AAMC Physician Workforce Research Meeting

[UGoLong]

What is the AAMC?

 

As far as EMR, I can gather it would be an issue in the ER. As a cardiology PA, I think EMR is great. I can get to all the old tests, etc very quickly and our progress notes and easy to develop. Consults in the hospital are dictated (and then they go to EMR) and that seems like the best of both worlds.

 

We have one system in the office (Centricity) and three different ones in the three local hospital systems. Cerner, BTW, is my least favorite; good luck figuring out what one time doses a patient has already received. My favorite is EPIC.

[UGoLong]

What is the AAMC?

 

As far as EMR, I can gather it would be an issue in the ER. As a cardiology PA, I think EMR is great. I can get to all the old tests, etc very quickly and our progress notes and easy to develop. Consults in the hospital are dictated (and then they go to EMR) and that seems like the best of both worlds.

 

We have one system in the office (Centricity) and three different ones in the three local hospital systems. Cerner, BTW, is my least favorite; good luck figuring out what one time doses a patient has already received. My favorite is EPIC.

[True Anomaly]

EMR's are the devil. they suck productivity and offer little in return.

 

We've been down that road before. I agree that when first introduced they are a pain in the ***, and can cause a decrease in productivity. However, I believe we're in such a state of transition all over the country in going from completely on paper to completely paperless that we're all experiencing growing pains to a certain degree. This will eventually work itself out and (again, my belief) ultimately allow the healthcare system to be more streamlined and productive.

 

I really only want two things from the advent of EMR's:

1. Allow me to decipher what other providers are saying- other ER providers, consultants, specialists, primary care folks...ANYONE who has touched the patient and has a little something to offer. Major league frustration with getting a consultant's note and not being able to pick out a damn thing they say, and ultimately having to either track them down or repeat studies to achieve the same result because they couldn't (or wouldn't) write legibly. I may get roasted for this, but I firmly believe that writing illegibly is one of the most selfish things you can do in healthcare- it only helps you, and does an absolute disservice to anyone trying to read your note who MIGHT learn something about the patient you're caring for, and maybe not encounter the same problems you did with them (ie, pt attempts to forge narc rx and you document it because you saw it, but no one else can decipher it).

2. Maybe, just maybe....allow regional hospitals to actually SHARE information on a similar network- easier to do eventually with EMR's. Not saying this would happen even in the next 10 years, but the possibility is there. Limit the amount of redundant workups. Hell, I'd be happy with everyone just being on the same PACS/radiology system.

 

E, I've learned to agree to disagree with you on this :D

[True Anomaly]

EMR's are the devil. they suck productivity and offer little in return.

 

We've been down that road before. I agree that when first introduced they are a pain in the ***, and can cause a decrease in productivity. However, I believe we're in such a state of transition all over the country in going from completely on paper to completely paperless that we're all experiencing growing pains to a certain degree. This will eventually work itself out and (again, my belief) ultimately allow the healthcare system to be more streamlined and productive.

 

I really only want two things from the advent of EMR's:

1. Allow me to decipher what other providers are saying- other ER providers, consultants, specialists, primary care folks...ANYONE who has touched the patient and has a little something to offer. Major league frustration with getting a consultant's note and not being able to pick out a damn thing they say, and ultimately having to either track them down or repeat studies to achieve the same result because they couldn't (or wouldn't) write legibly. I may get roasted for this, but I firmly believe that writing illegibly is one of the most selfish things you can do in healthcare- it only helps you, and does an absolute disservice to anyone trying to read your note who MIGHT learn something about the patient you're caring for, and maybe not encounter the same problems you did with them (ie, pt attempts to forge narc rx and you document it because you saw it, but no one else can decipher it).

2. Maybe, just maybe....allow regional hospitals to actually SHARE information on a similar network- easier to do eventually with EMR's. Not saying this would happen even in the next 10 years, but the possibility is there. Limit the amount of redundant workups. Hell, I'd be happy with everyone just being on the same PACS/radiology system.

