by Richard L. Lindstrom, MD

EMR, DICOM, SNOMED, HIPAA, CCHIT — how many readers can explain in detail what each of these means to their practice? While to date only a few more than 10% of us have fully adopted electronic medical records, by 2015 we will all face significant penalties if we are not fully engaged in this next government mandate.

We at Minnesota Eye Consultants are still delaying implementation of electronic medical records (EMRs), partly because the costs are staggering, the technology available for ophthalmology is in evolution, and especially because of the horror stories we have heard from so many of our colleagues who have made the attempt to go electronic in the past. I am concerned that the penalties may be significantly greater than just the astronomical cost of implementation and the potential for reduced reimbursement for those who are noncompliant.

I am now old enough to have a few medical maladies of my own — hypertension for one, well managed on medical therapy, and a few sports injuries requiring joint surgery. Just this last week, I visited my internist who is part of a large multispecialty clinic that adopted EMRs 2 years ago. As I sat in the examination room, first the nurse and then the physician recited a long list of required questions while seated in front of a computer monitor, the whole time intent on the monitor and keyboard, without once looking up at me as they completed the history. Clearly, to me, this was a major disconnect in the way I have classically interacted with patients in our currently non-EMR clinic. Of course, there was an examination and a little laying on of hands with a few follow-up questions. Then another 5 minutes for me to look at the back of my physician as the data was entered and the treatment plan formulated.

On a positive note, a summary of the plan of therapy was immediately printed and handed to me, and the physician, one of the best internists in Minnesota, did turn and look me in the eye as he went over the plan and answered any questions. Having a good relationship with this committed physician, I asked him what he thought about EMRs. After a long sigh, which was in itself the answer to my question, he conceded that on the positive side, EMRs were a potentially powerful tool for large multi-specialty clinics such as his, where multiple providers at multiple locations participate in a single patient’s care. All caregivers at all locations have access to all the data immediately once it is entered. He admitted it was also a constructive tool for monitoring physician productivity and patterns of care, providing a powerful data set to those managing and regulating our practices.

The negatives were, however, even more important. He felt that he had lost significant rapport with his patients because he was required to enter so much data, which was an extremely time-consuming task. On many days, he felt more like a data entry clerk than a highly valued clinician. I certainly had to agree with him on this point, as two-thirds of my time with him had been devoted to data entry and only one-third to utilizing his training and skills as a physician. In addition, he said the data entry tasks had negatively affected his efficiency significantly, requiring him to reduce the number of patients he could schedule in a day.

His overall analysis: The EMR winners are management, regulators and third-party payers. The losers are patients and physicians. The bottom line: An easy-to-read computer-generated medical record does not guarantee high-quality personalized patient care.

So, at a cost of billions to physicians and surgeons already struggling to remain solvent, we enter into an era of more depersonalized care and reduced physician efficiency and productivity. Perhaps in time with dedicated physicians, increased experience, the use of scribes (which will also increase costs) and advances in voice recognition technology so that we can again look our patients in the eye when we talk with them, we will make EMRs a positive for the patients we care for every day. But for now, for most of us, it will simply be another government-mandated cost and inappropriate intrusion into the practice of medicine with no clearly demonstrated benefit to physicians or patients in regard to quality of care or patient satisfaction. No surprise, but disappointing nonetheless.

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