Home Forums Discussions Feedback and Recommendations updates to help limit malpractice

I have version 3.6.19 . After completing a medical mp risk assessment for my insurance carrier(to get a discount), I noticed a couple of questions that were flags.

1)Does your EMR included decision-support prompts such as alerts for certain tests, medication conflicts, duplication of tests or meds, visit timelines etc.

2) tracking lab data and creating alerts for when repeat labs are necessary

Does the new versions provide this? If so-how do I create these alerts? My practice is still small and growing, but looking into the future, I need some safeguards/systems in place to tract important data.

On another subject-did they fix the demo screen to automatically have the receptionist enter the copay?

Are these things that you are interested in for your own practice, or are you trying to satisfy an insurer's requirement? The reason I ask is that some of these so-called "requirements" don't seem so necessary to me. I am sure we can help you find a way to do what you are wanting to do.


I would say:
Tracking lab data and creating alerts for when repeat labs are necessary = yes.
Alerts for certain tests = are you repeating yourself or is this a separate feature from the above?
Visit timelines = yes.
Duplication of tests or meds = no, but why should that be mandatory?
Medication conflicts = no, but why should that be mandatory? There are cheap or free third-party programs to check interactions, if you're not sure.


I am not sure about this one. If not, I know that the financial part of the program is something Jon is working on for the new version.

Hey, I know you to be a very nice guy, so don't take this the wrong way, OK? But it sounds like the people you are talking to are falling for and handing you a bunch of CCHITT to put it mildly. Just what did docs do only a few years ago before EMR's for half of these things? Much of these issues are dreamed up by the vendors and CCHITT to push their products or the government so they can use all providers and citizens as datapoints in the invasive games.

Let's not even get into the fact that none of the data collected by any provider is never really blind and with informed consent its not blind to the patient either. Not a real strong experimental model there.... Commonly know, Psych 300-400 level Experimental Methods source of experimenter and test subject bias. Nobody asked me if I care to have me or my children included in their healthcare databases and studies. Where is my informed consent or right to opt out as an American citizen or patient?

Most of this P4P and other measures based CCHITT is just the new, HMO like catch phrase for having a nail to hang their hat on to withold payments from hard working PCP's who will have the most multiple issues and conditions to track and be penalized for. Not that other tough specialties won't also start getting slammed too.

Do you really want to play their game and have to start dropping your less than ideal patients from you panel, just to keep your numbers up? Shouldn't we be retaining and trying to coax such patients into better care? Shouldn't we actually be compensated more for some of these patients who will actually bring the numbers down??? Where is their P4P for all the tough patients that are hard to deal with, resist your advice, call multiple times a day, and don't want to come in, get some exersice and change their diets??? I challenge them to devise a fair system that pays a real bonus for all of that. We have a number of success stories here that we might have had to try to get off the panel so as to maintain good P4P data. Now that is pure BULLCCHITT. We as a society and a profession are better than that.

Lastly, from day one, whether it is appointment reminders or labds or Annual follow ups, since when did we become the world's mother? You don't want to go get your lipids checked or a PAP smear, how and why is it now our uncompensated task and responsiblity to perform these duties for perfectly healthy adults. If you assume this responsiblity then the lawyers and their clients will certainly try to hang it on you. Obviously, we always tell folks to get their proper tests, but at some point where is their own personal responsiblity to follow thru and do their end of it??? I am not your mother and I will resist having that burden and it's liablity dropped at my feet. "Your a big boy, go take care of yourself. You have been informed."

Sorry to bitch on so. Again I'm not picking on you. I'm just sick and tired of the world wanting to go around dropping what is their own personal stuff on our doorsteps. Don't take the bait my friend. Resist, resist.

Good Night and Good Luck,
Paul

After thirty years of practice, I do think that a good primary care physician has a bit of father/mother duty and now, thanks to AC, it is fairly easy to accomplish.
We print out the AC Summary Sheet at each patient visit and hand it to the patient for review.
I realize that, at this point, some will say "waste of paper", but hear me out.
We place the preventive maintenance items in the "Directives" section on the Demographics and the Cholesterol (date and value of last test), Colonoscopy, Pap, Mammogram, PSA etc. show up on the Summary Sheet for the patient to review and sign off on at each visit. Ditto for the current diagosis, current meds and allergies. All of this is done with no effort on my part except the time spent to enter the preventive portion on the Demographics.
I agree with Paul and Brian that you should not jump through hoops simply to satisfy an insurance company's whims. I have been fortunate not to have been sued in thirty years (lucky is more like it), but I think that a significant portion of that is leaving the perception with the patients that you care and part of that is the father/mother attitude. AC certainly makes it a lot easier.
Jim

sfernandez,

For my part, your question is extremely well taken. Sure, while I do not want to do these for the insurance companies and want to decide on my own if I wish to do a Hb or Lead level on a nine-month-old, most of what you listed makes a lot of sense. 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.

@Paul, good points but your argument about what did we do before EMRs is like saying what did we do before fax machines. We adapt. 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). 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. Also as much as we all hate P4P on the front end, i.e. having to do it, when you get a check for $4,100 from Mainecare as I did last week, it seems pretty cool.

Jim, I guess there is no way of knowing how much having the father/mother attitude helps with litigation. And, I can't say too much, but from my vantage point, I think it means nothing. Well, of course, we are talking an "n" of one. And, I would rather receive the papers that say I am now in a lawsuit than the release form that states I need to send records to Low, Lower and Lowest. Then you never know where you stand.

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?


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.


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.

By the way, here's a good list of online drug interaction checkers, with reviews:

http://davidrothman.net/2008/01/16/online-drug-interaction-checkers/