 

E, I've learned to agree to disagree with you on this :D

[True Anomaly]

EMR's are the devil. they suck productivity and offer little in return.

 

We've been down that road before. I agree that when first introduced they are a pain in the ***, and can cause a decrease in productivity. However, I believe we're in such a state of transition all over the country in going from completely on paper to completely paperless that we're all experiencing growing pains to a certain degree. This will eventually work itself out and (again, my belief) ultimately allow the healthcare system to be more streamlined and productive.

 

I really only want two things from the advent of EMR's:

1. Allow me to decipher what other providers are saying- other ER providers, consultants, specialists, primary care folks...ANYONE who has touched the patient and has a little something to offer. Major league frustration with getting a consultant's note and not being able to pick out a damn thing they say, and ultimately having to either track them down or repeat studies to achieve the same result because they couldn't (or wouldn't) write legibly. I may get roasted for this, but I firmly believe that writing illegibly is one of the most selfish things you can do in healthcare- it only helps you, and does an absolute disservice to anyone trying to read your note who MIGHT learn something about the patient you're caring for, and maybe not encounter the same problems you did with them (ie, pt attempts to forge narc rx and you document it because you saw it, but no one else can decipher it).

2. Maybe, just maybe....allow regional hospitals to actually SHARE information on a similar network- easier to do eventually with EMR's. Not saying this would happen even in the next 10 years, but the possibility is there. Limit the amount of redundant workups. Hell, I'd be happy with everyone just being on the same PACS/radiology system.

 

E, I've learned to agree to disagree with you on this :D

[physasst]

You forgot the lawyers. 40% of what I do is to prevent buying someone else's lawyer a new house.

 

Not so much. Providers are great at rationalizing their own behavior. I wrote this a few months ago....it spun off of a much more formal systematic review I finished on the effects of tort reform on healthcare spending. Here's the bottom line. It (direct reforms) hasn't slowed healthcare spending ANYWHERE it has been tried, and in some cases, has accelerated it. Indirect reforms likely hold some promise, but again, not a huge savings.

 

http://www.pasconnect.org/does-tort-reform-work/

[physasst]

You forgot the lawyers. 40% of what I do is to prevent buying someone else's lawyer a new house.

 

Not so much. Providers are great at rationalizing their own behavior. I wrote this a few months ago....it spun off of a much more formal systematic review I finished on the effects of tort reform on healthcare spending. Here's the bottom line. It (direct reforms) hasn't slowed healthcare spending ANYWHERE it has been tried, and in some cases, has accelerated it. Indirect reforms likely hold some promise, but again, not a huge savings.

 

http://www.pasconnect.org/does-tort-reform-work/

[physasst]

You forgot the lawyers. 40% of what I do is to prevent buying someone else's lawyer a new house.

 

Not so much. Providers are great at rationalizing their own behavior. I wrote this a few months ago....it spun off of a much more formal systematic review I finished on the effects of tort reform on healthcare spending. Here's the bottom line. It (direct reforms) hasn't slowed healthcare spending ANYWHERE it has been tried, and in some cases, has accelerated it. Indirect reforms likely hold some promise, but again, not a huge savings.

 

http://www.pasconnect.org/does-tort-reform-work/

[EMEDPA]

E, I've learned to agree to disagree with you on this :D

your points are valid. I'm just a luddite so a lot of this is anti-technology mumbling on my part but I honestly feel slowed down by these systems. a few like electronic t-system allow for some speed but it seems the whole world is going to epic which has a lot of built in redundancy and requires a 2 page procedure note to pop a pimple.

you've seen my phone. remember I'm the guy who learned to text last yr and still has a watch that requires winding...:)...I also drive a stick shift car and miss my cassette players....

