Posts Tagged EMR

Penalty for Failure to use EMR — CMS doing the right thing for patients

scoffing

Physicians scoff at rules requiring them to use electronic records and now they must pay the penalty.

Melinda Beck reported in the Wall Street Journal 12/18/14 “Medicare to Cut Payments to Some Doctors, Hospitals”.  Of the 893,851 physicians in the US, Ms. Beck reports 257,000 will be fined 1% of their Medicare fees for failure to adequately use an electronic medical record.

For example, the technically challenged doctors have failed to use electronic prescriptions, favoring instead marginally-legible  hand-written prescriptions.  And, they undoubtedly harmed patients by not taking advantage of allergy and interaction checks that are part of electronic prescribing.

AMA president-elect Steven J. Stack is reported as saying he was “appalled” by the government action.  Every physician, obviously excluding Mr. Stack, was informed 5 years ago that fines would be imposed in 2014 by Medicare if physicians that bill Medicare fail to use electronic records in a meaningful way.

Why would a rational physician choose not to use an electronic record…?

  • Because North Korea might hack the system
  • Because the government told them to use an EMR (they give orders, not take them)
  • Because they will be retiring soon and won’t need to learn about computers (the real reason)
  • Because they will need to pay for a system to help patients
  • Because young physicians want the systems, older physicians say no to all this newfangled stuff.
  • Because a an electronic record might be used in court against them.

There you have it — a detailed explanation.  Appalling, don’t you agree?

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E-Prescribing — if not why not?

e-prescribing 2011

The above map comes from Internal Medicine News.  State by state it shows where doctors are using electronic prescribing.   A simple question for those doctors in the white states:  why live in the past?  Huge numbers of pharmacies accept electronic prescriptions, patients like electronic prescriptions better than paper prescriptions, prescribing errors are much lower, patients get better care, drug interaction checks can be done BEFORE the prescription is sent (so the pharmacist does not have to call),  and a record of the prescription is available as part of the medical record.

The doctor perspective:  “Just more computer work for me”

The patient perspective:  “I like the idea of fewer errors”

How does it work?
The prescriber needs to have several things in place:

  • An electronic medical record
    (without this much of the advantage is lost)
  • An electronic list of the patient’s active prescriptions
  • An electronic list of the patient’s allergies and intolerances
  • A diagnosis associated with the prescription
  • A record entry to document the thought process for the prescription
  • An internal link to the insurance drug formulary

A very good process is to have the computer screen for prescribing where the patient can see the actions of the prescriber.  That way the patient can see what  is being prescribed, whether it is covered by insurance, where the prescription will be sent, the instructions, the amount and the refills.  If there are problems the patient can comment — it is much better to have feedback at the time of prescribing rather than the patient not take the medication or get phone calls later with questions from the patient or pharmacist.  Physicians who use e-prescribing don’t ever want to go back to the old way!  Pharmacists never liked physician handwriting anyway.

So, if your physician is not using e-prescribing give them a copy of this post!

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