Doctors + Computers = Better Medical Care?
~ Demystifying the Electronic Health Record ~
By Jeannae Dergance, MD, and Shelly Thomas, CPC
IPC/Senior Care of Colorado ~ You’ve probably noticed a change happening at your physician’s office over the past few years. In “the old days,” your doctor would come into the exam room carrying your chart – a folder containing all of the information compiled about you over the years. The physician might make a few notes, tick off a box or two, and perhaps write a prescription. The rest of the visit would consist of the doctor examining you and asking you questions. Fast forward to today. It is likely that your doctor may now be using a computerized electronic health record (“EHR”) or electronic medical record (“EMR”). Instead of relying on the paper chart, he or she may either carry a laptop or use a computer in the room. And, because this is all new, it may even seem like the physician is paying more attention to that computer than to you.
Is this what the practice of medicine has come to? The answer is a resounding “yes.” The government (as well as the insurance industry and other interested parties), wants all healthcare providers to evolve into the digital age. There are currently financial incentives for providers who implement electronic record systems, but these incentives will begin turning into penalties for those who don’t comply by 2015. The good news is studies are beginning to show that, over the long run, adoption of EHRs is improving patient outcomes and efficiencies while reducing overall costs.
So what’s actually going on behind those screens? When you call in to schedule an office visit, the staff uses the scheduling portion of the system to see what appointment times are available and schedule you into the slot you select. When you arrive for your appointment, the medical assistant records your vital signs and the reason for your visit directly into your electronic record. Then your provider can use the computer to review the history in your record, see what medications you’ve been taking, record information about your current complaint and condition, order tests, send your prescriptions to the pharmacy, and document the appropriate codes needed for billing the visit to your insurance company. The information entered will be connected to your electronic chart going forward, easily accessed by the office team, the providers and, perhaps, even hospitalists, specialists or others as needed in the future.
Depending on the clinic, much of this important work may be done in the exam room when the physician is with you. That way, by the end of your visit, you will have your prescriptions, your referrals to specialists, lab orders, or whatever other paperwork you may need. Alternately, depending on your physician’s style or your care setting (if you’re in a nursing home or rehab unit, for example), they may only glance at the computer and make a few quick notes. This means that they will have quite a bit of work to do behind the scenes later – an important thing to remember if it seems like your physician is not spending much time on your visit.
In our practice, we train our providers to remain primarily focused on the patient – the person in front of them, not the computer. We take the time to explain to our new patients what we’re doing in the EHR and why it is important. If you ever feel that you are not getting the personalized attention that you deserve from your physician – that they are more concerned about what they’re recording in the computer than interacting with you, the patient, we strongly encourage you to speak up and let them know! They are probably working very hard to ensure that everything is right for you in the system and may not realize that you are feeling slighted. Open, direct communication between the patient and their healthcare provider should be priority one.
One of the most important benefits associated with the EHR, especially with senior patients who may be on multiple medications, is that the system will flag potential drug interactions. With the thousands of medications being prescribed out there, not to mention over-the-counter drugs and supplements that patients may self-prescribe, it is virtually impossible for your physician to keep track of all possible harmful interactions. When everything you’re taking is recorded in one place, this danger is greatly reduced.
Another aspect that has been incredibly helpful in our practice has to do with after-hours emergency room (“ER”) admissions. Let’s say that one of our patients who lives in a nursing home is admitted to the ER for a medical crisis in the middle of the night. Our on-call physician may not be the patient’s primary care provider; in the past, he or she would have known nothing about the patient’s history or condition. Because our EHR system is online, we can log in from home, pull up the patient’s record, and be well-informed to advise the ER staff.
And one great convenience to our patients is that, when they need copies of their medical records, we can access everything and print specifically what’s needed with the click of a mouse. In the past, with mountains of charts and the ever-present piles of random unfiled papers, it could have taken days to locate and photocopy the relevant records.
The eventual panacean goal is for each person to have one master medical record that contains every bit of health information from birth through death: illnesses, accidents, medications, surgeries, tests, treatments, and hospitalizations. All of this data could be accessed by any medical provider to whom the patient gives permission. But we are a long way from making this happen. With literally hundreds, perhaps thousands, of different software systems currently being used by physicians, hospitals and others, the challenge becomes getting them all to “talk” to one another. And of course there are many valid concerns around issues like privacy and fraud. We are making progress in the right direction, however, using the available technology to improve patient care.
Jeannae Dergance, MD, graduated from the University of Colorado School of Medicine and has an MS from the University of Texas Health Science Center. She currently serves as a Practice Group Leader, mentoring and assisting her peers at IPC/Senior Care.
Shelly Thomas, CPC, is an expert in physician billing and information systems who has worked in the business of geriatric medicine since 1995. She is currently the Assistant Director of Financial & Operational Strategies at IPC/Senior Care.
Dr. Dergance and Shelly have both been intimately involved with the implementation of IPC/Senior Care of Colorado’s EHR system. Schedule an appointment with an IPC/Senior Care provider or learn more at 303.306.4321 or www.SeniorCareOfColorado.com.