jmj11 Posted May 12, 2014 Share Posted May 12, 2014 I just heard of the third local MD who is quitting medicine over EHR implementation. All three were over 60 but were not planning on retiring this early. But it was the combination of EHR implementation and growing difficulties with insurance prior auths. Do you think this is a national trend and will it further affect the supply of PCPs? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 12, 2014 Moderator Share Posted May 12, 2014 I will probably leave my current job when we transition from paper to epic. we are struggling to keep up as it is spending 2-3 min/chart. when we go to epic they have said they will not add staff. that will create 5 + hr waits every shift unless folks will document at home( I won't). I'm not willing to deal with that on a regular basis. everywhere else that I have worked that has gone paper or dictation to emr has DOUBLED STAFF to see the same # of pts. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted May 13, 2014 Share Posted May 13, 2014 I can't for the life of me figure out why more ED/UC groups don't use the electronic T-System (no affiliation)? Paper system was great and having worked for them in a consultation capacity the system was looking good (never messed with the finished product). Link to comment Share on other sites More sharing options...
UGoLong Posted May 13, 2014 Share Posted May 13, 2014 I hear a lot of this talk. I've taken part in EMR conversions in 4 hospital systems. It does take longer, especially in the beginning. And if they don't have the server and bandwidth capacity, it can be a difficult process. If that's enough to make you hang up your cleats, them who am I to argue? At the same time, all three of the acute care facilities now have been up and running for a few years (one each with ORB, Cerner, and EPIC) and the ERs and wards do not appear to be suffering. And I can actually read other providers notes! Do what you will careerwise, but it might pay to see what a system that has been up for a few years is like. As far as the prior auths go, I'm with you! I don't have 20 minutes to explain to someone on the phone why I want to do a chemical stress test on a guy with DJD. Link to comment Share on other sites More sharing options...
Guest Paula Posted May 13, 2014 Share Posted May 13, 2014 Prior auths are a pain to do. I end up doing my own as we are understaffed and I don't have a personal MA or LPN working with me now. We are in the midst of training for our second EHR. The first one was a failure and lasted 2 months. We are going with a system called Intergy and it is web based, not a program installed into our computers. In the cloud system, I guess. So far the training has not been the best as it is all done on-line with a trainer at the other end. I think it will take us a good 2 years or more to get used to it plus we are not adding more staff, just giving out more duties to our already stretched staff. We have seen more and more paperwork, prior auths and our longstanding referral base is shrinking due to some clinics not taking medicaid anymore. Time will tell how it all pans out for us and I expect lots of stress for the first 6 months or so. Hence, I am on vacation for 2 weeks now and will be up for the punishment when I get back right before we implement the system. Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 13, 2014 Moderator Share Posted May 13, 2014 I think most the EMRs pretty much stink it is going to take the Hitech funds running out, and then having massive consolidation and it will boil down to a few huge, likely much more user friendly, EHR's I do see a few things with local docs 1) just forgoing the whole hitech issue - heck it is only 2% hit (this is what I have done, although I am on an EMR - it is amazing how much faster it is to just document and not have to check off all the unmeaningful use crap) 2) keep seeing patients and caring for them the way they always have (which for most of them is a good thing) 3) those that are burned out on medicine and basically just enjoying their high earning years, and not looking for a challenge, are much more likely to just retire...... Honestly, if you are private practice doc you just decline, if you are a big group employee it is harder... I suspect some of these doc's will simply come back into medicine on their own and have small clinics on paper records..... Link to comment Share on other sites More sharing options...
