05/14/2015    Alan Meyerberg, DPM

EMR is Here to Stay (Gerald Mauriello Jr., DPM)

EMR is here to stay isn't a good enough reason
for me to utilize it. At first it sounded like
an improvement to health delivery. I actually
got on board, especially when the government
was helping defray the cost and my hospital
also shared in the expense. Electronic
transmission of prescriptions and the ability
to retrieve the prescription history of a
patient instead of relying on their memory
makes a great deal of sense. The ability to
share the results of various tests will reduce
the frequency of duplicate test ordering. No
more sloppy handwriting. Well, has everyone
discovered the real reasons for jamming this
monster down our throats?

First, after getting the $44,000 bribe you can
count on an audit that will result in many give
backs and accusations of fraud. The promises
of improving health care looks like it took a
back seat to political correctness and
demographic gathering for whatever political
uses the government has. Why do we need to
report a patient’s ethnicity? I used to get a
referral for a patient that was one sheet with
relevant info and a reason. Now my printer is
spitting out volumes of mostly boiler plate
notes from other offices. I'm 60 years old and
my staff has been with me for over 20 years. We
are old dogs and new tricks just to make it
easy for the government to harass me is not
smart. If I want to counsel patients on
cigarette smoking shouldn't that be MY choice?

Prescriptions aren't getting to the correct CVS
on Amboy road, there are several in Staten
Island. I rarely am able to retrieve the past
history from the pharmacy. By the way, when i
lock up my charts in a file cabinet I can rest
assured NOBODY can steal the information. How
do we protect info on the Internet? I think
it's irresponsible to say "Paper charts are no
longer the standard." We should determine what
the standard of care is not the bureaucrats.
Will we be forced into lock step with central
planning? Maybe! If this fiasco was an
improvement to the patients care I wouldn't
complain so bitterly. I hope I never succumb to
Big Brother's pressure (the carrot or the
stick) at the detriment to my patients care.
Who is John Galt? ICD-10 next great idea.

Alan Meyerberg, DPM, Staten Island, NY

Other messages in this thread:

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05/14/2015    Ray Posa, MBA

EMR is Here to Stay (Gerald Mauriello Jr., DPM)

Dr. Mauriello is exactly correct, there are no
free lunches and EMR is no exception.
Currently there are several manufactures who
offer “free” EMR software. So, having been in
the technology field for over 3 decades let me
explain how this “free” software model works.
There have been many software products over the
years that were “free” and then one day they
become fee for use or they are acquired by a
rival company.

What software companies try and do is build a
large user base, this give the product and the
company value. When the user base hits a
desired value the company can then switch to a
fee for use model in the hopes that the users
enjoy the software and perceive a value in it
and are willing to pay for it. The other option
is the software company gets a large enough
install base and then sell their clients to a
rival or a larger company and cash in on their
investment.

So, if you currently use a free EMR this is a
situation that you need to be prepared for, the
free ride will not last forever.

The second point that Dr. Mauriello makes is
that of being “forced” to use EMR. The
handwriting is already on the wall, look at
HIPAA it has been on the books since 2003 and
several state courts have already ruled that
being HIPAA compliant is now the standard of
care. Very soon, EMR will be ruled as the
standard of care. This can come in the form of
malpractice carriers requiring their clients to
use EMR, state courts can establish case law
requiring it use, or States can require EMR use
as a requirement to remain licensed to practice
in that state (this is very close to happening
in Massachusetts). So to choose to not use EMR
is a very short term solution if you plan on
retiring or selling your practice in the next 5
years. Beyond that, not using EMR will not be
an option.

Finally, Dr. Mauriello makes the point of the
cost of EMR. When the government instituted the
Meaningful Use Stimulus program, the idea was
to acceleration the adaption of EMR
technologies and to help of set some of the
cost. When the marketplace saw all of this
money being poured in, manufactures cashed in
by raising their prices, I have seen some raise
their prices by 200% - 300%. That was just due
to the influx of money, think what will happen
when you are required to use EMR software, you
can expect another sharp rise in cost.

The take away on the EMR situation is that you
will be required to use it in the near future,
the cost of adopting it now will be much less
expensive now than in the future. Implementing
new technology is always easier when done on
your timeline then when you are up against a
hard deadline. Choose your EMR wisely, staying
in the EMR market is very costly and with new
government mandates coming every year, many
companies will not survive. The industry
estimate is that by 2017 half of all EMR
companies will be out of business. We are
already seeing early signs of contractions in
the EMR market and it will accelerate as we
head for Meaningful Use Stage 3.

Raymond F Posa, MBA, Farmingdale, NJ