Ms. DiVenere: Very profoundly. From the point of view of an ObGyn in private practice, EHRs offer a number of benefits. They can:
- help make sense of our increasingly fragmented health-care system
- improve patient safety
- increase efficiency
- reduce paperwork.
In addition, insurers may save by reducing unnecessary tests, and patients can certainly benefit from better coordination and documentation of care. These advantages don’t necessarily translate into savings or revenue for physician practices, however. Many ObGyns—especially those in solo or small practices—don’t feel confident making such a large capital investment. In fact, only about one third of ObGyn practices have an EHR.
OBG Management: Is it primarily cost that deters ObGyns from adopting EHRs?
Ms. DiVenere: That, and the fact that EHR systems are not yet fully interoperable across small practices, insurers, and government agencies. The initial cost of purchasing an EHR system for a small practice is about $50,000 per physician, and there are ongoing costs in staff training and hardware and software updates. A steep learning curve means fewer patients can be seen in an hour. It can take a practice months—even years—for physicians to return to their previous level of productivity. That’s a lot to ask a busy practicing physician to take on.
OBG Management: Is there any way around the push for EHRs?
Ms. DiVenere: Congress wants to move us to full adoption of health information technology (HIT). Under health-care reform, beginning in 2013, all health insurance plans must comply with a uniform standard for electronic transactions, including eligibility verification and health claim status.
In 2014, uniform standards must:
- allow automatic reconciliation of electronic funds transfers and HIPAA payment and remittance
- use standardized and consistent methods of health plan enrollment and editing of claims
- use unique health plan identifiers to simplify and improve routing of health-care transactions
- use standardized claims attachments
- improve practice data collection and evaluation.
Uniformity and standardization can help address one of the major roadblocks to physician adoption of HIT. Still, it’s little wonder that median expenses for private practices have been steadily rising in relation to revenues.
The view from private practice: Take #2
So far, the cons of an EHR outweigh the pros
My private practice made the transition to electronic health records (EHRs) about 4 months ago. We have discovered that EHRs do have a number of positive characteristics:
- Prescriptions are completely legible and can be sent directly to the pharmacy
- The staff no longer needs to search for charts
- If test results have been downloaded, they can be quickly accessed.
However, EHRs also require a lot of time to learn how to use them properly. And the problems don’t end there. For example, instead of looking at a patient’s face when taking a history, we now look at the monitor.
In addition, the templates have many data fields that auto-populate as “normal.” There is an illusion that a thorough history and physical were performed—so it requires a lot of time meticulously reviewing each chart to make sure that it is accurate. One must always be aware of the potential for insurance fraud and the medicolegal risk of documenting something as normal when it isn’t.
Ordering labs is cumbersome because each test must be handled separately, and the terminology does not always match the options at our contracted laboratories. We spend a lot of time searching for each lab that is ordered.
To achieve “meaningful use” of the EHR, certain parameters must be met at every single visit. The medication list must be reviewed (even if the patient takes no medications), and there must be a notation that cervical and breast cancer screening have been ordered, even though recent Pap smear and mammogram results are included in the chart. Regardless of the patient’s age or situation, the issues of contraception, sexually transmitted disease, tobacco use, and domestic violence must be addressed.
So when a 65-year-old woman presents with postmenopausal bleeding, I have to comment on these issues or delete them from the report. I have to provide the same documentation when she returns the next week for a biopsy and the week after that when she returns for the results.
It has become impossible to see patients in the time frame I have used for the past 24 years, and my patients and staff remain frustrated. I am always behind schedule, and I fear that the computer gets more attention than my patients do during the office visit.
—Mark A. Firestone, MD
Aventura, Fla
Is there a physician shortage in ObGyn?
OBG Management: There has been a lot of attention focused on the shortage of physicians in this country. How severe is the shortage likely to be in the specialty of ObGyn?