QMC 5 Should I invest in EMR?

I had a question from Dr. KC the other day,asking if he should invest in an EMR?

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For those of you who’re still stuck with paper and pen, then here’s the low down. EMR is an Electronic medical record. All records are entered and stored on a centralized system.

The EMR trend gained traction largely because of Insurance companies and not to deliver better health care. With the arrival of billing, insurance, and ICD-10 the pressure on doctors is increasing to micro diagnose.
I’ll give you the advantages and disadvantages of the EMR and leave you to make your own decision. I’m comfortable with the EMR, because as an author I’m a very fast typist. It doesn’t make me a better doctor. But I do find that sometimes, a return to paper would be far better than wasting time checking all the boxes and filling an entire EMR. I’ve worked with a number of EMR’s, from ready-to-use software to customized EMR’s. Similar problems are pervasive throughout.

Advantages:
1. Clear, no ambiguity – Since handwriting does not come into play, nothing is vague. Everything is clear, in black and white. There’s no second guessing a doctor’s orders. It’s fairly easy to catch a mistake.
2. Organized- All the information is in one place. You don’t need to rely on a secretary or a filing system to search for files, reports, etc. It’s all on the system.
3. Labs and X-ray uploaded electronically. You don’t need to have a physical copy in your hand. If the lab uploads the reports on the system, instantly you have it.
4. Accessibility -You can see if another doctor has seen your patient and follow his notes online.
5. Easy- For a tech savvy person, it’s pretty easy. The ease of filling up information can actually disrupt any summary or history writing skills you have.

Disadvantages:
1. Privacy – As much as we trust doctors to keep things confidential, there are issues of privacy. Any doctor, nurse, physio that has access to EMR will be able to see files, unlike with physical copies where a secretary would guard them with her life & only let you see it, if you’re a consultant on the case. This is a major issue
2. Time- The AMA says, it definitely has increased the time doctors spend on filling paperwork by forty eight minutes. It can be a bit of a time-suck, typing and checking all the boxes.
3. Costs- Its expensive. Whether its a pay per episode, per patient or per GB, its expensive, which is why its not something all hospitals are transitioning to. North of 5 lacs in INR and 33,000$ depending on where you are. The agencies that do customize this, charge you every time you want to change something.
4. Loading time- If too many people are on the system or too many files are open, the system does slow down considerably. Not nice, when you’re sitting with your patient and he’s blankly staring at your face, because you have no clue what his last blood pressure was. Frustrating to say the least.

For a small group practice I would say the cost benefit ratio is low. Unless you plan to expand to multiple centers or branches. But if you’re running a large practice with multiple doctors, multiple centers or something institutionally larger like a nursing home or hospital, you should definitely consider it.

What do you think of the EMR? Many of my friends have transitioned back to paper after working on the EMR in order to fight the insurance lobby. What do you think?

References:
McDonald, Clement J.; Callaghan, Fiona M.; Weissman, Arlene; Goodwin, Rebecca M.; Mundkur, Mallika; Kuhn, Thomson (November 2014). “Use of Internist’s Free Time by Ambulatory Care Electronic Medical Record Systems”. JAMA Intern Med. 174 (11): 1860–1863. doi:10.1001/jamainternmed.2014.4506.

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