Doctors feel the pain of electronic records requirements

[Omaha Steve]

http://www.livewellnebraska.com/health/doctors-feel-the-pain-of-electronic-records-requirements/article_999da952-3de8-5b05-af77-4d8b4dc1eb7a.html




KENT SIEVERS/THE WORLD-HERALD
Dr. Jeffrey Strohmyer, right, works with patient Salinda Swartzendruber, going over her medical records by accessing them electronically at Premier Family Medicine in Papillion on May 8, 2014.

Posted: Friday, December 26, 2014 1:00 am
By Rick Ruggles / World-Herald staff writer

Some doctors in Nebraska and elsewhere might punch the off button on installing medical records systems that meet federal requirements, experts and physicians said last week.

The requirements are complicated and costly, especially for small clinics. The federal government, through its Centers for Medicare & Medicaid Services, sent letters to 257,000 medical providers last week informing them that they would be penalized 1 percent of their Medicare revenues in 2015 because they hadn’t adequately reached “meaningful use” of electronic medical records.

“It’s just not a reasonable program,” said Dr. Bob Rauner of Lincoln, chief medical officer of SERPA ACO, an organization that includes 12 clinics in Nebraska. Some doctors nationwide have tried and failed to meet the requirements, Rauner said, and others have said that it’s not worth attempting. Many might decide they don’t get enough Medicare revenue anyway and will simply absorb the penalty, Rauner said.

He said his clinics are in compliance now but are considering whether it’s worth it to step up efforts to meet tougher Stage 2 requirements, which kicked in this year for some and next year for many. The penalty applies to physicians who see Medicare recipients within their patient load.

FULL story at link.

[napi21]

1. So, what are the requirements that they feel are not worth keeping up with?

I don't know if my doc is in compliance or not, but I know all my records are computerized and accessable throughout the entire medical network in this area. I think it's a great idea. If you go to a new doc, you don't have to try to remember everything about past treatments, the diff. meds you took, etc., it's all there.

Sometimes I wonder if we aren't dealing with a lot of older docs who just don't want to mess with technology.

[Brickbat]

2. Start here.

http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html

[Igel]

7. Depends on the doc.

Electronic prescriptions. Making sure all the case notes are electronic. Putting all the vaccinations on their system and making sure the interchange formats are consistent for easy transfer.

My kid's pediatrician was involved in a rather good practice that had many doctors. It was all electronic (except for prescriptions) in 2005. This was too early, so their system was completely at odds with the current requirements. They've got their recent records available, but if I want my kid's current pediatrician to have access to them some data entry clerk is going to have to sit down and enter their records from 2004-2010 into a compliant database or they'll have to pay to have all the records converted. That's a decent expense to provide service to a non-client.

My endocrinologist was involved with an extensive practice that was pretty much self-contained--affiliated with a medical school and a teaching hospital, she'd record her case notes in real time and at the end of my appt. push a button. The sound file would be packaged up and put on a server where munchkins in India would access it and produce a transcription available by start of business the next day. Still, they didn't have electronic prescriptions and it was a hassle--you needed to know where your pharmacy was. Fine if you have one you always go to, not so fine if you don't.

My kid's current pediatrician has three clerks on duty at all times handling paperwork--insurance, prescriptions, keeping all the electronic records up to date. These aren't nurses--all they do is sit there and do data entry. It's nice once it's done, but it certainly imposes a cost on the business. So much so that they have a big sign up saying they accept no health-care exchange patients and no new Medicaid patients.

[Thinkingabout]

3. The US is far behind other nations such as France. It would be valuable to the patient and doctor

To have the history and we don't have to re-enter the history again.

[jwirr]

4. The clinic I go to is up to date on its records and they can be share within the system/hmo but

when I use a doctor from another system they are not hooked it. I am assuming that is some of the up dating that is required. We still have a very competitive system with groups that do not refer outside of their own group.

I can see where it is necessary for the government to know how the patient is treated in order to know what changes are needed to make it better.

[Orrex]

5. I hear that some docs in Nebraska favor carrier pigeons

As opposed to, say, those pesky email machines.

[MH1]

13. The requirements are a mess, and there are a multitude of proprietary systems,

and the less expensive ones that single-provider clinics can afford, are crappy and hard to use for non-IT people. (Shockingly, most doctors and their staff are NOT IT people and don't automatically know how to use these kinds of systems.)

I am an IT person and painfully close to a doctor who is NOT an IT person and has one of these crappy systems.

Unfortunately I am not geographically close enough to be much use to help them through it. (Webex type sessions aren't much use for someone who has already given up.)

Just pointing out that there are complexities that you may not be aware of, and maybe you should tamp down the mockery a bit.

Of course, the big medical conglomerates have NO PROBLEM meeting these requirements (or at least faking it good enough to get by). If you are one of those progressives who is happy to see sole providers go under and only the massive corporate clinics survive, well okay then.

[Yo_Mama]

16. IMO, an ignorant comment

The requirements are complex. The systems that purport to fulfill them are very expensive. Some that are certified are in fact not compliant, and the BEST OF ALL:
You can buy one of these systems, get it up and working, and still not meet the requirements, because part of the MU2 requirements are for electronic exchanges that do not in fact exist in the real world of care.

