The vast majority of dermatologists still aren't using electronic medical records in their practices, but those who have made the switch say they would never go back.
"It's sort of like a marriage. You've got to commit to it," said Dr. Artis P. Truett, an Owensboro, Ky., dermatologist whose practice has been virtually paperless for the last 5 years.
The transition can be daunting, especially for those who aren't comfortable with computers, but it's worth it in the long run, he said. It's made practicing easier and more efficient, and has improved the quality of care, Dr. Truett added.
But most dermatologists have been reluctant to take that leap. About 7.5% of dermatology practices have fully implemented EMRs and about 11% report some type of EMR use, the American Academy of Dermatology Association (AADA) said in a questionnaire submitted to the Certification Commission for Healthcare Information Technology (CCHIT).
Some may be wary of the financial investment in EMR software, hardware, and maintenance. But others may be waiting for the right system. Current EMR systems lack the functionality needed to meet the needs of dermatologists, the AADA said.
Specifically, AADA cited a need for digital-imaging capture and storage, anatomical graphic management capabilities, and dermatopathology lab interface for biopsy tracking and management.
"Very few of the [software] programs are geared toward us," said Dr. Dirk Elston, director of the department of dermatology at Geisinger Medical Center in Danville, Pa.
Many of the EMR products on the market today don't have the features that allow physicians to keep disease registries that could be helpful as more insurance companies move toward pay-for-performance programs, he said. Dermatologists also need functionality that will help to make coding more exact and efficient. Interoperability that would allow for the easy transfer of laboratory results is also important, he said.
But although it's easy to get hung up on what's missing from many systems, most still have the basic features necessary for keeping a complete medical record and for billing an insurance company, said Dr. Neil Brody of the department of dermatology of the State University of New York, Brooklyn, who practices in Manhasset, N.Y. He was able to find software that also allows him to store and display clinical images.
Dr. Brody's practice went paperless—with some minor exceptions—about 3 years ago. When he went shopping for his EMR system, he found that products were sort of strung together, he said. He advises physicians who are looking for an EMR system to do their research. Try out a lot of systems and go online to find out where the industry is. And don't rely on the demonstration by the salesperson, he said.
Be skeptical about the return on investment promised by vendors, Dr. Brody cautioned. His experience has been that savings aren't realized by reducing staff.
But he said that he has found that the switch to an EMR makes his day more pleasant, and he believes the quality of care is higher. With his system, he is able to see the other medicines that the patient is taking, even when they are prescribed by another physician, and he can check for drug-drug interactions.
Where he has seen some financial benefit is in the space saved by not having to house thousands of paper charts.
Those who switch to an EMR should also expect to experience some growing pains during the transition. "In the beginning, no one is good at [using] an EMR," said Dr. Anthony Wong, a Mohs surgeon in Smithtown, N.Y.
Dr. Wong and his colleagues have been using their EMR system, which they leased instead of purchasing, for nearly 2 years. Although they are happy with the new system, he said, they had to make some minor adjustments. For example, one of his colleagues doesn't type very well, so he now uses voice recognition software to dictate his notes.
Dr. Michael Crowe, a dermatologist who practices with Dr. Truett in Owensboro, Ky., said they quickly found that it was not efficient to use the computer while in the exam room with patients. Instead, he has an assistant in the room with him who can help to enter information during the visit and can pull up photos and lab results as needed.