Recently, I was asked to share my opinion on a letter sent into Physicians Practice from a pediatrician, who wrote, “Call me old-school, old-fashioned, or just plain hard-headed, but you can’t tell me it’s worth the financial outlay to marginally improve patient care, if at all, with no guarantee.”
In a way, he’s sort of right for pediatrics, which is very templated and predictable. There are few quality measures for pediatricians to track, so there’s much less chance pediatricians will realize quality improvements commonly found in, say, family practice or internal medicine. A pediatrician’s main measuring stick for quality are immunization rates, and most pediatricians have fairly good rates.
But…there are some areas where this paper-based doctor can’t touch me on quality. It all centers around the power of an EMR’s reporting capabilities. For example:
I can call in patients who don’t have appointments and are behind on their shots. This not only improves my quality numbers, but it increases my income. During the slow months of the year, we contact patients who are due for shots but don’t have an appointment. Making a list of such patients takes about twenty seconds.
I can quickly search a lot number of an immunization that is bad, or a medication that is recalled. When the FDA pulled Vioxx from the market, we had a letter in the mail to our patients that same day. One of our patients who had moved to Florida wondered how we were so on the ball; her current doctor had never notified her.
I can document more completely, and so, I get paid better and have far less fear of being audited. Like it or not, the payment system in medicine is driven by documentation. You can only charge what is documented, not what was done. If you charge more than you document, you have committed fraud in the eyes of payers. Our EMR crosses the “t”s and dots the “i”s with little effort; we don’t fear an audit.
The work flow regarding phone calls is far superior with an EMR than with paper. For example: Say a patient (a child) comes to the office and gets an antibiotic prescription for an ear infection. An hour later, the mother calls up and says she lost the prescription. She doesn’t know which antibiotic, but wants you to call it in to the pharmacy. What is the work flow for the nurse who took the call?
Tell the mother she will call back.
Try to find the chart.
If necessary, track down the doctor to ask what the prescription was.
Call the patient back and ask what pharmacy to call the prescription to.
Call in the prescription.
Document the phone call.
Doesn’t happen -- the prescription was faxed directly to the pharmacy during the patient’s visit.
Or, worst case:
The nurse sees the prescription in the electronic chart, along with the pharmacy name, and calls it in immediately.
These sorts of changes don’t just produce incremental quality improvements; they produce exponential improvement. They make a level of quality possible that is simply not attainable using paper charts.
Robert Lamberts, MD, is a primary care physician with Evans Medical Group in Evans, Ga. He is board certified in internal medicine and pediatrics, and specializes in the care of adults, pediatrics, diabetes, high blood pressure, asthma, preventative medicine, attention deficit disorder, and emotional/behavior disorders. Dr. Lamberts serves on multiple committees at several national organizations for the promotion of computerized health records, for which he is a recognized national speaker. He can be reached at rlamberts@EvansMedicalGroup.com.