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Separating EMR implementation hype from fact


I can't tell you how many wonderful things I've heard from medical administrators and non-physician consultants that will result from the adoption of the electronic medical record (EMR). But like most of us, I've been taught to believe that if something sounds too good to be true, it probably is.

Key Points

Even though I recognize that some of the positive characterizations of the EMR may in fact be accurate, there is an important other side to this story. The following is based on my own personal experience as well as the experience of many other physicians who have reported to me the multitude of problems they have seen while implementing the EMR.

It will save money. First and foremost, incorporation of an EMR in an established, typically high-volume dermatologic practice is NOT inexpensive. Even if one does not figure in the actual cost of the EMR that has been selected (commonly in the $35,000 to $50,000 range), since the government has announced a $44,000 tiered reimbursement that occurs over time (once meaningful use has been proven), there are still other costs that must be incurred.

In my opinion, the answer to the question about whether the introduction of the EMR will save money is this: I'm afraid there are no certain answers. In the near term, I'm certain that most clinicians would likely say that institution of an EMR takes a lot of effort, time and expense for which there is no benefit to the practice. However, if one takes the long view, say five to 10 years, I believe it is possible that the EMR could save money by reducing redundancy of efforts in the areas of physical examinations, radiological and laboratory tests, or even the repetitive usage of unhelpful medications.

It will improve the quality of care. The EMR might improve quality of care when two things happen; there is widespread acceptance and implementation of EMR among the vast majority of physicians (so that sharing of network information is possible without violating the patient's privacy), and the individual physician uses it in a meaningful way to review prior office visits and previous lab and pathology results. Without the routine sharing of this type of information by all of a given patient's physicians or other healthcare providers, the EMR will only be an electronic version of the old paper medical record, and all of the potential cost savings will be lost.

It will reduce the time required to perform a thorough office exam. It is possible that the EMR could reduce the amount of time required to perform a complete office exam by allowing for a more thorough review of the prior visits and studies obtained, but I've heard from many dermatologists that if they enter the data themselves at the time of the visit, they have "depersonalized" the office visit by not making eye contact with the patient.

Many of the dermatologists I've spoken with feel the nature of making EMR entries to document what is being said while the patient is in the exam room produces a sense of remoteness with the patient. And in the event of a bad outcome, could this "depersonalization" of the dermatologist lead to enough dissatisfaction that they might pursue legal action?

It will facilitate specialty consultations. Again, with widespread acceptance and use of the EMR, I can see how the EMR might facilitate consultations. But since this has never been a personal problem for me, even if this were to happen, it would NOT be a major advantage to me.

So, what's the best course of action when deciding whether to adopt EMR technology? Obviously, that's a very individual and personal decision that has, unfortunately, been pushed onto the American physician so that little choice remains. My advice is to carefully seek out answers from dermatologists in your locale to find out what works well (or poorly) for them, and then get involved in the learning, training and utilization of the best EMR for your practice as soon as possible.

Ronald G. Wheeland, M.D., is a private practitioner in Tucson, Ariz.

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