I have recently been asked several times about the fact that, at TFC, we do not use electronic medical records (EMRs).
The patients who asked me (with the exception of one who was trying to sell me his company’s product), were genuinely curious and concerned that we might be falling “behind the times”. I would like to assure each of you that our decision to resist the pressure to convert to an EMR is a well thought-out, conscious choice that we have made for many reasons.
It seems that everywhere you turn, “experts” are touting the value of EMR. They are portrayed as the cure for many of the ills affecting our healthcare system today. We are told that an EMR can save money, improve accuracy, and enhance the portability of a patient’s records as they move through the healthcare system. Surely physicians want to save money; surely we acknowledge that our poor handwriting legibility may lead to potential medical errors; and surely everyone wants to save trees by transmitting medical information electronically rather than using reams of paper every day. What self-respecting healthcare provider would therefore refuse to install an EMR immediately?
Us. We refuse to install an EMR at this time because we believe that these “facts” are simply not true and because we are committed to holding down costs while maintaining your privacy .
Although I certainly respect and acknowledge the potential offered by EMRs, the simple truth is that they are just not “there” yet. As of June, 2013, there is no universally accepted standard for EMR systems. No one can agree on many of the basic issues – such as levels of security, access, and integration with billing systems – much less the even more important specific issues that affect each individual medical practice.
Here are the EMR facts:
1. EMRs are very expensive. They can cost upwards of $200,000 to install and maintain. The “off the shelf” systems offered by most vendors do not apply to our very complex practice – one that incorporates multiple medical offices, an IVF laboratory, an andrology laboratory, and a surgery center. Although the government offered financial incentives that partially offset the cost of EMR acquisition and installation to physicians enrolled in governmental healthcare programs (Medicare, Medicaid, etc.), as we do not participate in governmental programs, we do not qualify for these incentives. I have spoken to literally hundreds of physicians who have installed EMRs in practices that are significantly smaller and less complex than TFC and the typical quote is that “the systems cost 2-3 times what you are initially told and they take up to a year to learn to use”.
2. EMRs do not offer any credible financial savings to a medical practice. In addition to higher than anticipated upfront costs, most of my friends have had to hire additional clerical personnel or transcription services to handle the data entry – or they do it themselves, further increasing the amount of time they spend away from their families.
3. Although there are some potential improvements in accuracy – office notes are easier to read and electronic prescriptions are always “legible” – much of the material in our charts is already typed. For example, all operative reports, lab reports, and radiology reports are sent to our office already typed. The overwhelming number of prescriptions that we write are either emailed or called into the pharmacy directly, or written on pre-typed prescription pads – and yet rare mistakes by the pharmacists still occur.
4. When we receive medical records from a referring physician – even those with an EMR – the records come in hard copy form. In fact, with many EMR systems, we receive either multiple copies of the entire record, or multiple copies of individual office visits and/or lab results. We are all amazed that significantly more paper is received from practices with EMRs than from practices without them. This would not change even if we had an EMR, because the simple fact is that most EMRs are proprietary and do not communicate seamlessly with each other.
5. EMRs do not protect patient privacy. Despite such incredible technological tools as data encryption and SSL data transmission, nothing prohibits any individual with mal-intent who comes in contact with your records from printing/copying/disseminating your personal information. Even before the recent controversies involving the government’s inappropriate access to and use of what private individuals believed was protected information, we were concerned about patient privacy. We have the utmost respect for the extremely sensitive nature of the medical and social information that we have at TFC. We understand that the inadvertent or irresponsible dissemination of that information can have significant implications for the relationships between our patients and their families, church community, employers, coworkers, friends, etc. We are therefore reticent to transmit this data over the internet.
6. EMRs adversely impact physician:patient interactions. Each of our physicians thoroughly enjoys the opportunity we have to interact with our patients every single day. We want to remain totally engaged during our interactions so that we don’t miss the implications of a smile, a tear, or a subtle change in body language that can offer us insight into what our patients are going through. We believe that having to enter data into a computer during our visits is a distraction rather than an enhancement, and we prefer to maintain the integrity of our patient interactions. While an alternative would be to continue to take notes and enter data into an EMR at the end of the day, we each have interests and relationships outside of the office, and none of us relish the thought of sacrificing an additional 1-2 hours per day so that we can transcribe our office notes.
While I could go on with a long list of other issues that we considered in reaching this decision, suffice it to say that we have not yet been convinced that a transition to an EMR is in the best interest of either our practice or our patients at this time.
At TFC, we have perhaps one of the most cutting edge practices in the world – we use lasers and surgical robots, perform microsurgery on embryos, and inject sperm into eggs. No one can make a credible case that we are technophobes. We will continue to evaluate new technologies as they emerge and maintain the fluidity to adopt those that we believe will enhance our practice.
While other fertility practices in town may follow the EMR trend, we at TFC remain totally committed to you, to our relationship with each of you, and to the integrity and security of your medical information.
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