David Lee Scher, MD, FACP, FACC, FESC, FHRS.
Dr. Scher was, until recently, a practicing cardiologist and cardiac electrophysiologist. He has extensive experience in the medical device and healthcare IT industries, and is now Director at DLS HEALTHCARE CONSULTING, LLC concentrating in device and IT marketing.
Electronic health records should be a digital representation of a provider-patient interaction as well as a repository for test results, medications, and interactions with outside providers. According to the vision of the ONC (government healthcare IT regulators), it should be a tool with Meaningful Use, a secure, fluid flow of information among appropriate players in the healthcare spectrum of that patient. This is very wishful thinking on a number of levels.
What Electronic Healthcare Records DO
EHRs will bring medicine into the digital age more so than it is now. The lack of physician offices being ‘wired’ has been embarrassing for the professionals who have adopted this technology for the good of our patients years ago. Technology utilized in the diagnosis and treatment of disease uses leading edge developments in IT. But the more important communication of this technology among providers has been in the Stone Age. The transition is proving painful but necessary. Government penalties for lack of adoption are estimated to exceed incentives to successfully adoptees by $600 million by 2017.
The adoption of Electronic Healthcare Records will increase patients’ access to their own medical data. Part of the Meaningful Use regulations mandate short time limits between patient requests for their record and the transmission of them by the provider. This applies to emergency department visits, office visits, and the entire patient medical record. This is a right of a patient. The time limits set forth by the ONC are a bit onerous and may very well be revised, but the principal is sound. Patient educational tools will be a function of this portal as well.
EHRs will become a good tool for medical malpractice documentation, both for the defense and plaintiff. Entries will be timed, entry provider identified, and difficult to alter. Providers need to be educated about this aspect of EHRs very well, as it represents a different set of guidelines in this regard.
What Electronic Healthcare Records DO NOT DO
Electronic Healthcare Records will not be accurate coders for services rendered in the office. EHR companies are promoting their products as moneymakers for providers, touting their systems as products that appropriately upgrade coding for higher visit fees. These are very loosely on E and M components of billing. Most of these systems are from automatic drop down lists of history and physicals. These types of systems lend themselves to gross errors. The complexity of the decision making process, the review of records furnished by other providers, and other factors can drastically change the automated billing code. Be wary of EHR companies that put this on the top of the list of why you must buy their product!
Electronic Healthcare Records will not be compatible with all systems out there utilized by other providers, labs, hospitals, etc. This is the true Achilles heel of Meaningful Use and expectations of EHRs. The huge amount of EHR and other product providers as well as the cost and healthcare political issues involved will slow this goal down indefinitely as far as I can see.It mimics many aspects of our healthcare system that are complicated by the sheer diversity of players (insurance companies, governmental agencies, providers, institutions).
EHRs will not necessarily save money, improve patient outcomes, or decrease adverse drug reactions. None of these have been show thus far. The jury is out. These are the most laudable goals of EHRs. At the minimum EHRs are getting healthcare into the 21st century. Let’s give this a chance!
David Lee Scher, MD, FACP, FACC, FESC, FHRS
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