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GOVERNMENT INTERFERENCE
Government interference in the process will be an ongoing concern, as the feds are riding this horse very hard.
Government bureaucrats are anathema to the KISS (Keep It Simple, Stupid) concept. They are involving groups like
CCHIT (mentioned earlier) and others to try to make up for their lack of understanding of the total picture. And
I suspect they will make it very difficult to qualifY for the Stimulus money.
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I am familiar with a 50-doctor multispecialty clinic that adopted an EMR that forced the providers to
completely change their daily routines. That formerly 50-doctor clinic is now a 39-doctor clinic, and according
to its currently unemployed prior administrator, it is now
having serious financial difficulties.
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In my opinion, in order to satisfY the government's requirement that HIT be used "in a meaningful way," the
following elements are the Big Three:
An electronic record of the patient encounter with the provider. Electronic prescribing of medications. Electronically ordering laboratory tests and receiving the results.
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requisition, electronic ordering not only could automatically populatethe patient's demographics (as
well as the requested tests), it could also, if linked to the patient's insurance information, assure that the
lab work getssent to the correct lab. Too often a patient is sent to "Lab A" for a blood test, etc., only to
find out too late that the insurance company will not cover the cost of the test because its clients must use
"Lab B." In addition to the electronic order, a facsimile paper requisition can also be generated for the
patient to take to the lab.
Now for my idea of a practical EMR solution involving minimal cost and very little disruption to your practice:
Assuming that your preference is to avoid the pitfalls that befell the 50-doctor clinic discussed earlier, you
might desire a relationship with a password-protected, Web-based medical transcription company with full VPN,
FTP, and HL7 capabilities. That company should archive your records permanently and offer easy search capability.
In addition, your page on the transcription company's Web site ideally should provide you with the ability to
e-prescribe as well as order tests from your reference labs and access the results, all of which would be linked
with the patient record.
As simple as it seems, this solution offers you the three main components of an EMR at very little additional
cost beyond that for your normal transcription. The records and capabilities are maintained on one Web site for
easy access, and your providers can continue to interact with their patients with little or no disruption of
their daily routines. Instead of waiting until October 2011 to apply for Stimulus money to help defray the cost
of implementing an expensive EMR that requires routines to change significantly, and results in seeing fewer
patients and generating less revenue, it may be more practical to go with a simpler solution now.
Then, if at some future point you wish to transition to a full-blown EMR, all of your digital records can be
easily imported into any system you might choose, as opposed to having to scan in non-digital records, which can
be costly as well as cumbersome. Perhaps the federal bureaucracy, in its infinite wisdom, will someday even come
to appreciate the beauty of a "KISS" EMR and ultimately agree that a simple solution, such as described herein,
is all you really need.
REFERENCES
Steele E. No use = no "meaningful use." EMR Straight Talk. May 12,2009;
http://blog.srssoft.com/blog/?paged=3.
Steele E. The risk of automated EMR coding. EMR Straight Talk. April 29, 2009;
http://blog.srssoft.com/blog/?paged=3.
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