Our household has had the dubious honor of being deeply and directly affected by some of the major initiatives contained in the economic stimulus package. My husband, who is a sales manager at Mid City Motor world has been working long, busy days trying to accommodate the rush of car buyers flooding in to take advantage of the “Cash for Clunkers” program, while our pediatric office, with the promise of future reimbursement for “meaningful use” of an EMR, has begun the process of converting to electronic medical records.
The cash for clunkers program is meant to reduce carbon emissions by encouraging people to turn in gas guzzlers and purchase more fuel efficient vehicles, but questions remain as to the overall benefit. Cash for Clunkers does not reduce, recycle or reuse in the least. The clunkers must be destroyed and sent to landfills,—so no used vehicles come out of the transactions to sell again, and no parts can be gleaned for resale. Jobs involved with used car sales and parts resale are thus short-circuited by this program. Some of the “clunkers” are in relatively good condition, and would be the type of car that some one of limited means (like our college-age kids!) could afford, and they are taken out of circulation. While this does reduce the number of gas guzzling vehicles on the road, there is a “carbon cost” to the construction of a new vehicle, and whether the emissions saved by the better fuel efficiency will outweigh that is debatable. Hopefully this program will not be the equivalent of economic junk food that gives the economy a "sugar rush" that is only hollow and temporary.
I am a huge fan of computers (in fact I am writing this on Google Docs right now) and I am very enthusiastic about Eureka Pediatrics" new software. Among the advantages I am looking forward to include never again searching for a lost chart, inputting data one time only, and having the computer do tedious tasks like plot growth charts, calculate BMI's or fill out physical exam forms. However, there are many hurdles yet to be overcome.
The media touts electronic medical records as some sort of panacea to all of medicine’s problems; that errors will be reduced, unnecessary duplications will be prevented and inefficiency will be eliminated. Though electronic storage of records has advantages, I doubt error reduction will be one of them. Now, in addition to human error (data is only as good as its input), we will add computer errors, which are strange and largely incomprehensible to the human mind. For example, our new software will allow me to type or dictate paragraphs without any signal whatsoever that I am in a screen that cannot accept data. As soon as I attempt to save my text or change windows, all my work disappears into nothing. While for the most part our new software has run well, at times appointments have been changed or lost, and data has been put into the wrong places. In a critical care environment, such errors could impact patient care. Yesterday (on Allscripts) I almost sent over an e-prescription for 6,000 isotretinoin tablets, and the computer didn’t mind in the least. I know the pharmacist would notice in a heartbeat. And what about those strange messages you get, like: "Patient cannot have a birth date in the future" (that from the state vaccine registry). I still don't know what a "critical error" is, though I have committed many of them.
As for eliminating the duplication of testing, this depends of whether or not the differing software program can interface with each other, and at this point most do not. Creating interfaces is expensive and time consuming.
The third supposed advantage of computerized records is said to be efficiency. Well that is just not the case. Using computers in the medical office slows everything down. Despite all computers have to offer, it is still hard to beat the efficiency of good old paper and pen. With paper, there is no scrolling through windows trying to find the right place to enter the data, no error messages, no frozen screens, and no waiting while the computer has to be rebooted. I am not planning to throw out my carbon paper just yet.
Nevertheless, I am getting used to our new system. I enjoy the clean crisp look of a chart note when it prints out in neat black type ( I know we're not supposed to print them up and put them in the paper chart, but I can't help it). I have learned a tremendous amount about medical coding by using the coding aids built into the system. I got motivated to tune up my Dragon Naturally Speaking dictating software to the point where my accuracy is great . But every so often my dictating software seems to take on a life of its own, and signals the Office Practicum software to open strange windows or freeze up my work. I can just imagine the two programs laughing softly to each other as I frantically try and figure what happened to my last 15 minutes of labor.
The cash for clunkers program is meant to reduce carbon emissions by encouraging people to turn in gas guzzlers and purchase more fuel efficient vehicles, but questions remain as to the overall benefit. Cash for Clunkers does not reduce, recycle or reuse in the least. The clunkers must be destroyed and sent to landfills,—so no used vehicles come out of the transactions to sell again, and no parts can be gleaned for resale. Jobs involved with used car sales and parts resale are thus short-circuited by this program. Some of the “clunkers” are in relatively good condition, and would be the type of car that some one of limited means (like our college-age kids!) could afford, and they are taken out of circulation. While this does reduce the number of gas guzzling vehicles on the road, there is a “carbon cost” to the construction of a new vehicle, and whether the emissions saved by the better fuel efficiency will outweigh that is debatable. Hopefully this program will not be the equivalent of economic junk food that gives the economy a "sugar rush" that is only hollow and temporary.
I am a huge fan of computers (in fact I am writing this on Google Docs right now) and I am very enthusiastic about Eureka Pediatrics" new software. Among the advantages I am looking forward to include never again searching for a lost chart, inputting data one time only, and having the computer do tedious tasks like plot growth charts, calculate BMI's or fill out physical exam forms. However, there are many hurdles yet to be overcome.
The media touts electronic medical records as some sort of panacea to all of medicine’s problems; that errors will be reduced, unnecessary duplications will be prevented and inefficiency will be eliminated. Though electronic storage of records has advantages, I doubt error reduction will be one of them. Now, in addition to human error (data is only as good as its input), we will add computer errors, which are strange and largely incomprehensible to the human mind. For example, our new software will allow me to type or dictate paragraphs without any signal whatsoever that I am in a screen that cannot accept data. As soon as I attempt to save my text or change windows, all my work disappears into nothing. While for the most part our new software has run well, at times appointments have been changed or lost, and data has been put into the wrong places. In a critical care environment, such errors could impact patient care. Yesterday (on Allscripts) I almost sent over an e-prescription for 6,000 isotretinoin tablets, and the computer didn’t mind in the least. I know the pharmacist would notice in a heartbeat. And what about those strange messages you get, like: "Patient cannot have a birth date in the future" (that from the state vaccine registry). I still don't know what a "critical error" is, though I have committed many of them.
As for eliminating the duplication of testing, this depends of whether or not the differing software program can interface with each other, and at this point most do not. Creating interfaces is expensive and time consuming.
The third supposed advantage of computerized records is said to be efficiency. Well that is just not the case. Using computers in the medical office slows everything down. Despite all computers have to offer, it is still hard to beat the efficiency of good old paper and pen. With paper, there is no scrolling through windows trying to find the right place to enter the data, no error messages, no frozen screens, and no waiting while the computer has to be rebooted. I am not planning to throw out my carbon paper just yet.
Nevertheless, I am getting used to our new system. I enjoy the clean crisp look of a chart note when it prints out in neat black type ( I know we're not supposed to print them up and put them in the paper chart, but I can't help it). I have learned a tremendous amount about medical coding by using the coding aids built into the system. I got motivated to tune up my Dragon Naturally Speaking dictating software to the point where my accuracy is great . But every so often my dictating software seems to take on a life of its own, and signals the Office Practicum software to open strange windows or freeze up my work. I can just imagine the two programs laughing softly to each other as I frantically try and figure what happened to my last 15 minutes of labor.
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ReplyDeleteHi Emily - I'm another Emily (from Practice Fusion). It's interesting to hear your first-hand perspective on the trials and tribulations that come with EMR adoption. Are you on Allscripts now and changing to something else?
ReplyDeleteI'd like to hear more of your thoughts. You can connect with me at facebook.com/practicefusion or twitter.com/practicefusion.
Good luck with it!