One practice’s reluctant adoption of EMRs

Issue: October 10, 2011

ByRichard L. Lindstrom, MD

Richard L. Lindstrom

I have written a commentary on the topic of electronic medical records before. At this time, EMRs have not yet shown their value, (July 25, 2009, page 3). Overall, my thoughts have not changed, but one major thing has changed: At Minnesota Eye Consultants, we are adopting EMRs in 2012, so it is crunch time for me personally and our practice collectively.

We have 10 ophthalmologists, 12 optometrists, 12 offices, eight optical dispensaries and three ambulatory surgery centers in our practice. We have been carefully studying the available systems and picking the brains of colleagues with similar practices for more than a year. We are down to four systems and will be making a final decision in the next few months. We are all intimidated and surprised by the time required just to select an appropriate system, not overly happy with any of the currently available options, and very concerned about the costs in real dollars and lost productivity we will experience next year as we go electronic.

Unfortunately, for us doctors in America, EMRs are like death and taxes, an unavoidable but unpleasant reality. We are a resilient group at Minnesota Eye Consultants, and in general we embrace change and advances in technology, so we know we will make it work, but we are not adopting EMR because we think it will enhance our productivity, reduce costs or improve the quality of care we provide. We are quite happy with our current system, which includes significant use of drawings and imaging in our very visual specialty. We have learned to understand and interpret our fellow doctors’ notes, and it is extremely rare that a chart is unavailable.

So, why are we enduring the transition to EMR? Like so many other decisions in our practice life today, we are transitioning to EMR solely to satisfy the desires of our federal and state governments and a host of third-party payers and regulators who believe they will be able to better monitor our practice and billing patterns if we chart electronically. To be honest and direct, I suspect they are correct in that regard. So, we physicians will bear another significant expense that has demonstrated no ability to enhance quality of care or reduce costs so that others can audit our practice patterns, charges and clinical outcomes in more detail and with less effort. I hope we physicians and our patients appreciate some benefits, such as more accurate coding and fewer payment denials, but I fear that we will still make the inevitable, occasional honest mistake in billing, which may make us even more vulnerable to overly aggressive and highly incentivized auditors. So, we do not adopt EMR with great enthusiasm for the benefits it will provide us or our patients, but with great anxiety, fear and trepidation.

I hope in a year or two we are pleasantly surprised, but I suspect the reality may be even worse than anticipated. The day will come when our governments’ ever more expensive mandates and reduced reimbursement for care will break us, but for now our commitment to our patients and our community drives us to comply. It is probable that some practices on the edge financially will be tipped into failure by the ever increasing demands for compliance, including EMR, with an ever increasing number of rules, regulations and mandates. It is hoped that our elected representatives appreciate before it is too late that the physician heavily in debt, veering toward bankruptcy, burnout and depression is not likely to provide the highest quantity or quality of care.