the patient's benefit, it is for the Federal government's benefit (as well as the Insurance Carriers).  EHRs are likely to result in reduced doctor/patient interaction - which cannot be to the patient's benefit.

We have discussed these issues on this board before.  If you search, you are likely to find similar comments.

rdmoore2003

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Re: What are the promises and realities of an EHR
« Reply #7 on: July 08, 2014, 01:42:48 PM »
. I've not seen ONE physician with a hand out on privacy for the patient.

WE DO!!!!
Regina

kristin

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Re: What are the promises and realities of an EHR
« Reply #8 on: July 08, 2014, 07:47:06 PM »
I have a bit of a dual perspective on it, because the office I run does not have an EHR, nor will it ever, and the various doctors I do remote billing for all switched to EHR's in the last few years. Believe me, my doctor is the happiest one out of the bunch. She doesn't have to deal with Meaningful Use, PQRS, E-prescribing, etc. She isn't, nor are her staff, chained to a laptop/tablet during patient visits. Her eyes are on the patient the whole time, and patients tell us how "nice" that is, compared to their other doctors with EHR's. But we are lucky...she is retiring in a few years, and when I ran the cost/benefit analysis of getting an EHR and implementing it, versus not getting incentive money, and getting dinged by Medicare down the road, we still come out ahead.

For the doctors I deal with that do have EHR's, while they like certain things about them, overall, they wish they hadn't gotten them. But they all have a good 15 years or more of practice life left, so they really didn't feel they had a choice. And most of them won't get the incentive money, due to scope of practice, and other issues. Not one of them have set up the patient portals, either.

Of the seven different EHR's/PM softwares I use for my remote billing(because of course, not one doctor happens to use the same one, LOL!), frankly, one is worse than the other....especially when it comes to actual treatment notes. The whole use of templates causes real problems, and there is no "flow" to the notes. Plus there is the EHR function of "prompting" the doctor to choose certain codes/EM levels, and that is a whole other issue. So yeah, I am not a fan.

DMK

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Re: What are the promises and realities of an EHR
« Reply #9 on: July 09, 2014, 10:56:08 AM »
Love this discussion!  We've been seeing, directly, what's motivating this whole EHR movement.  Drugs, drugs, drugs. The ability for the insurance companies to see who smokes, who's fat, and who has high blood pressure and depression, so they can raise rates, drop patients or put them on drugs.

Our software actually prompts us to counsel on weight loss, smoking cessation, and test for depression.  None of it is in our scope!

We've been trying to educate the patients about their rights.  Most don't like the EHR AT ALL!

jessyp

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Re: What are the promises and realities of an EHR
« Reply #10 on: July 10, 2014, 05:35:22 AM »
According to a New York Times analysis of Medicare data from American Hospital Directory, Medicare payments increased by 47% for hospitals that received government incentives for adopting EHRs. EHR also plays a vital role in enhancing quality of work and productivity of coders as it gives them a chance to access their work remotely.

Jessica Parker
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shanbull

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Re: What are the promises and realities of an EHR
« Reply #11 on: July 10, 2014, 11:41:45 AM »
We went electronic in 2006, it is illegal here now to not have EHR and electronic claims submission according to state law. EHR solves some inefficiencies, but creates new ones. I think overall, most EHR software is released for public use LONG before it should be allowed out of beta testing.

PMRNC

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Re: What are the promises and realities of an EHR
« Reply #12 on: July 10, 2014, 03:59:37 PM »

Quote
We went electronic in 2006, it is illegal here now to not have EHR and electronic claims submission according to state law. EHR solves some inefficiencies, but creates new ones. I think overall, most EHR software is released for public use LONG before it should be allowed out of beta testing.

I have to question that it's illegal NOT to have an EHR. The federal mandate doesn't even force it upon providers who do not see Medicare/Medicaid patients. That's getting into some sticky waters of "fair trade" to force doctors to use EHR before the federal mandate PLUS ALL Doctors? I'd have to see this law to believe it.
Linda Walker
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shanbull

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Re: What are the promises and realities of an EHR
« Reply #13 on: July 10, 2014, 05:16:29 PM »
Here is the EHR law: http://www.health.state.mn.us/e-health/hitimp/ (apparently it's not "mandatory" until 1/1/15)

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62J.495 ELECTRONIC HEALTH RECORD TECHNOLOGY.
Subdivision 1.Implementation. By January 1, 2015, all hospitals and health care providers must have in place an interoperable electronic health records system within their hospital system or clinical practice setting. The commissioner of health, in consultation with the e-Health Advisory Committee, shall develop a statewide plan to meet this goal, including uniform standards to be used for the interoperable system for sharing and synchronizing patient data across systems. The standards must be compatible with federal efforts. The uniform standards must be developed by January 1, 2009, and updated on an ongoing basis. The commissioner shall include an update on standards development as part of an annual report to the legislature.

And the electronic claims law: https://www.revisor.leg.state.mn.us/statutes/?id=62j.536

Quote
(g) Notwithstanding any other provisions in sections 62J.50 to 62J.61, all group purchasers and health care providers must exchange claims and eligibility information electronically using the transactions, companion guides, implementation guides, and timelines required under this subdivision.
« Last Edit: July 10, 2014, 05:22:52 PM by shanbull »

PMRNC

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Re: What are the promises and realities of an EHR
« Reply #14 on: July 10, 2014, 05:58:07 PM »
Quote
Here is the EHR law: http://www.health.state.mn.us/e-health/hitimp/ (apparently it's not "mandatory" until 1/1/15)

This is one slinky dinky law..LOL In this section:

The statute defines a health care provider, through Minnesota Statute
§62J.03 (Definitions), as “a person or organization other than a nursing home that provides health care or medical care services within Minnesota for a fee and is eligible for reimbursement under the medical assistance program

Then you have this one:

Minn DH understands the §62J.03 portion of the 2015 Interoperable EHR Mandate to include any health care provider who provides a service that could be
reimbursed by Medical Assistance or MinnesotaCare, whether or not the provider accepts these patients or accepts payment for the service.

How are physicians liking the fact that whether they take medical assistance (Medicaid) or not they are forced into EHR?? This ONE statute seems to be very contradictory.
Linda Walker
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