MAUI, HAWAII Physicians are needlessly resisting the inevitability of electronic medical records, according to Dr. Martin J. Bergman.
As of 2005, about 23% of office-based physicians used electronic medical records (EMRs), said Dr. Bergman, citing statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics that were reported in 2006. In contrast, almost 80% of office-based physicians used billing software, he added.
Reasons for resistance include complaints that EMRs are difficult to complete, interrupt the office flow, and take too much time to administer and review, said Dr. Bergman, chief of rheumatology at Taylor Hospital, Ridley Park, Pa.
The first obstacle is cost, he noted. EMRsoftware can run $5,000 to more than $30,000. Still, the better software does not necessarily cost more. Once EMRs are established in the practice, physicians can expect significant savings, especially on transcription fees.
Twelve years ago, Dr. Bergman said he was paying just under $20,000 a year for transcriptions. "I no longer use a transcriptionist. Over 12 years, I've saved close to $250,000" on those fees alone.
However, there is a "steep learning curve" in getting used to using EMRs; it takes about 3 months to become familiar enough with the software that it no longer slows the physician's practice. But after that, he said, "your productivity doubles."
Dr. Bergman pointed out that physicians can use EMRs to track metricsmeasures of patients' progresswhich is difficult to do with paper files. Metrics can quickly help gauge the success of the practice, and the news is not always good. "Until you start doing metrics, you think you are doing better than you are," he said.
Benefits of EMRs include:
▸ An increase in productivity. Dr. Bergman observed that, now, paper records slow him down. EMRs give him instant access to entire histories, including lab tests and drugs used.
▸ Easy creation of referral letters. Print them by pressing a couple of buttons, and upon leaving the computer, he said, "I'm done when I'm done."
▸ A tool for research. Patient data can be graphed to show results of treatment over time, which provides a good source of private practice research.
▸ Access to databases. Data extracted from the database can readily be shared with existing databases.
Patient data typically collected in an EMR include demographic information, active and comorbid diagnoses, current and formerly used medications, lab reports, DAS28 findings, both physician and patient global scores, and patient-reported measures such as pain, functionality, fatigue, and tender and swollen joint counts, Dr. Bergman said during his presentation at a symposium sponsored by Excellence in Rheumatology Education.
EMR software offers two basic options: template or database software. The choice might depend on whether the physician is in a solo or group practice.
The solo dermatologist will be better served by database software, which is flexible and can be altered on the fly to fit special information-gathering needs. But a group practice or hospital will more likely want template software, which requires all users to fill in the same kinds of information in the same format.
Dr. Bergman said although he has been using EMR software from Stat Systems for 12 years, he is not a spokesman for nor an owner of the company.