EMRs are good for your practice - really

Some years ago I wrote an editorial in this magazine about my early experience with an electronic medical record (EMR). I indicated that there were definite pitfalls, but overall, it was worth considering for your practice. Over the years I have become far more enthusiastic about this technology and would now strongly recommend it to all dermatologists, other than those who will be retiring very soon or those with a morbid fear of the 21st century and all that it has to offer.

Slightly less than 50 percent of all dermatologists currently employ an EMR. For those several thousand still using paper charts there are many reasons given for not implementing this technology. These include the following:

1. It is too expensive to switch from what I have to an EMR. Some estimates are as high as $80,000 to $100,000 in acquiring the hardware and software, training the office personnel and reducing the number of patients seen while the changeover takes place.

I cannot speak for others but the software package and training cost our office about $17,000 and we had very minimal disruption and lost revenue while ramping up the program. I would guess that the whole process cost us less than $25,000. Practices buy phototherapy units for $20,000 and lasers for $50,000 and up. A $25,000 expenditure that never wears out and enhances your ability to serve your patients better seems well worth the cost.

2. What will I do with the thousands of paper medical records? It will probably cost me a fortune to transfer them to the new EMR.

This can be a costly and tedious exercise to transfer medical records. However, there is a much less painful solution. When our “old” EMR system became obsolete about one year ago, we switched to a totally different EMR system. Since that time, we have added all new encounters into the new EMR while having the older EMR available when older records need to be reviewed. At first, almost all return patients required a look at the older EMR records before new data could be placed in the new system. After one year, there are days where I do not look at the old data even once. The same approach could easily work in practices with paper charts.

Next: Will implementing EHRs disrupt my practice?

3. With so many regulatory and other changes occurring, adding more uncertainty and chaos to the front office will be too disruptive to be practical. Besides, I have always done it one way and it works for me, so why should I make any radical change?

Ready or not, radical change in the way we practice medicine is upon us. For those who do not possess the appropriate tools to manage these developments, practice as you know it may soon be impossible. For example, when the new ICD-10 coding system is implemented in October 2015, it is estimated that it may take a coder up to 10 minutes to complete work on a single encounter.

My EMR already generates the appropriate ICD-10 code based on the data that is placed in the clinic note, thus taking me exactly no time to prepare an accurate superbill. This is impossible for those who now use paper charts. There are those who believe that some knight in shining armor is going to appear and cancel the ICD-10 initiative forever. Psychiatrists call this magical thinking.

4. I don’t need an EMR because I do not plan on using the electronic prescribing module. I am concerned about privacy issues in sending prescriptions electronically and I like the patient to have something in writing with my signature when she leaves the office.

Electronic prescribing is absolutely safe, does not compromise patient privacy and is an excellent way of documenting these transactions in the medical record. In addition, it saves the patient an extra trip to the pharmacy just to drop off the prescription. As for accuracy, there is no question that a printed prescription has a far greater chance of being misread or misinterpreted than does one sent electronically. A painful reminder of this is a case with which I am familiar where a dermatologist wrote a prescription for Diprosone that was misread as Diprolene. After about 20 refills for this prescription, the patient developed horrible striaie.

In conclusion, you all purchased computers when it became obvious that you could not practice without them. You switched from pagers to cell phones when the new technology surpassed the old. In the same way, electronic medical records are inevitably going to replace written charts. For those of you who have not made the switch, it is time.

Related:

Mark Kaufmann, M.D., discusses EHR implementation