gbrothers98 Posted May 13, 2014 Share Posted May 13, 2014 Lot's of great points above. If I was in a year or 3 of the end, I would pull that trigger too. I don't think our society is realizing how practicing medicine is turning into such a slog at times. On the other hand, there are ways to be and stay productive plus there is also a need to draw a realistic line professionally. It is necessary that one has to chart in the exam room or at the bedside. As the stethoscope is a tool at the ready, the same with the computer or documentation device you have to use. The knowledge of the software is just as important as your knowledge of any given medical condition. So that means having good software and hardware available. The downside to the cloud model is the lag at times in screen refresh and access. These seconds add up to real time, much like extra clicks. I wonder if I will be able to get disability for the crippling arthritis I am developing in my right index finger. Much of this software is still only usable on a workstation, it needs to port to better form factors to achieve realistic goals. The software is lacking overall, some do a reasonable job, all need work. Most of the EMR companies, best solution and integrated, have been rushing to meet all the deadlines with meaningful use that they have rolled out products that arent ready for prime time. Then much time is spent fixing what they rushed out. Our expectation in medicine s that everything will be perfect. The software perspective is roll it out and we will fix bugs as they are found. Quite a business model, we should try that and see how far we get. Health IT and their ability to seek a bye or do over on a regular basis needs to be curtailed. Training is important. Knowledge of how to use this software effectively is just like any other skill in medicine. That means refresher training along with a worthwhile investment in the initial training, both on the trainers and the trainee parts. This really has become something you just cant phone in at either end. I would agree that getting sucked into the trap of charting after work or at home is just that. Your life is being stolen from you. A hard look at your workflow to maximize getting out at the end of the day is necessary. I think there are 2 ways to approach this from the PA perspective. Complain, do your time, get burnt out and walk. Or work on getting involved, do some extra training, look for avenues of improvement, provide some leadership. This really is a wide open field in it's infancy. Clinical input is in demand, seek out a way to provide it. If your shop doesnt have an EMR, jump into that process or you will get delivered something to live with for the next several years. Believe it or not, we are trailblazing. 10 to 20 years from now much of this will be a bad memory. Personally I remember carrying around 2 floppy discs in college, one with the pirated word processing program, the other with my precious 20 page term paper to edit on a library computer. Now I have more than enough computing power in my phone to argue digitally with idiots I will never meet, get stupid cat pictures from my mother and plenty leftover to fly every single mission to the moon. Good times. George Brothers PA-C Link to comment Share on other sites More sharing options...
gbrothers98 Posted May 13, 2014 Share Posted May 13, 2014 I can't for the life of me figure out why more ED/UC groups don't use the electronic T-Systems (no affiliation)? Paper system was great and having worked for them in a consultation capacity the system was looking good (never messed with the finished product). T system is great for the ED. Problem is the integrated records bring out their main selling point.....integration. Admin and IT dont care about the ease the ED provider has in documenting. They worry about the issues with software bridges and lab links back and forth between the T. They have a hard enough time keeping the network up and working along with answering the usual hardware and software concerns plus teaching everyone how to use their email. If the integrated record has a workable ED product then there is no argument, that is why the T is coming out with a network module that provides just the documentation portion of their product. Plug it in and access it through a portal of the integrated record. The ED's main complaint of poor documentation is answered while maintaining the overall integration. G Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 13, 2014 Moderator Share Posted May 13, 2014 T SYSTEM >CERNER>EPIC>MEDITECH Link to comment Share on other sites More sharing options...
rcdavis Posted May 13, 2014 Share Posted May 13, 2014 T SYSTEM >CERNER>EPIC>MEDITECH T system > a4 w dragon> epic > meditech Link to comment Share on other sites More sharing options...
UGoLong Posted May 13, 2014 Share Posted May 13, 2014 The following probably wouldn't work for everyone, but it works for us: We're in a specialty (cardio) and use Centricity with fairly general forms. We flat out type our HPI and plans. I type fast and usually write in sentences. My SP types in short phrases. Neither of us sweat spelling or grammar. Our EMR autogenerates letters to PCPs from our typed transactions. We have some piecework helpers who remotely review these letters (one is an MA and the other is a PA who now stays home with her kids.).Our helpers edit, fixing grammar (like turning my boss' terse phrases into sentences and fixing my typos), as well as correcting spelling and punctuation mistakes. It's a few dollars per letter (I think $4) and it has worked out well for us. We type during the patient encounter and maybe for a minute later, then sign off on our transactions. This orders the scripts and the various test we've ordered. Rather than having a zillion boxes to check, we just let the editors clean up our prose and make it a letter. Someone in our office briefly reads the result before it gets sent out. In the end, we get reasonable letters and use the notes from the patient's last visit to chronologically roll through all the tests, admissions, and phone calls that happened since the last time they were in to see us. (Not to mention changes in weight, blood pressure, and -- in our case -- cardiac-related complaints for which we do have EMR boxes to check.) The result is that we don't spent time away from work writing notes, our MAs load up the chart with data from hospital admissions and tests, and the system adds structure to our visits. It's not perfect but it beats our old paper charts where we couldn't read each other's notes and often couldn't find test results. Patient calls that the nurses can't handle get sent to me as alert flags so I can see the patient's chart while I'm formulating an answer. Not the ideal situation, but not bad. And I'm an old guy! Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted May 13, 2014 Moderator Share Posted May 13, 2014 Believe it or not, we are trailblazing. 10 to 20 years from now much of this will be a bad memory. Personally I remember carrying around 2 floppy discs in college, one with the pirated word processing program, the other with my precious 20 page term paper to edit on a library computer. Now I have more than enough computing power in my phone to argue digitally with idiots I will never meet, get stupid cat pictures from my mother and plenty leftover to fly every single mission to the moon. Good times. George Brothers PA-C This x 1000. EMR is a series of growing pains, but I've always been convinced it's necessary. The sheer number of systems is just reflective of a new expanding market that hasn't had the time to allow market forces to allow for the cream to rise to the top, but it's getting there. Legible documentation, which EMR forces you to do, is more likely to prevent unnecessary retesting or referrals to specialists, or prescribing medications that have already been tried but don't work. Link to comment Share on other sites More sharing options...