Most doctors in smaller practices are not going to meet MU2, no matter how hard they try.

Much of the responsibility for one of the worst regulatory clusterfucks I have ever seen lies with CMS, because they have been issuing the regulations stating what systems have to do to be certified very late. Consistently - just like they did with the ACA exchange regulations, with much the same result.

The burden is impossible to meet for small clinics that deal with poorer clients, so those clinics will get the cuts. It's a totally indefensible public policy.

[Orrex]

18. That's not really an argument against electronic record-keeping, though

The bullshit of bureaucracy is indeed bullshit, and it should hardly be the responsibility of individual clinics to meet impossible requirements set by myopic bean-counters.

However, I have heard/seen quite a few nurses state outright that (typically older) doctors simply won't transition to electronic recordkeeping, for no better reason than "because they don't want to."

That is the sentiment that I was addressing.

[Yo_Mama]

19. They don't want to because of the bullshit.

Most doctors were already using EHRs. They have become more expensive and less useful as a result of this round of regulation.

Just wait and see what's going to happen this year - Medicaid patients are going to start losing access, and Medicare patients have had a problem.

You think it's fun to snark at doctors, but make their professional lives impossible, and people can't get medical care.

[dixiegrrrrl]

6. I don't blame my doc for going nutz over this requirement

I just spent 20 minutes trying to find out what the core objectives were, after following link after link.
As a retired professional who has worked with QA requirements for years, this latest mess of bureaucratic language is almost impossible to figure out.
I know for a fact the back office at my Doc's place does not understand it.


They DO understand that the Health Act allowed them to double prices for all services, tho.

I suspect this is a way to reduce Medicare outlays, and shove people onto for profit insurance, since it is the insurance companies that wrote the Health Care Act, and we all know, the devil is in the details.

[sendero]

8. I'm 100% for the adoption of EHR...

... and while my personal Dr. whined about it at first, and even had to abandon a poorly designed system and start over, he is starting to admit that there are some great benefits to it as well.

Doctors are a hidebound bunch that don't want to change anything. This is NECESSARY and will lower costs and reduce medical mistakes once widely enough implemented.

Hospitals who are willing to take the 1% hit on Medicare payments are free to do so, but there is nothing stopping CMS from increasing that deduction to 2% or more in the future.

The information age is here and the medical system needs to grow up and get used to it. And BTW, the argument that the requirement is vague or whatnot is silly. Nobody expects a doctor to implement this. They do so by purchasing or subscribing to a software service or package. It is the package creator's job to keep up with requirements, not the doctor's.

[MH1]

14. Just curious, which "poorly designed system" did they abandon?

I'm curious because someone I know is caught in this mess and is considering abandoning their system. I think their system would be just fine, if only they could afford a full-time consultant to figure out how to use it to actually do the stuff they need to do for patients.

Next question of course, is what system did they "start over" with and did they find it to be a big improvement?

The someone I know is NOT "hidebound" and embraced EHR with gusto ... only to have this p.o.s. system kick his ass.

[CurtEastPoint]

9. My docs are part of Piedmont Healthcare in ATL and they are all on the system.

It makes info lookup and scrip reorders and messaging so easy for the patient. It doesn't appear to overly burden the docs. Some do type slowly, however.

[napi21]

10. That's like the system I was sreferring to in my first post.

I live in North Ga, and my records are available to all members of the NGHS (North Georgia Health System). I think it's great from all standpoints. I was referred to a new clinic several years ago and I had to rack my brain to provide them with all the treatments I'd had, all surgeries, all docs, all med. It was awful. 1 1/2 years ago I was referred to a different clinic and bingo, they had access to all my info. All I had to do was confirm some things. What an improvement.

I realize how much of a job it is to transfer all past info to electronic form, and would require hiring some data entry clerks to spen a lot of hours doing so, but once it's done, it's done, and there are lots of advantages to everyone.

[CurtEastPoint]

11. I'm sure it's a herculean effort but it's time the US come into the 21st century re: med records.

I had a procedure recently and the info on hand made it go much more smoothly, IMHO.

[daredtowork]

12. As a patient I am also frustrated

Half the 15 minute appointment time is taken up by the doctor trying to find information through scattered EMR system records. And this also seems to force them into giving short shrift on patient notes. For poor patients who are entangled in "the system" and who need extra strong documentation of their situation, this can be extremely frustrating. We don't know what the doctor is documenting or not documenting during the visit, and we can only hope that certain "keywords" are being recorded that will smooth are "cases" along. Because if the documentation isn't there, the reality of the situation won't matter.

[PADemD]

15. Why didn't Medicare set up its own system?

That way, every doctor, no matter what practice or hospital to which they belong, would be able to log onto Medicare and enter data.

[Scuba]

17. In 1999, the Institute of Medicine released "To Err Is Human" documenting 100,000 deaths/year ...

... that were caused by medical errors. Half of these deaths were the result of handwriting transcription errors on prescriptions.

Electronic physician orders eliminate all those handwriting errors, and can also do checking for drug/drug interactions, body weight, age and other "reasonableness" of the order, and then alert physicians of possible problems.

Since then, virtually all doctors coming out of medical school expect EMRs. It's the older doctors, set in their ways, who are resistant. It's time for them to either get with the program or retire. Patient safety demands it.