What are the promises and realities of an EHR

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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?

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.

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

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.

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.


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