Automate Your Clinic — Part II: Automate Around the Doctor
My last article discussed the emphasis placed on automating health care by the new Obama Administration as being a force that started with the Federal Mandate Executive Order 13335 signed by George Bush in 2004 to computerize all of health care by 2013.
What’s new is that now, compared to 2004, the U.S. economy has been decimated and there’s a serious need to fix a very costly and crippled health care system that experts say costs over $1.3 trillion dollars per year. Did you know the U.S. economy lost over 2.5 millions jobs in 2008? The health care industry is one of the only industries that are actually looking to add jobs this year. In fact, the health care industry is the largest employer in the U.S. and accounts for almost 17 percent of the nation’s gross domestic product. Adding jobs into a very broken and inefficient system can further stifle a downward spiraling economy that many economists say could doom the U.S. economy for years to come.
That’s Ok, I have until 2013!
While the first thought for many doctors is that they have until 2013, the following excerpt from President Obama’s speech of January 9, 2009 exhibits a sense of urgency:
“To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within five years, all of America’s medical records are computerized. This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests. But it just won’t save billions of dollars and thousands of jobs – it will save lives by reducing the deadly but preventable medical errors that pervade our health care system.”
Until now, the attitude of most doctors have been avoid making changes in current daily operations because of the cost and the time it takes. That is very valid since computerizing the clinical part of your practice can be very costly and needs sustained focus from you to make the transition to EMR processes successful. Yet your primary focus is caring for your patients, not computerizing their records. The problem is that you do not have until 2013. The 2008 Office of Inspector General (OIG) report from the Centers of Medicare Services (CMS) targets pain management doctors because of the major billing increases of pain procedures over the past few years. You have to start the process now because, if you do not, you will see a marked decline in your reimbursements over the next two years. With the economy in such bad shape, you will experience (if you have not already) a decrease in patients affording your treatments because they either do not have insurance after losing their jobs or they elect to live in pain due to reduced discretionary income.
The Current State of Doctor Computerization
The vast majority of doctors have not done anything towards computerization. There are many reasons for this. First of all, many of you are not aware of the Federal Mandates and if you are, are just too busy to do anything about it. I attended a ‘Towards Electronic Patient Records (TEPR)’ conference hosted by the Medical Records Institute in January 2009 where I heard that the New England Journal of Medicine (NEJM) recently reported that there is only a 4% adoption rate of computerization by U.S. doctors. I had previously heard estimates of up to 20%. When I talk with doctors, many of them think they are computerized because they have computerized billing, then dictate and receive back their dictated files in a Microsoft Word document format. Dictating and getting back your transcription in an electronic format and then printing them off is not being computerized. I also talk with doctors who have their own templates in an electronic format and, in using them, they too think they are computerized. While the template concept is a step in the right direction, such electronic templates provide “isolated sets of information” since you are writing textual content into standalone form rather than storing data into a structured system patient file that “rolls over” from visit to visit. That distinction makes you more susceptible to an audit. And then again, most of you print off the patient record, which adds to the paper-based inefficiencies of your clinic. I agree with the NEJM estimates and believe the true computerization of U.S. doctors to be in the 4-5% range. Doctor computerization is very low but will be changing rapidly because of the fact that:
“Computerizing your faxes is one of the most profound and easiest steps that virtually no one currently has implemented....The average patient encounter generates 10-15 pieces of paper and that information needs to be shared with staff and other providers.”
Another issue is that the new administration tried to appoint Tom Daschle, who had written a book titled Critical: What We Can Do About the Health-Care Crisis, as the U.S. Secretary of Health and Human Services (HHS) (until he withdrew because of personal income tax payment issues). And while I have not read his book, I understand from doing some research that it purports a philosophy that patients and especially the elderly may need to learn to live with certain ailments if there is no justifiable treatment. This philosophy is especially detrimental because of the current lack of data to validate the efficacy of care for such treatments. Doctors that bill for such treatment will see a decrease in payments. In a paper system, there is no easy way to collect granular data for validating such care. Apparently, the new administration embraces this philosophy and has put into the new economic stimulus package money to come up with a health care information exchange network that you will have to communicate with, as well as funds to investigate doctors that cannot fully document patient care. This will be sobering to many pain doctors. Think about it, how many elderly patients do you treat?
