If you have ever looked at a patient chart, probably your own, you have likely seen that phrase: Patient tolerated the procedure well. I have often wondered who started wording it that way. Patients never seem to do fabulous or great. I envision the first doctor writing that and it catching on because it doesn't say much about the screaming or wailing. (Remember, anesthesia is relatively new in the historical sense) What if I had screamed, would it show up in the record?

 

Today, our patient is the medical community and they are confused, sick and angry. They are getting conflicting diagnoses, being told by some that they are overweight and by others that they need to eat more. Some say they need to eat at a single restaurant while others champion a mixed diet of commercial plans, Medicare and TennCare. The medical community is asked to do more with less and told to be happy about. But that was pure BS. By that, I mean "Before Stimulus". 

 

Now via the great stimulus plan the oracles say, "Thou shalt have an Electronic Medical Record (EMR)". Everywhere you turn in healthcare you can not get away from the core belief among the planning elites that part of our salvation, our ability to pay for ever growing numbers of people on public health care plans, is to have an electronic medical record application in each physician office. Today less than 10 percent of physician practices (remember most practices are less than four docs) have an electronic medical record application that they use to store and use clinical information.

 

Embedded in the stimulus bill is an aggressive effort beginning in 2011 to cause physician offices to install an EMR. The government is putting our money where their mouth is. As it is written, a window of six years will open and the incentives will flow from Medicare and CMS. Before you get overwhelmed at the log jam of carrots flowing downriver, pay close attention, the long range forecast has sticks in it. If you don't install an EMR and use it to accomplish achieving certain clinical standards, the carrots magically turn into sticks in 2015. Your reimbursements will gradually be reduced from Medicare. The stimulus giveth and it taketh away.

 

The EMR carries the opportunity to transform for the better the office and clinical experience of each patient. But please take it from someone who has seen it first hand, implementing an EMR is HEAVY lifting. The EMR doesn't immediately make things better. In fact, it can magnify what may already be wrong in a practice. The process demands a wholesale review of how most things in the office are done, from the simple to the complex. By the way, most of the applications are still working on the interface with the Drug Reps to choose each day's tasty lunch (lol). The task is so great (with 90 percent of the offices left to "electrify") that one has to ask how we can muscle the sheer people power to install, train and support this development. There aren't enough people who know what they are doing to make it happen. 

 

To be sure, the intentions are good. The money is helpful. But an EMR is not a panacea for all that ails us. The patient may tolerate this well. But you better put him in a sound proof room. We don't want to scare the other patients.

 

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