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Debate continues over electronic records, paper charts
P. Dee Stephenson, MD, FACS, ABES, FSEE, and David A. Goldman, MD, offer their opinions on which system works best in their office.
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Welcome to CEDARS-ASPENS Debates, a monthly feature in Ocular Surgery News.
CEDARS (Cornea, External Disease, and Refractive Surgery Society) and ASPENS (American Society of Progressive Enterprising Surgeons) is a joint society of cornea, cataract and refractive surgery specialists, here to discuss some of the latest hot topics in ophthalmology.
Ophthalmologists around the country continue to struggle with the mandate to transition to electronic health records. While there is great opportunity for added efficiency in the future as the technology improves, the implementation of EHR into a practice can come at a significant cost. Unfortunately, there are significant penalties for not participating as well. This has led to the dilemma: Should I adopt EHR or not? This month, Dr. Dee Stephenson and Dr. David Goldman discuss the advantages and disadvantages of EHR and paper charts. We hope you enjoy the discussion.
Kenneth A. Beckman, MD, FACS
OSN CEDARS-ASPENS Debates Editor
My paper chart is better than your EMR
After 25 years of being in practice, I have come to another crossroads: electronic medical records. Five years ago, I thought that I needed to be on the leading edge of implementation of EMR because I felt that when the deadline for compliance occurred, there would not be enough technical support. I wanted to be well on my way with all of the attestations. So that being said, after a long, hard process, I recently decided to change to a different EMR company. The original implementation, after all is said and done, cost me about $150,000.
P. Dee Stephenson
There are many things that have been extremely difficult for me, including the customization of the programs. You have to use the programs for a while before you know what you want changed, and by the time you know what you want to change, the programs are not supported. All the technology you have in your office for ancillary testing has to be incorporated into the EMR, but each instrument that you add costs money. Then there are instruments that are not using the same programs, so they cannot be incorporated or they need an expensive software program in order to make them compatible. For example, I had to purchase a new IOLMaster (Carl Zeiss Meditec) because the old one could not be incorporated into my EMR.
There are also other issues. The decrease in the number of patients I could see due to the intense input by my technicians and myself. The long hours to learn the system. Never being paperless. There is a whole other issue with the practice management aspect. Hours of overtime to learn and more costs that involve clearing houses. Is it compatible? Is there a bridge, or is it totally integrated? Did I want to do this all over again?
What happened next let me know that I may have made a big mistake. My computers went down one day, and for about 6 hours, all of a sudden there was a weight lifted off my shoulders. I could finally practice medicine the way I love, by being totally attentive to the patient I was seeing, no longer typing but instead interacting, listening, touching, healing. Since I implemented EMR, I see about half the number of patients that I used to see because of all the input that is required, and I extended the amount of time I work. I do not go home before 7 p.m. I suffer from hand pain from using a mouse for 12 hours a day. That one day, not only did I see all my patients, but I also sent 12 referral letters with copies of OCTs or fundus photos. I spoke to some families on the phone. I left my office at 5:30 p.m. with a great feeling of accomplishment as a physician. That day was a great reminder of why I practice and love ophthalmology. Maybe we need to reassess the reasons for EMR or make them more user friendly so we can return to the art of medicine.
For more information:
P. Dee Stephenson, MD, FACS, ABES, FSEE, can be reached at Stephenson Eye Associates, 200 Palermo Place, Venice, FL 34285; email: eyedrdee@aol.com.Disclosure: Stephenson reports no relevant financial disclosures.
EMR allows better practice of ophthalmology
“Dr. Goldman, I’m so sorry to call you on the weekend,” the conversation began. “It’s Gloria Smith (name changed). I’m sure you don’t remember me, but I’ve run out of my glaucoma drops and I’m scared to go without them.”
David A. Goldman
“I absolutely remember you. How is your granddaughter enjoying Penn State?”
“Wow, I can’t believe you remembered that! Again, I’m so sorry to bother you.”
“That’s OK. I’ve already sent a refill for your Travatan to your CVS. It should be ready for you shortly.”
Time of call: 2 minutes
Patient satisfaction: 100%
Exponential practice growth from patient satisfaction: Priceless
This is only part of the value of EMR.
In my past practice setting in academia, I worked with paper charts. Had I received a call like the one above on a weekend, I would have absolutely no idea who the patient was, what drops they were on or what pharmacy to call the prescription into. By the time I had resolved everything, at least 10 minutes would have passed with me navigating pharmacy menus on my phone. Even in a daily clinic, oftentimes a chart would not be available because it was being held in the billing office or another office location. This would always cause discomfort for the physician and significant dissatisfaction from the patient.
Going with cloud-based EMR, I am able to access patient charts from any computer, iPad, iPhone and/or Android device anywhere, anytime. Within seconds, I have access not only to the last visit note, but any visit note or diagnostic test (including photos of the patients themselves). There have been times when a patient will call from out of town with an emergency. “Dr. Goldman, can you speak with Dr. ‘X’ about my history?” “I’ll do even better. Give me his fax number, and I’ll have your records and testing sent over in a minute.” Of course, this ease in faxing notes is not only beneficial for emergency situations, but general visits as well. As ophthalmologists, we are referred patients from multiple health care providers: PCPs for diabetic screens, other ophthalmologists for second opinions and more. To be able to instantly draft and fax a thank you note to the referring doctor with all pertinent findings is a huge time saver clinically. It is also greatly appreciated by the referring doctors.
With ICD-10, PQRS, meaningful use and other mandates, we will be inundated with paperwork. Practices can either A) hire an army of billers to search the proper ICD-10s and track PQRS in paper charts, or take a greater penalty each year on reimbursements or B) use an EMR, which automatically puts together billing/coding/PQRS. I recently attested for meaningful use and PQRS, and with the benefit of my EMR, I was able to do both combined in about 20 minutes. I also save significant overhead by not having any billers whatsoever, simply allowing the EMR and practice management systems to do the work for me.
Of course, the timeless arguments against EMR are, “It’s painful, it will slow me down, and it will cost me too much money.” My response would be, “You just chose the wrong EMR.” In my opinion, most EMRs are horrible. They are not user friendly, and they were certainly not built for ophthalmology. Similar to learning a skill such as cataract surgery, a new EMR takes time to become quick and comfortable with. I currently see just as many patients with EMR as I did with paper, but now with a high-tech edge that both the patients and I appreciate. With Modernizng Medicine’s EMA Ophthalmology, cost is a simple monthly subscription fee, without the obscene “initiation fee” so many companies charge, and compared with the cost of additional staff, it is money well spent. For me, adding EMR has allowed me to practice better ophthalmology.
For more information:
David A. Goldman, MD, can be reached at Goldman Eye, 3401 PGA Blvd., Suite 440, Palm Beach Gardens, FL 33410; email: drdavidgoldman@gmail.com.Disclosure: Goldman reports he is a consultant to Modernizing Medicine.