Once again, I find myself agreeing with Al, who has always been right on the money when it comes to government and healthcare. I have read the NEJM article and read word by word the "Core Set" of objectives which must be met in order to qualify for the $44,00 for Medicare and $60,000 plus for Medicaid.
I too see little chance to be able to comply with these guidelines, which are not only impractical but I would find them extremely difficult to remember.
From looking at these core objectives, it seems obvious to me that before EMRs, doctors who were forced to actually take care of patients using pen and paper were not practicing medicine in a way that was meaningful. It is also ironic that while only a small percentage of us made the decision to obtain EMRs to improve our practices and patient care over ten years ago. Now the government is not only going to mandate that the 80% + who were too technophobic or had other reasons to not move to EMRs and are now going kicking and screaming, but they will at the same time not applaud those who were early adopters but punish them. While it was impossible to assess fully the outcome of the use of our endeavor via structured data, we were still light years ahead of our colleagues when it came to organize care through the electronic implementation of patient visits and documentation.
I, for one, am apalled at seeing the government once again coming very late to the party only to try to act like they are the ones coming up with this concept. The change from the original rules secondary to the more than 2,000 written objections to two sets of rules involving a set of core objectives which must be met along with an ala carte group of rules that each doctor can decide him or herself which ones they wish to implement. If you look at the overwhelming and daunting list of objectives that are not only impossible to comply with but are nearly impossible to remember, the $44,000 seems it will find its way back to the bailing out of big business whose only core objectives seem to meet all the criteria of mismanagement of their business.
The article by Mr. Tuttle on the 11 things needed in order to design the perfect medical record system, if looked at in a different light, seems to have already been done via the laws of the market place. While EMRs have come and gone, EMRs like Amazing Charts have fluorished simply because they meet almost all of the criteria that he states. Most of his suggestions revolve around the ease of use and a doctor's ability to easily see and assess data. Therefore, the rapid adoption of an EMR, especially after the average consumer of these, has already demoed an average of five to ten other systems seems to indicate that AC meets those requirements and more.
The irony is that for an EMR to meet his standards while at the same time have the capability of recording over 50% of 13 year old's lack of trying cigarettes in structured data is almost mutually exclusive. I ask about cigarettes, alcohol and other illicit drugs of every patient over 12 and recording that I have done this, while helpful for the infamous medicolegal reason, does nothing for me to help patient care. And, whether or not my labs are faxed to me, and I sign them off after reviewing them thoroughly versus having them entered directly into AC in structured format doesn't change my care. And, I keep track of my immunization rates just as well using my programs rather than the states IMMPACT program, which is cumbersome and slower than hell.
No, I am beginning to realize -- no have already come to the conclusion -- that I will never be entitled to the money, even though I practice what I think is good medicine. Jon has given us all the tools we need to see patients in a way that meets their needs. Now, the government needs to just step aside and let us do our jobs. We do them for our patients, because our patients want nothing less. And, while drug interactions and allergy monitoring is a potentially life-saving addition, many of us already use 3rd party applications such as Lexi-Comp, ePocrates, eMedicine, UpToDate and Isabel.
I really had to laught when one of Mr. Tuttles 11 recommendations for the perfect EMR was that the software should be useable in a way that replicates software that the user is already familiar with. How can one possibly know what software they should have been familiar with prior to looking at EMRs?
No, it is unattainable for me, and I am going to just keep doing what I have always done. Open Amazing Charts, watch it connect to SQL Server, read the funny quote of the day (we need more Jon) and then practice what I consider good medicine.