physasst Posted May 13, 2014 Share Posted May 13, 2014 I will probably leave my current job when we transition from paper to epic. we are struggling to keep up as it is spending 2-3 min/chart. when we go to epic they have said they will not add staff. that will create 5 + hr waits every shift unless folks will document at home( I won't). I'm not willing to deal with that on a regular basis. everywhere else that I have worked that has gone paper or dictation to emr has DOUBLED STAFF to see the same # of pts. We didn't double staff. The initial curve was difficult, but paper is dangerous. When our ED converted to PICIS we saw a big increase in wait times initially, but then, it normalized out to about 5-8 minutes longer LOS per patient. No need to double staff. Honestly, I think it's a good thing. I think using paper charts is incredibly inefficient and unsafe. There is a wealth of data on the use of CPOE embedded in the EHR to prevent medication errors for example. Financially it makes sense too, paper records DON'T work. We were losing over 5 million per year in facility fees because of simple things like a nurse failing to document a "stop time" on their IV documentation. NOW, they cannot sign or exit the chart without it. Same with physician billing. It was all over the map, and often wasn't supported by the paper or dictated documentation. We were losing over 1 million annually here. NOW, the chart will not let you bill a certain level without the documentation to support it. It will turn red, and warning sign will appear letting you know what you are missing. Also, it's a multi-authored chart, why is that helpful? Because the nurse enters the PMH/PSH, FH, SH, and Meds. We entered HPI, exam, tests, results, IRP, and diagnosis. The nurse entered the facillity fee, and we entered the physician fee. As far as staffing. We were paying 2 people full time to go through the paper records and trying to find errors (which they did sometimes and other times didn't)....then we were paying a team of coders to review the dictated documentation and ensuring that it met the criteria for the billing listed, and then they had to manually enter it.... NOW, all of those people are gone. The documentation is automatically fed into billing system and the bill is generated and sent. BTW, my patient LOS only increased when I was there by 3 minutes. Not because I did anything special, but because I had my macro's tuned in, and used dragon to dictate HPI and IRP. I'm a fan....and you should be too. Link to comment Share on other sites More sharing options...
Guest Paula Posted May 13, 2014 Share Posted May 13, 2014 It will be quite a ride on the EMR train. I was just informed our office had hired another individual who is very familiar with the system we are implementing to be the super user. Plus she is a rad tech and will be filling that position, too. Now our nurses will be freed from that task. Yay! We definitely have to hire more people in order to handle the increased tasks due to EMR. I will be typing some of my notes as I am a fast typer and may use dragon, too Link to comment Share on other sites More sharing options...
Guest Paula Posted May 13, 2014 Share Posted May 13, 2014 I agree with getting rid of paper charts. Ours are a nightmare! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 13, 2014 Moderator Share Posted May 13, 2014 many places will not pay for dragon. at least when I was at kaiser they let us dictate the H+P into epic. most places don't. Link to comment Share on other sites More sharing options...
msjernigan37 Posted May 13, 2014 Share Posted May 13, 2014 I just found out that the hospital I will be working at in June is footing the bill for scribes for MLPs in the ER:-) I was an awesome scribe before PA school, so I know how awesome they can be:) I am looking forward to it! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 13, 2014 Moderator Share Posted May 13, 2014 most places make providers pay for their own scribe.... Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted May 13, 2014 Moderator Share Posted May 13, 2014 E- the hospital I'm going to this summer also utilizes scribes, but my understanding is that it does not come out of my hourly pay Link to comment Share on other sites More sharing options...
jmj11 Posted May 13, 2014 Author Share Posted May 13, 2014 I worked for two years developing my own EHR with a programmer. Then I merged it with an off-the-shelf system. The EHR is beautiful. I can get through some of the most complex exams and visits with only mouse clicks. Dragon is part of it, but I'm not using it because I don't need it. But the problem for us is with the other parts of the total office management system. I think we have good system. However, it has cost me at least $20,000 to implement when you combine the software upfront cost with the new hardware we had to buy and the training time of employees. The worst part was a three-month interruption in our collections as our new computer system and clearing house had to "adjust" to the insurance companies. This was almost deadly to the practice. The other problem, and is true with all systems, are the down times and bugs. For example, today, our allscripts part of the system suddenly (after three months) doesn't recognize me as an authorized prescriber. The IT guys have worked on it all day but it still doesn't work. But every system I've worked on, and it must be about four now, there are these electronic glitches where the little 1s and 0s get lost on the semiconductor . . . or something like that. Link to comment Share on other sites More sharing options...
