Electronic Health Record challenges . . .

One of the challenges of using an electronic health record (EHR) is that of communication and order generation with ancillary services.  Medicare has mandated conversion to the use of electronic prescribing and commercial insurance has followed suit. The challenge is that as we are all becoming more paperless, ancillary services are no longer accepting prescriptions that don't have an "actual signature".  Medicare as also mandated that every order be "physically signed" which is becoming impossible with use of EHR.

This hasn't posed a problem with Medicare or with the commercial insurances, but it has begun to drive a wedge between the patient and his or her physician. We send a prescription electronically and the ancillary service kicks it back because it isn't "actually signed on paper."  Patient's feel our office is not doing its job correctly because the ancillary services told him that he "orders were signed correctly."  We are doing our job and having to duplicate services.  Everyone gets irritated all the way around the process.
Because we as a society are used to getting "our burger our our way" within a two-and-a-half minute window, my staff frequently gets an ear-full. Screaming and cursing at the doctor's office staff is not the way to get things done or aid your cause.
The burden that is created by the mandate for EHR use causes a significant change in the office flow.  It takes a good 6-12 months for a physician's to improve efficiency when the whole office flow changes.  My office is not alone in this problem.  We just recently changed our electronic health care record and significant process changes were made which has caused us delay and efficiency drops while we accommodate the new flows and attempt to write orders that were signed with electronic signatures with "actual wet signatures."
I have been using electronic health records for over 11 years.  The process isn't getting any easier, unfortunately. If you are a patient, or an ancillary service, please be patient with your doctor's office.  We are becoming as regulated as the airlines . . . who knows  . . . you may soon need to pass through a TSA scanner before you can enter my office.  Wouldn't that be exciting?!

Medicine and Fast Food

No, the practice of medicine is not like fast food.

We live in a society of fast cars, fast food, instant messages, and instant pictures.  We want it our way and we want it now.  This is evident by the fact that the average American household has $16,000.00 in credit card debt (2011 Household Statistics).  We want it now and well worry about payment or consequence later. This is also evident by the successes of instant messaging services, cell phones and fast food restaurants.

As a family practitioner, I feel pressured by both patients and insurance companies to serve up a diagnosis and a low cost generic pill with the same speed.  No, the practice of medicine is not like fast food. If it were, then I would install a drive up window next to my office desk, and place a large marquee with a clown wearing a stethoscope at my front door.

Medicine is an art.  A picture is painted of the patient by what is seen, heard, felt and understood through the eyes of the practitioner.  This can't be done over the phone or through a drive-through window. It requires a patient who is willing to place his or her history, symptoms, feelings, private concerns and trust upon the examination table It requires the astute observer to see all the reflections of light and shadows and all the highlights.  It requires the observer, the doctor, to recognized that many times this is difficult for the patient.  That trust is built through a relationship that occurs over a period of minutes and a period of years.  The beauty of the art occurs when the practitioner and the patient understand one another and application of healing can begin.

The art of medicine paints a different picture every time. That's why art isn't sold under the golden arches, or at the corner pharmacy.  No, the practice of medicine is not like fast food.