Docs not tech-savvy? Not so fast…

By David Sullo, MD
Electronic medical records (EMRs) are slowly making headway into both hospitals and doctor’s offices.  My office has now been paperless for six years, and there are many benefits.  However, I cringe when I see the mainstream media declaring “if those old-fashioned doctors would just get with the times, medicine could all be electronic!”  There are legitimate reasons why many pediatric offices have not gone electronic, most of which get overlooked in the press.  Here’s a few:

Cost

Yes, these systems are quite expensive.  There is software, computer terminals, a wireless network, antivirus software, several printers, a central server to hold the information, a battery backup for said server in case the power goes out…you get the idea.  Usually we’re talking six figures when all is said and done.

Lack of standards

Right now, each EMR has it’s own way of storing data.  As a result, it is nearly impossible to share data from one system to another.  If a practice buys one system, and is displeased, switching systems means losing data, or printing every chart out of the old record and scanning it into the new system.  As you can imagine, this makes doctors highly apprehensive about buying a system and getting stuck with a lemon.

The outside world

Some local pharmacies still do not e-prescribe.  We are able to access information about a patient’s insurance plan (copays, etc) electronically from some insurers, but not from others.  Summer camps require health information “on their form only,” even though we can print out the same information from our system.  My favorite is the state, which is receiving federal funds to encourage EMR adoption, and then decides that things must also be “on their form only!”

Skewed incentives

The federal government has allocated funds to partially reimburse offices which have gone paperless.  However, the criteria to receive these funds are heavily weighted against pediatricians.  An office is required to have a certain percentage of Medicaid patients, of which most pediatric offices fall short.  Even if they qualify, they are still only eligible for 2/3 of the money that an internal medicine office would receive through Medicare for the same program.  So pediatrics, which is the lowest paid medical specialty, also gets the least help in subsidizing purchase of an EMR.I hope it is clearer now why doctors, and pediatricians in particular, might be slow to adopt this new technology.  Rather than aggressively pushing adoption of an imperfect system, we should improve the system until incentives are not needed.  In my next post, I’ll talk about a few basic fixes that could achieve this.

Dr. Sullo is a board-certified pediatrician and a Fellow of the American Academy of Pediatrics. He is a practicing pediatrician in Rochester, New York

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4 thoughts on “Docs not tech-savvy? Not so fast…

  1. Just imagine if all EMRs adopted a universal camp/school form, accepted by ALL camps and schools… nah, too simple, rational and reasonable!

  2. For those practices that have been electronic in keeping medical data for some time like your practice, I’m sure there are benefits and shortcomings with computerized records. As one who struggles to use the EMR effectively, I am reminded often that being able to see the forest for the trees is critical in any medical record. While we store so much data and use templates that can streamline charting, while we prescribe without the burden of bad handwriting, while we celebrate what’s easy about EMR, we must also be faithful to accurate charting. A medical entry cluttered with unorganized information and irrelevant templated “normal” data can easily obscure a real problem. An EMR not designed to address the unique needs of one specialty (like vaccines or a growth chart for preemies in pediatrics) might also create issues for managing patients.
    It’s not a panacea to use to an electronic record, but overall, it’s better than what a traditional chart can provide for overall data keeping. It’s important, however, to remember that you get something and give something in exchange. It’s my hope that someday the patients (and in our case, their parents) will also participate with us in keeping these electronic records of their health and illnesses.

  3. Pingback: Docs not tech savvy, or tech not doc savvy? | Survivor: Pediatrics

  4. Anyone not willing to change with technology will not grow. EMR software has been around for some time now. Paper offices are delaying the inevitable. It will be the standard, and it will be enforced by the government. That’s way they are offering incentive now.

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