Guest Paula Posted May 4, 2013 Share Posted May 4, 2013 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. Link to comment Share on other sites More sharing options...
rcdavis Posted May 4, 2013 Share Posted May 4, 2013 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. And, while following guidelines may be good for some.. those in medicine which innovate, or discern new uses (off label) for medications, will be hampered because, some one from on high hasn't gotten the message.. or incorporated it into a "standard". so the practice will be dictated by "standards" which are sometimes both behind the times and subject to debate. example?? TPA in embolic stroke.. just check the literature in the EM circles versus NINH and neurology... use of Compazine, magnesium, depakon, reglan for migraines. until very very recently, all of these medications did not have an indication for migraines, and were not in the usual "protocols"... what changed was the EDs started using these meds, and changed the approach to migraines thru off-label use of medication, and no "evidence based protocols.. these guys ESTABLISHED the ideas that the evidence base protocols were proposed in response to... dictating "evidence based medication" (which changes every 20 years or so, look at digoxin which suddenly is looking good again) may standardize practices.. but will, i maintain, impeded practice improvement. on a more personal note.. these records become easily accessible to non medical governmental agencies... a la the 4 patients in new York which answered their doctors queries about gun ownership, answered in the affirmative, and a little while later had authorities coming to their home to confiscate the weapons. HIPPA will not, and is specifically designed to not, prohibit government perusal of your data.. while they data mine your histories, physicals, labs, etc. the only way around this is to 1) find a doc which does not buy into EMR, and doesn't do it, which will require 2) paying cash for his services. sounds conspiratorial I know , but if you trust the government (this government in particular) to approach your record as simply between you and your doctor, then you are in for a rude awakening. Link to comment Share on other sites More sharing options...
rcdavis Posted May 4, 2013 Share Posted May 4, 2013 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. And, while following guidelines may be good for some.. those in medicine which innovate, or discern new uses (off label) for medications, will be hampered because, some one from on high hasn't gotten the message.. or incorporated it into a "standard". so the practice will be dictated by "standards" which are sometimes both behind the times and subject to debate. example?? TPA in embolic stroke.. just check the literature in the EM circles versus NINH and neurology... use of Compazine, magnesium, depakon, reglan for migraines. until very very recently, all of these medications did not have an indication for migraines, and were not in the usual "protocols"... what changed was the EDs started using these meds, and changed the approach to migraines thru off-label use of medication, and no "evidence based protocols.. these guys ESTABLISHED the ideas that the evidence base protocols were proposed in response to... dictating "evidence based medication" (which changes every 20 years or so, look at digoxin which suddenly is looking good again) may standardize practices.. but will, i maintain, impeded practice improvement. on a more personal note.. these records become easily accessible to non medical governmental agencies... a la the 4 patients in new York which answered their doctors queries about gun ownership, answered in the affirmative, and a little while later had authorities coming to their home to confiscate the weapons. HIPPA will not, and is specifically designed to not, prohibit government perusal of your data.. while they data mine your histories, physicals, labs, etc. the only way around this is to 1) find a doc which does not buy into EMR, and doesn't do it, which will require 2) paying cash for his services. sounds conspiratorial I know , but if you trust the government (this government in particular) to approach your record as simply between you and your doctor, then you are in for a rude awakening. Link to comment Share on other sites More sharing options...
