EMRs, what doctors really want.

I’m in the EMR business. Although I’m not in sales, I do perform sales demos (more technical than sales) and work directly with doctors and clinical staff to design and implement customizations of their EMRs. This has allowed me a unique insight into “what doctor’s really want” as it pertains to the functions of their EMRs, and why they want it that way. It’s a good look inside the MD mind. I warn you, it can be a scary place.

Let me establish the setting. To understand the mentality of doctors, you have to understand their business model. That’s right, its business. I’m not even talking about health care anymore. When dealing with small practices, the doctors are at the very top of their business structure. They are the kings of the hill. They are at the apex of their pyramids, with each having as many as 10 or 15 staff members to support him/her. It’s a reciprocal relationship. The staff’s job is to supports the doctor and it is the doctor’s job to maximize revenues so that $$$ can trickle down to support the staff below and keep the business running. So what does this mean? This means that doctors are under tremendous pressure to generate revenue. In private practices, doctors are revenue generating machines. They have been doing this for a very long time and many are quite efficient at it. Likewise, so is the staff. The efficiency of the doctor determines how much $$$ he/she makes and also how much $$$ his staff and office get as a result.

Now, we tell them that they must buy and use an EMR to do what they’ve been doing for years. Remember, doctors are revenue generating machines. They don’t have time to waste. They can’t even afford to write properly. So what is their response? I’ll tell you, now… since you’ve been so very patiently.

Doctors don’t’ like EMRs. For the most part, EMRs introduce numerous impediments to doctor workflow. Many of the doctors I’ve worked with are only interested in the EMR because of the incentive plan. Others are doing it to avoid the 2015 penalty. Sadly, not one doctor I’ve worked with is implementing for the sake of improving patient care. But that’s not a surprise. Based upon the timing, this period would capture the demographic that is chasing government dollars or attempting to avoid the government stick.

One doctor I worked with sees about 60 patients a day, on a regular 8 hour day. That’s about 1 patient every 8 minutes. This is a highly established practice and generates very impressive numbers. The doctor expressed to me that he needs to see more patients each day. Cheers to that! Nothing wrong with increasing one’s availability. To do this, the doc wants the EMR to perform the clinical diagnosis. In other words, the EMR is to replace the doctor. If a patient comes in and complains of X, the system would automatically diagnose Y and prescribe treatment Z. This is completely possible by the way, at least programmatically (a highly detailed and comprehensive decision tree could actually be used, but that’s another story). What’s wrong with this? Well, a doctor’s medical function is to utilize the extensive clinical training to assess each patient’s physiology, medical history and unique circumstance and, based upon their based professional judgment, produce a personalized treatment plan. That’s why they get paid the big bucks. This particular doctor, who already makes big bucks, basically wanted to skip all the personal patient stuff just routinely diagnose and prescribe the same 5 treatments, automatically. He wishes for it to be so automatic that anyone could do it, that he need only sign off on the note. Perfect, so the doctor now functions only to provide his signature. I wouldn’t’ want to be his patient. But then again, he doesn’t need much more, he’s getting 60+ patients a day.

If you think from the perspective of the doctor, the EMR really gets in the way of “seeing more patients.” Many of the benefits of an EMR can be quickly realized by the administrative and clerical staff, but the doctor doesn’t care about that. And, when doctors have to deal with other doctors who use EMRs, they don’t like it much either. Whereas the typical patient file was perhaps a few pages long before, because it was hand written, now could be 15 pages long as much of it is automatically generated by the system. In the system we produce, one simple click on a “Routine Denies All” produces about a page worth of seemingly personal health information. A very click happy doctor could produce well over 20 pages with of clinical notes for a single patient encounter. Now… imagine the next doctor who has to read through that.

Don’t get me wrong. EMR technology is definitely the way to go. But with any new technology or now implementation, it takes time to evolve and become accepted. Software vendors will have to continue to develop improved interfaces, reduce clicks, and improve automation to compete with each other. In time, EMRs will be much more useful. It won’t be long I imagine. Just can’t wait to see a truly great EMR.