Hi Dr. West, could you tell us your educational background and EMR experience?
I completed my fellowship in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. I began using an electronic medical record when I opened my practice in December 2009.
1. You’re on your second EMR after a failed EMR experience. I know you can’t reveal the name of your first EMR vendor, but what went so wrong?
Lots of things, but mainly it was the fact that it didn’t perform as the vendor described it would. Different parts were always malfunctioning. For example, the History of Present Illness section of my notes would sometimes get deleted when we tried to format the notes for faxing to a referring doctor. Different buttons on the screen which were supposed to be for functions were never functional. You would click them and nothing would happen. The accounting part of the software would not allow patients to be issued refunds in the case of overpayment, and so our financial books could not be kept accurate. Etc, etc.
2. What frustrated you the most about your first EMR?
That the company would make promises to fix it and never completely get it done. When one fix was completed, another part of the system would develop a new bug that was not there before. I think they were amateurs who basically got in over their heads and could not dig themselves out of the hole.
3. I know you are very happy with your current Free EMR, Practice Fusion, but after your failed EMR experience did you want to quit using EMRs all together? If not what or why were you still convinced there had to be a way to make EMRs work for your practice?
No, we had heard stories of other companies who had needed to change vendors and were prepared to keep on our mission of being an electronic practice. But it was indeed a scary time because we had just gotten burned with our first vendor. That said, I can see how many doctors who are less certain about the EMR concept for their practices may not have tried again at that point.
4. What do you think other doctors and healthcare professionals should avoid so that their initial experience with EMRs are less traumatic and more rewarding?
I think they should avoid rushing into a relationship with an EMR vendor; they should avoid signing a contract that does not include a satisfaction and money-back guarantee; and they should avoid continuing with an EMR vendor that has not provided a system to their satisfaction after an introductory period.
5. What should doctors and practice managers be looking for in their pursuit of finding an EMR that fits their needs?
I recommend searching for a vendor that is willing to let a provider test drive the EMR in the provider’s practice for an introductory period before committing to it. I think that a month would be enough time to find out all the problems, if any. There may need to be a deposit for this, but that should be fully refundable. They should be looking for a vendor that does not have a lot of very specific hardware requirements since hardware is not easy to return in the case where a provider needs to switch to an different EMR vendor.
6. What specific questions should other practices ask before signing a contract to have an EMR software package installed?
I think many of the answers are in my answer to question 5.
7. American Medical News reported the results of a recent study conducted by UC Davis which connected decreased productivity with EMR systems because of a lack of customization for given specialties. Was this an issue for you?
No. Practice Fusion is designed such that you can build your own templates to include whatever you like in the notes. After you create your own templates to your liking, I found that I could see patients faster and complete their notes sooner than before. All of my daily notes are essentially done by 5 pm.
8. Did you try other EMR software in between your first disastrous EMR experience and your current EMR?
We interviewed other vendors and viewed demos, but we had no other EMR in practice.
9. If you did, could you tell us about why you chose not to use them and could you tell us what the Practice Fusion EHR had that enticed you to go with them?
We went with Practice Fusion because it was free and web-based. Therefore it could be tried and discontinued, if necessary, without additional cost to us.
10. You’ve commented on your time being freed up because of using EMR, what was the most time consuming element in your pre-EMR life that no longer exists in your current, happy, para-EMR life?
If you mean before using any EMR whatsoever, then I would say charting in general. At Hopkins you had to dictate all your notes, spend additional time reviewing and editing them, and then sign. Now, using customized templates that I designed myself, that is all gone.
11. Besides Practice Fusion being free, can you tell those who might want to test the waters what you like the most about it?
It’s very intuitive. I like to call it the Gmail of EMRs. I imagine that eventually nearly everyone will have an account.
12. Explain the benefits of customized templates and details regarding how you designed your templates?
Benefits include a more uniform approach to common problems, such as diabetes and thyroid nodules. All patients with these conditions follow a thorough and well-defined path of questions designed to gather the most meaningful and relevant information.
13. How have you handled the issue of making each record unique to your patients’ medical issues when using templates?
Well, you still have to add unique contextual details, and for this you have to type a sentence here and there. These can be as long or short as you like.
14. Medicare and Medicaid decided to eliminate consultation codes. Is that one of the reasons you have decided against taking Medicare patients?
Yes, but only one of many reasons.
15. Why did you opt out of participating in the EHR government incentive plan? Aren’t you forfeiting a substantial sum of money by not participating?
On the surface it would appear so. It’s been an issue of angst for me personally, and I may blog on this inner struggle in the future over at happyemrdoctor.com.
16. In a recent survey conducted by the AACE, it was revealed that because of Medicare’s decision to remove the code allowing the consult charge, 4 out of 5 endocrinologists were going to reduce the number of patients seen in their practice. Are you aware of any groups working to reverse Medicare’s decision? What impact will this have on the future of Medicare?
I previously blogged on this at Happy EMR Doctor.
As far as groups working to reverse Medicare’s decision, I am aware that AACE already sent CMS a letter, and I found this letter as well.
In making this change, Medicare will save a lot of money for itself and shift the burden of payments back to patients who cannot find a subspecialist within travel distance who will accept Medicare. They will be forced into paying out-of-pocket for needed medical services. What most patients don’t know is that, under current Medicare rules (unlike commercial insurance companies like Blue Cross Blue Shield), patients cannot send in claims to Medicare for services rendered by doctors who have opted out of Medicare. To see an opted-out doctor, patients are forced to sign a Medicare contract stating that they will not send in any claims, despite having had necessary medical services. Medicare makes it more financially painful not to use their contracted doctors than do commercial carriers who have out-of-network options. As for the future of Medicare, I think that less doctors will be available in the system to supply demand to a growing number of baby-boomer Medicare patients.