[EMEDPA]

E, I've learned to agree to disagree with you on this :D

your points are valid. I'm just a luddite so a lot of this is anti-technology mumbling on my part but I honestly feel slowed down by these systems. a few like electronic t-system allow for some speed but it seems the whole world is going to epic which has a lot of built in redundancy and requires a 2 page procedure note to pop a pimple.

you've seen my phone. remember I'm the guy who learned to text last yr and still has a watch that requires winding...:)...I also drive a stick shift car and miss my cassette players....

[EMEDPA]

E, I've learned to agree to disagree with you on this :D

your points are valid. I'm just a luddite so a lot of this is anti-technology mumbling on my part but I honestly feel slowed down by these systems. a few like electronic t-system allow for some speed but it seems the whole world is going to epic which has a lot of built in redundancy and requires a 2 page procedure note to pop a pimple.

you've seen my phone. remember I'm the guy who learned to text last yr and still has a watch that requires winding...:)...I also drive a stick shift car and miss my cassette players....

[discogenic]

your points are valid. I'm just a luddite so a lot of this is anti-technology mumbling on my part but I honestly feel slowed down by these systems. a few like electronic t-system allow for some speed but it seems the whole world is going to epic which has a lot of built in redundancy and requires a 2 page procedure note to pop a pimple.

you've seen my phone. remember I'm the guy who learned to text last yr and still has a watch that requires winding...:)...I also drive a stick shift car and miss my cassette players....[/QUOTE]

 

At least you didn't say 8 track player. :=D:

[discogenic]

your points are valid. I'm just a luddite so a lot of this is anti-technology mumbling on my part but I honestly feel slowed down by these systems. a few like electronic t-system allow for some speed but it seems the whole world is going to epic which has a lot of built in redundancy and requires a 2 page procedure note to pop a pimple.

you've seen my phone. remember I'm the guy who learned to text last yr and still has a watch that requires winding...:)...I also drive a stick shift car and miss my cassette players....[/QUOTE]

 

At least you didn't say 8 track player. :=D:

[discogenic]

your points are valid. I'm just a luddite so a lot of this is anti-technology mumbling on my part but I honestly feel slowed down by these systems. a few like electronic t-system allow for some speed but it seems the whole world is going to epic which has a lot of built in redundancy and requires a 2 page procedure note to pop a pimple.

you've seen my phone. remember I'm the guy who learned to text last yr and still has a watch that requires winding...:)...I also drive a stick shift car and miss my cassette players....[/QUOTE]

 

At least you didn't say 8 track player. :=D:

[rev ronin]

Dragon helps--dictation straight INTO your EMR. That is, until your IT department upgrades computers and wipes out the local database so you have to retrain it from scratch. Didn't happen to me, I type well and fast enough I don't use it, but such a scorched-earth upgrade royally screwed up one of my colleagues' days this week.

[rev ronin]

Dragon helps--dictation straight INTO your EMR. That is, until your IT department upgrades computers and wipes out the local database so you have to retrain it from scratch. Didn't happen to me, I type well and fast enough I don't use it, but such a scorched-earth upgrade royally screwed up one of my colleagues' days this week.

[rev ronin]

Dragon helps--dictation straight INTO your EMR. That is, until your IT department upgrades computers and wipes out the local database so you have to retrain it from scratch. Didn't happen to me, I type well and fast enough I don't use it, but such a scorched-earth upgrade royally screwed up one of my colleagues' days this week.

[physasst]

We've been down that road before. I agree that when first introduced they are a pain in the ***, and can cause a decrease in productivity. However, I believe we're in such a state of transition all over the country in going from completely on paper to completely paperless that we're all experiencing growing pains to a certain degree. This will eventually work itself out and (again, my belief) ultimately allow the healthcare system to be more streamlined and productive.