LIPPER Posted May 13, 2014 Share Posted May 13, 2014 While the quantity of patients I saw with EMR dropped off in 2013, my collections increased 15%.... And since I'm steadily improving and becoming more efficient this bodes well. Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
Boatswain2PA Posted May 14, 2014 Share Posted May 14, 2014 An urgent care I part-time in uses Veloci-Doc. I actually like it MORE than I like T-sheets. The nurses do the ROS, and I look at the positives and click a button. Link to comment Share on other sites More sharing options...
gbrothers98 Posted May 14, 2014 Share Posted May 14, 2014 BTW, my patient LOS only increased when I was there by 3 minutes. Not because I did anything special, but because I had my macro's tuned in, and used dragon to dictate HPI and IRP. This is key especially with the integrated records. Macros, autotext, smartwords, precompleted notes, copy to new note. Very easy for providers to say they will just free text or dragon. Free text takes time and likely you are saying the same thing for many pts. Make it into an autotext and you saved minutes. I still dont get dragon. First, for medical dragon, I got quoted 3K per yr per provider by our IT. Then the time spent getting it to know you. Did not seem worth it. But where I found the EMR to be helpful was as a prompt to remember to ask pts the right questions during the HPI. Yes, I have been doing this for 15 yrs and still forget. Last, I am able to order on the fly since I bring the laptop with. So when the nurse finds me for the morphine order on the hip fracture when I am exiting the room and documenting on the sore throat to get them out, I can switch screens and get it done and not deal with a nurse pi**ed at the end of the shift b/c I missed my order. CPOE is a great thing as long as you have the interface. If you spend a lot of time adjusting orders, that defeats the purpose. Make sure this is bullet proof before you go live. You should have an electronic order sheet that presents you with at least your most common tests and imaging. The same with eprescribe. Everything should be a click and sign. Keep harping on that till you get what you need. Good luck. George Brothers PA-C Link to comment Share on other sites More sharing options...
msjernigan37 Posted May 14, 2014 Share Posted May 14, 2014 Initially the ER group physicians only had scribes (that they paid for)-but the hospital admin saw the positive impact and a few months ago decided that they would pay for MLPs in the ER to have scribes-won't come from my pay. Pretty sweet deal. Link to comment Share on other sites More sharing options...
kittryn Posted May 15, 2014 Share Posted May 15, 2014 The following probably wouldn't work for everyone, but it works for us: We're in a specialty (cardio) and use Centricity with fairly general forms. We flat out type our HPI and plans. I type fast and usually write in sentences. My SP types in short phrases. Neither of us sweat spelling or grammar. Our EMR autogenerates letters to PCPs from our typed transactions. We have some piecework helpers who remotely review these letters (one is an MA and the other is a PA who now stays home with her kids.).Our helpers edit, fixing grammar (like turning my boss' terse phrases into sentences and fixing my typos), as well as correcting spelling and punctuation mistakes. It's a few dollars per letter (I think $4) and it has worked out well for us. We type during the patient encounter and maybe for a minute later, then sign off on our transactions. This orders the scripts and the various test we've ordered. Rather than having a zillion boxes to check, we just let the editors clean up our prose and make it a letter. Someone in our office briefly reads the result before it gets sent out. In the end, we get reasonable letters and use the notes from the patient's last visit to chronologically roll through all the tests, admissions, and phone calls that happened since the last time they were in to see us. (Not to mention changes in weight, blood pressure, and -- in our case -- cardiac-related complaints for which we do have EMR boxes to check.) The result is that we don't spent time away from work writing notes, our MAs load up the chart with data from hospital admissions and tests, and the system adds structure to our visits. It's not perfect but it beats our old paper charts where we couldn't read each other's notes and often couldn't find test results. Patient calls that the nurses can't handle get sent to me as alert flags so I can see the patient's chart while I'm formulating an answer. Not the ideal situation, but not bad. And I'm an old guy! can I get one of those jobs correcting notes and work from home? I'd love it! :) Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.