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    Monday, January 17, 2005

    EMR Saga: A physician reader asked me to elaborate on the saga of my electronic medical record. There's a lot of pressure for physicians to forsake their old dead tree based record systems and adopt computerized electronic medical records. The use of a computerized record would, theoretically, cut down on errors as a result of bad documentation and bad hand writing. Even the President is pushing for them. (Although his dream of one universal record that can be accessed anywhere by anyone is a little daunting, and more than a little scary in its implications for patient privacy.) And yet, few of us have made the move.

    Frankly, we fear them. They're expensive - very expensive. To those of us who have only ever known a paper system, they seem intuitively less secure. There's the fear that an errant touch of a button or a computer malfunction could evaporate thousands of patient charts. Or that someone could walk away with all of the charts by stealing the hardware. Or that an employee could download a virus or worm that destroys the whole system. And there's just the general fear of the unfamiliar. I count myself among the fearful, but in the end decided to move to an electronic medical record because I hate paperwork. A hate so strong it finally overpowered my fear.

    I ended up choosing a system called SOAPware, largely because it's one of the more affordable, if not the most affordable, programs available. Most companies make you go through the process of talking to and meeting with a sales rep before you can learn how much the system is going to cost, but SOAPware had all of their prices on their website, along with an online demo. In addition, I had heard good things about it from a few other doctors on a family medicine email listserve, and I had a chance to see it in action a few years ago at a conference. The biggest selling point, though, was the ability to buy it in modules. This let me purchase the most basic features I needed at a price I could afford. (I spending about $1500, a far cry from the $23,000 quote from another company.)

    I'm looking forward to being able to write prescriptions and referral letters with the click of a button. I'll even be able to fax prescriptions to pharmacies. I'll be able to do that in less time than it now takes me to give my staff the OK to call in a prescription. And my staff will no longer waste time on hold with the pharmacies. A click of a button and orders for tests will be written, complete with diagnosis codes and patient demographic information. Ditto authorization requests for insurance companies. And when a test result comes in or another physician calls about a patient, I won't have to ask for the chart to be pulled, I can pull it myself. With the click of a button. Charts won't get lost or misfiled, and my staff won't have to go through the office searching for through "call-back" and "to be done" stacks. We won't have to copy charts for patients who are leaving. Instead we can download them to a CD-ROM or print them out. With the click of a couple of buttons. I'll even be able to dowload selected parts of a patient chart to my Palm for easy transport to the hospital. (Password secured, of course.)

    There are some drawbacks, however. SOAPware isn't very attuned to pediatric patients. Documenting immunizations in the standard form that most practices use on paper is difficult, but not insurmountable. And there are no growth charts, although the flow chart module can automatically calculate height, weight, and head circumference percentiles. I miss the graphic data, though, and will probably continue to do those on paper.

    Perhaps the biggest drawback is the lack of tech support, although this could be an advantage to those who are more computer literate than I am. When it came to buying the appropriate hardware and putting the software on the computers, I was on my own. The SOAPware people provide a list of hardware vendors and consultants who can help with these matters, but that's more money and a degree of trust in strangers that I just don't have. It's also a little more work to look them up and contact them and interview them than it would be if all of that support came with the package. (Of course, that's one of the reasons it was affordable.)

    My relationship to computers is akin to the one I have with cars. I can use them very well, but I don't know how they work. Luckily, I have a husband who is very computer savvy. By that I mean that he has experience with programming and problem-solving. Doubly luckily, he can also read my mind. That may seem beside the point, but as a computer illiterate, I often have trouble communicating with tech support people. I just don't use the right phrases and words to get my point across, or I don't use them correctly. My husband understands my limitations and was able to help me choose the networks and hardware I needed and set them up with a minimum of confusion. He also installed the program for me, a process he describes as "easy." I'm sure it was for him. It would have been impossible for me.

    ADDENDUM: For those beginning the process of looking for an EMR, the American Academy of Family Physicians has a comprehensive collection of useful links. Some are restricted to members only, but there's also a lot of useful information available to non-members. The Family Practice Management journal has many helpful articles. And although it's a little dated, I found this article a good place to start my search for a vendor.

    UPDATE: Here, in a nut shell, is why electronic medical records haven't been widely adopted:

    Buying an EMR system with adequate overall technical support is still very expensive, and the declining economics of primary care along with higher malpractice insurance and other expenses just do not allow the average small practice physician to make the investment. A lot of us look at this as just another potential unfunded mandate. If somehow I could project another 25K in income this year, I would be happy to invest it in an EMR. That's not going to happen.

    Maybe we could leverage tort reform and medmal insurance premium reduction into an EMR-subsidy. Just dreaming.

    And from someone with experience in medical systems design:

    Some things I've seen may explain your experience. The reason that it's hard to find medical applications that perform a reasonable task at a reasonable price is that too many docs want Ferraris, Maseratis, and Mercedes-Benzes. Not the cars--the computer applications equivalents.

    It's not enough to bring a product to the market that performs the required task effectively. The product has to make your breakfast in the morning, fly to Mars, and solve Fermat's Last Theorem as well.

    Especially breakfast in the morning. And coffee in the office, too.


    posted by Sydney on 1/17/2005 08:49:00 AM 0 comments


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