Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
By Jason Ruben, MD
Last fall, as hospitals and healthcare providers scrambled to meet impending EMR "meaningful use" deadlines, regulators were sending some decidedly mixed messages.
On Nov. 18, 2013, a representative from the Office of the National Coordinator for Healthcare Technology addressed a gathering of the American Medical Informatics Association. She insisted that meaningful use would proceed on schedule.
"Wish there could be a delay of Stage 2 meaningful use? Don't hold your breath," wrote a reporter from Healthcare IT News, who was covering the story.
Then, less than one month later on Dec. 6, the Centers for Medicare & Medicaid Services (CMS) announced that it would indeed extend Stage 2 for an additional year and delay the arrival of Stage 3 until 2017.
Human factors played a pivotal role in CMS' decision. By delaying the program a year, they hoped to create:
"Ample time for developers to create and distribute certified EHR technology before Stage 3 begins, and incorporate lessons learned about usability and customization."
Imagine yourself buying a luxury car — for argument’s sake, a Jaguar XKR-S convertible. It's got a 385-horsepower, 5-liter V8 engine. It's got plush leather seats, OnStar and Blue Tooth for your iPhone.
But there's a problem. The tires are missing.
The dealer apologizes and offers to put some new ones on for $300.
"Are you kidding?" you say. "I just dropped $140,000 on this car." And you roll the Jag out of the parking lot — clunking, scraping and destroying your expensive rims as you go.
So what does this absurdist little sketch have to do with healthcare reform? A whole lot when you think about hospital administrators' approach to the electronic health record (EHR). All too often, they're overlooking an inexpensive program that would help them get the most out of their mammoth EHR investment: scribing.
Steve Jobs knew that the key to Apple’s success was simplicity.
Apple products are painstakingly designed for simplicity. Updated Apple products are always better than their predecessor. If you question this, visit an Apple store at the release of the next iPhone or iPad.
Quite the opposite is true in the EMR-healthcare arena. The result: hospital executives are pressured to buy systems that “fit” into their existing IT platform regardless of physician usability. My intention is not to pile-onto the existing discussions about the 15-30% drop in productivity when EMRs are implemented. Unfortunately, I can attest to those numbers within our own organization (thus, the development of the scribe program).
The merits of the HITECH Act, the EHR Federal Mandate, and The Stimulus Package have been greatly discussed. I could argue that EMRs do not provide better patient care.
I want to know who will save physicians, hospitals and patients from the existing, pathetic breed of EMRs available today?
Recently, the Report on Medicare Compliance (from Atlantic Information Services) published an opinion article about the use of scribes in healthcare. The premise of the article was that hospital executives and physicians should re-examine the benefits of scribes because compliance risks grow when scribes are allowed to make entries into electronic health records. Furthermore, the article questioned the gains in physician productivity from scribe utilization.
Are these authors practicing physicians themselves? Do they understand the growing clinical pressures and demands placed on healthcare providers today? Have they ever used an EMR in an acute care setting (like an ED) where providers are expected to see upwards of 3 patients per hour? My guess is that they have not.
I believe that the authors are not only misinformed, but that their article will hinder the advancement of EMRs and the modernization of the healthcare workforce.
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