rcdavis Posted May 4, 2013 Share Posted May 4, 2013 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. And, while following guidelines may be good for some.. those in medicine which innovate, or discern new uses (off label) for medications, will be hampered because, some one from on high hasn't gotten the message.. or incorporated it into a "standard". so the practice will be dictated by "standards" which are sometimes both behind the times and subject to debate. example?? TPA in embolic stroke.. just check the literature in the EM circles versus NINH and neurology... use of Compazine, magnesium, depakon, reglan for migraines. until very very recently, all of these medications did not have an indication for migraines, and were not in the usual "protocols"... what changed was the EDs started using these meds, and changed the approach to migraines thru off-label use of medication, and no "evidence based protocols.. these guys ESTABLISHED the ideas that the evidence base protocols were proposed in response to... dictating "evidence based medication" (which changes every 20 years or so, look at digoxin which suddenly is looking good again) may standardize practices.. but will, i maintain, impeded practice improvement. on a more personal note.. these records become easily accessible to non medical governmental agencies... a la the 4 patients in new York which answered their doctors queries about gun ownership, answered in the affirmative, and a little while later had authorities coming to their home to confiscate the weapons. HIPPA will not, and is specifically designed to not, prohibit government perusal of your data.. while they data mine your histories, physicals, labs, etc. the only way around this is to 1) find a doc which does not buy into EMR, and doesn't do it, which will require 2) paying cash for his services. sounds conspiratorial I know , but if you trust the government (this government in particular) to approach your record as simply between you and your doctor, then you are in for a rude awakening. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 4, 2013 Administrator Share Posted May 4, 2013 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? Yep. The second I code a new DM II, I have all the appropriate labs, patient education, and follow up staring me in the face. I have to cancel out the appropriate labs if I want to add a potassium-affecting medication. I have to specifically override to give high-risk meds to the elderly. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 4, 2013 Administrator Share Posted May 4, 2013 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? Yep. The second I code a new DM II, I have all the appropriate labs, patient education, and follow up staring me in the face. I have to cancel out the appropriate labs if I want to add a potassium-affecting medication. I have to specifically override to give high-risk meds to the elderly. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 4, 2013 Administrator Share Posted May 4, 2013 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? Yep. The second I code a new DM II, I have all the appropriate labs, patient education, and follow up staring me in the face. I have to cancel out the appropriate labs if I want to add a potassium-affecting medication. I have to specifically override to give high-risk meds to the elderly. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 5, 2013 Moderator Share Posted May 5, 2013 the annoying thing about the allergy "reminder" is that every time I write for vicodin for someone who gets gi upset from codeine I have to override the allergy setting and write"pt not allergic to codeine, gi upset only" in the reason for override. do that 5 times/day, every day and it gets old. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 5, 2013 Moderator Share Posted May 5, 2013 the annoying thing about the allergy "reminder" is that every time I write for vicodin for someone who gets gi upset from codeine I have to override the allergy setting and write"pt not allergic to codeine, gi upset only" in the reason for override. do that 5 times/day, every day and it gets old. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 5, 2013 Moderator Share Posted May 5, 2013 the annoying thing about the allergy "reminder" is that every time I write for vicodin for someone who gets gi upset from codeine I have to override the allergy setting and write"pt not allergic to codeine, gi upset only" in the reason for override. do that 5 times/day, every day and it gets old. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 5, 2013 Administrator Share Posted May 5, 2013 the annoying thing about the allergy "reminder" is that every time I write for vicodin for someone who gets gi upset from codeine I have to override the allergy setting and write"pt not allergic to codeine, gi upset only" in the reason for override. do that 5 times/day, every day and it gets old. Your EMR sucks. It's one button in my EPIC. :-) Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 5, 2013 Administrator Share Posted May 5, 2013 the annoying thing about the allergy "reminder" is that every time I write for vicodin for someone who gets gi upset from codeine I have to override the allergy setting and write"pt not allergic to codeine, gi upset only" in the reason for override. do that 5 times/day, every day and it gets old. Your EMR sucks. It's one button in my EPIC. :-) Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted May 5, 2013 Administrator Share Posted May 5, 2013 the annoying thing about the allergy "reminder" is that every time I write for vicodin for someone who gets gi upset from codeine I have to override the allergy setting and write"pt not allergic to codeine, gi upset only" in the reason for override. do that 5 times/day, every day and it gets old. Your EMR sucks. It's one button in my EPIC. :-) Link to comment Share on other sites More sharing options...
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