I have to respectively disagree with Brian on the medication cross-references. While I can certainly look up whether Depakote and Lamictal don't play well together (they don't), it would be nice if the program did that for you. Unfortunately, that's what makes programs like eMDs so expensive.
There's no disagreement. I agree that that would be a great feature to have.
I just don't think that an insurance agency or a government agency like CCHIT has any business handing out demerits to EMRs that don't have them. Because such features are not indispensible, and the mandatory incorporation of those features causes an EMR to increase in size and cost, and decrease in speed.
E-MD's looks like a neat program, but why can't doctors decide how much EMR power they want to pay for? Who gives these guys the right to come in and decide what features my EMR has? Who gives them the right to mutate Amazing Charts into something besides the unique, simple, affordable thing that it already is?
Now that we have EMRs, we want to use them to improve patient care (yes, I know not how insurance wants us to use them, but some of these things are good ideas).
As you hint at, the insurance companies don't come up with these quality guidelines because they love us, they do it because they think it saves money. Sometimes improving health saves money but sometimes it doesn't, and then our relationship with insurers becomes an adversarial one, and we must retain our role as patient advocates, if we are going to be effective healers.
Now, if they are going to pay you extra for doing something you already thought was a good idea, then okay. However, money has addictive properties. What happens when the Board of Directors votes that the results of controversial study X will now become company policy? If you disagree, you are a "bad doctor" and there will be "no treat!" for you. We can very easily sell ourselves out, if we are not careful.
For instance if my MA puts in that the mother is breast feeding her child, then at the one month, two month visits and so on, the EMR should alert me to ask about Vitamin D. Plain and simple.
Well, again, I think this is a neat feature, but not indispensible, and shouldn't be mandatory.
We have the ability to remind ourselves of these kinds of things with the present technology, via reminder templates, or yellow reminder tags, plus Jon said recently there were improvements to the reminder system forthcoming, so this may be a non-issue.
Please note, I have no qualms if a physician wants to set up reminder systems for
himself, my issue was just that "quality improvement" initiatives or guidelines presented by an insurer should be viewed with mistrust, because ultimately their goals and ours can be quite different. Just because the payor says a feature should be required in an EMR doesn't make it so.
