EHR changes are more than skin deep

The gains of EHRs have yet to come to my doctor's office, but business change is already here, and we'll see about the rest in time.

I had my regular check-up yesterday and my doctor had a surprise for me.

Their Electronic Health Record (EHR) is finally installed.

They went with NextGen, a unit of Quality Systems Inc., not for any technical reason but because the hospital they're affiliated with pushed it on them. It's Windows-based. The first thing I noticed was an error message. It was just like being at home.

My doctor is about my age, he's looking for a career exit strategy, so a close tie-in with his hospital, and the hiring of two new associates to replace one who left, provides all that. In time, my guess is, the hospital's name will appear over his door and that will be that.

I pre-loaded some stories here and I'm glad I did. My NextGen appointment took two hours, mainly because the staff had to start a new chart on me, re-taking the family history and medication list they already had in a file folder.

Rather than acknowledge the productivity hit the strategy seems to be that can be passed on to the patients. We were an hour late getting in and another hour late getting out.

Exam rooms now have a flat screen near the door, on a hinge, and a tray below it sporting a keyboard and mouse. There's also a terminal on the wall, sprouting all sorts of wired interfaces. I saw no WiFi.

The nurse who took my blood pressure found her wired mouse wasn't working. She went out to get another and then got very confused. I pointed out the other unit had a mouse port, and the one she'd grabbed was USB. Fortunately there was an extra port or I might still be there.

The chart was partly pre-loaded with my name (misspelled) and my date of birth. Everything else had to be filled-in. The nurse added my vitals but my new doctor, a very nice lady who formerly worked at Grady and considered the pace here "slower," did the rest. (Given the volumes the office was doing I had a laugh at that.)

Most of the benefits I saw of the new system flow to the business office. They barely glanced at me as I walked out. All billing, including co-pays, is now apparently electronic and tied into the hospital system.

The one material benefit I could see was e-prescribing. My doctor was able to give me a new heart pill to try while we were in the exam room. She just asked me for the pharmacy's phone number and it was waiting for me, accurately dosed, when I arrived. Sweet.

One patient goal of EHRs, and meaningful use, remains unmet. That is the Coordination of Care Record (CCR), a computer file or printed sheet detailing what was done during a visit and what the next steps should be for both patient and doctor. That's still on paper and kept at the office as a receipt.

All in all the experience was more like being in a hospital's clinic than in my old doctor's office. I think that's what is happening on the business end as well. But next time my old doctor adds a new clinician, he or she shouldn't have to do more than look up my name to know what's going on with me.

The gains of EHRs have yet to come to my doctor's office, but business change is already here, and we'll see about the rest in time.

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