 

I really only want two things from the advent of EMR's:

1. Allow me to decipher what other providers are saying- other ER providers, consultants, specialists, primary care folks...ANYONE who has touched the patient and has a little something to offer. Major league frustration with getting a consultant's note and not being able to pick out a damn thing they say, and ultimately having to either track them down or repeat studies to achieve the same result because they couldn't (or wouldn't) write legibly. I may get roasted for this, but I firmly believe that writing illegibly is one of the most selfish things you can do in healthcare- it only helps you, and does an absolute disservice to anyone trying to read your note who MIGHT learn something about the patient you're caring for, and maybe not encounter the same problems you did with them (ie, pt attempts to forge narc rx and you document it because you saw it, but no one else can decipher it).

2. Maybe, just maybe....allow regional hospitals to actually SHARE information on a similar network- easier to do eventually with EMR's. Not saying this would happen even in the next 10 years, but the possibility is there. Limit the amount of redundant workups. Hell, I'd be happy with everyone just being on the same PACS/radiology system.

 

E, I've learned to agree to disagree with you on this :D

 

Agreed. There are a lot of benefits to EMRs, such as a reduction in errors, reduction in billing errors to incomplete documentation, and an increase in quality of care, albeit a small one...for now, this will change dramatically with new more advanced, robust, decision support systems. Also, new payment models will necessitate that providers ALWAYS follow established evidence based guidelines (where available) OR document one heck of a reason why you are not following them on that patient, or you will risk not being paid. New EMR systems will help ensure compliance (or at the very least recognition) of the guidelines.

[physasst]

We've been down that road before. I agree that when first introduced they are a pain in the ***, and can cause a decrease in productivity. However, I believe we're in such a state of transition all over the country in going from completely on paper to completely paperless that we're all experiencing growing pains to a certain degree. This will eventually work itself out and (again, my belief) ultimately allow the healthcare system to be more streamlined and productive.

 

I really only want two things from the advent of EMR's:

1. Allow me to decipher what other providers are saying- other ER providers, consultants, specialists, primary care folks...ANYONE who has touched the patient and has a little something to offer. Major league frustration with getting a consultant's note and not being able to pick out a damn thing they say, and ultimately having to either track them down or repeat studies to achieve the same result because they couldn't (or wouldn't) write legibly. I may get roasted for this, but I firmly believe that writing illegibly is one of the most selfish things you can do in healthcare- it only helps you, and does an absolute disservice to anyone trying to read your note who MIGHT learn something about the patient you're caring for, and maybe not encounter the same problems you did with them (ie, pt attempts to forge narc rx and you document it because you saw it, but no one else can decipher it).

2. Maybe, just maybe....allow regional hospitals to actually SHARE information on a similar network- easier to do eventually with EMR's. Not saying this would happen even in the next 10 years, but the possibility is there. Limit the amount of redundant workups. Hell, I'd be happy with everyone just being on the same PACS/radiology system.

 

E, I've learned to agree to disagree with you on this :D

 

Agreed. There are a lot of benefits to EMRs, such as a reduction in errors, reduction in billing errors to incomplete documentation, and an increase in quality of care, albeit a small one...for now, this will change dramatically with new more advanced, robust, decision support systems. Also, new payment models will necessitate that providers ALWAYS follow established evidence based guidelines (where available) OR document one heck of a reason why you are not following them on that patient, or you will risk not being paid. New EMR systems will help ensure compliance (or at the very least recognition) of the guidelines.

[physasst]

We've been down that road before. I agree that when first introduced they are a pain in the ***, and can cause a decrease in productivity. However, I believe we're in such a state of transition all over the country in going from completely on paper to completely paperless that we're all experiencing growing pains to a certain degree. This will eventually work itself out and (again, my belief) ultimately allow the healthcare system to be more streamlined and productive.

 

I really only want two things from the advent of EMR's:

1. Allow me to decipher what other providers are saying- other ER providers, consultants, specialists, primary care folks...ANYONE who has touched the patient and has a little something to offer. Major league frustration with getting a consultant's note and not being able to pick out a damn thing they say, and ultimately having to either track them down or repeat studies to achieve the same result because they couldn't (or wouldn't) write legibly. I may get roasted for this, but I firmly believe that writing illegibly is one of the most selfish things you can do in healthcare- it only helps you, and does an absolute disservice to anyone trying to read your note who MIGHT learn something about the patient you're caring for, and maybe not encounter the same problems you did with them (ie, pt attempts to forge narc rx and you document it because you saw it, but no one else can decipher it).

2. Maybe, just maybe....allow regional hospitals to actually SHARE information on a similar network- easier to do eventually with EMR's. Not saying this would happen even in the next 10 years, but the possibility is there. Limit the amount of redundant workups. Hell, I'd be happy with everyone just being on the same PACS/radiology system.

 

E, I've learned to agree to disagree with you on this :D

 

Agreed. There are a lot of benefits to EMRs, such as a reduction in errors, reduction in billing errors to incomplete documentation, and an increase in quality of care, albeit a small one...for now, this will change dramatically with new more advanced, robust, decision support systems. Also, new payment models will necessitate that providers ALWAYS follow established evidence based guidelines (where available) OR document one heck of a reason why you are not following them on that patient, or you will risk not being paid. New EMR systems will help ensure compliance (or at the very least recognition) of the guidelines.

[EMEDPA]

I type well and fast enough I don't use it, but such a scorched-earth upgrade royally screwed up one of my colleagues' days this week.

did I mention I type with 2 fingers...25-30 words/min but still 2 fingers....

I can do a paper chart well in about 4-5 min. can dictate same in about 2 min.

on emr takes me 10+ min.

[EMEDPA]

I type well and fast enough I don't use it, but such a scorched-earth upgrade royally screwed up one of my colleagues' days this week.

did I mention I type with 2 fingers...25-30 words/min but still 2 fingers....

I can do a paper chart well in about 4-5 min. can dictate same in about 2 min.

on emr takes me 10+ min.

[EMEDPA]

I type well and fast enough I don't use it, but such a scorched-earth upgrade royally screwed up one of my colleagues' days this week.

did I mention I type with 2 fingers...25-30 words/min but still 2 fingers....

I can do a paper chart well in about 4-5 min. can dictate same in about 2 min.

on emr takes me 10+ min.

[Guest Paula]

Agreed. There are a lot of benefits to EMRs, such as a reduction in errors, reduction in billing errors to incomplete documentation, and an increase in quality of care, albeit a small one...for now, this will change dramatically with new more advanced, robust, decision support systems. Also, new payment models will necessitate that providers ALWAYS follow established evidence based guidelines (where available) OR document one heck of a reason why you are not following them on that patient, or you will risk not being paid. New EMR systems will help ensure compliance (or at the very least recognition) of the guidelines.

 

How will EMRs incorporate the evidenced based guidelines? Will they pop up on a screen telling us what they are and did we follow them? Frankly, it takes a lot of work in FamMed to keep up with all the guidelines. Those who work in specialties maybe don't have as much to keep up with, but I find it exhausting in FamMed to do keep up.

 

This is a bit off subject but: Will the new payment models and the ACA eventually only recognized board certified providers? I work with a GP. I could be in trouble if that is ever put in place.

[Guest Paula]

Agreed. There are a lot of benefits to EMRs, such as a reduction in errors, reduction in billing errors to incomplete documentation, and an increase in quality of care, albeit a small one...for now, this will change dramatically with new more advanced, robust, decision support systems. Also, new payment models will necessitate that providers ALWAYS follow established evidence based guidelines (where available) OR document one heck of a reason why you are not following them on that patient, or you will risk not being paid. New EMR systems will help ensure compliance (or at the very least recognition) of the guidelines.

 

How will EMRs incorporate the evidenced based guidelines? Will they pop up on a screen telling us what they are and did we follow them? Frankly, it takes a lot of work in FamMed to keep up with all the guidelines. Those who work in specialties maybe don't have as much to keep up with, but I find it exhausting in FamMed to do keep up.

 

This is a bit off subject but: Will the new payment models and the ACA eventually only recognized board certified providers? I work with a GP. I could be in trouble if that is ever put in place.