Electronic Health Records

Adoption & Implementation News

Physician series: OB/GYN EHR hurdles

By Patrick Ouellette

- Part II of our physician series with Cindy Basinski, MD and OB/GYN, focuses on how she uses EHR from a technical standpoint, such as ICD-9 codes. It can be hard for physicians to collaborate with an IT department on selecting vendors and products. Basinski also provides her opinions on meaningful use for specialty practices and healthcare providers in general.

An important role in EHR implementation in a physician’s office is also that of the practice manager and EHRIntelligence.com also spoke to Valerie Carter, who helped with Dr. Basinski’s data collection and organization.

Read Part I: EHR requirements for OB/GYN

Are some vendors too broad with coding in their EHR systems?

I do. It’s overwhelming. What I find, too, is that the way an IT person looks at healthcare is not at all the way a doctor looks at it. And rightly so - they’re looking at it from a technical basis and that’s confusing to the average physician. Because that is not how we approach our patients. And the way IT people look at documentation makes no sense to somebody like me and going into system like Epic or something like that is totally dysfunctional, and most of them are [like that].

READ MORE: Rural Hospitals Remain Weak Spot in EHR Interoperability

Are you eligible for meaningful use? What do you think of the requirements?

I have a very unique practice in which I have no Medicaid [patients] and less than 5 percent Medicare. So, the only group paying for meaningful use is Medicare and there’s no utility for me to go through that process of doing at this point, unless private insurance companies adopt that method by which they bonus or reimburse physician payments.

What’s frustrating to me about meaningful use is that to me, it’s like the health maintenance organization (HMO) praise that happened a couple decades ago. The way HMOs paid, a physician would get a block of money to take care of a patient and that money was tied to the primary care physicians (PCPs). So if the patient had a heart attack and needed bypass surgery, well that payment for the surgery would have to come out of the pool designated for that patient. And at the end of the year, if the PCP was doing a good job at managing that pool of money, they sort of got what was left over as a bonus. If they did a “bad” job and the patient used more than what was available in the pool, then they wouldn’t get bonused. Well, that’s exactly what meaningful use is, right? If you have the patient do whatever they’re supposed to do and you meet those criteria, then we’re going to give you a bonus at the end of the year. Because the theory is that it’s going to save healthcare dollars to do that. My problem is that there’s zero data to validate that this is actually true.

The whole idea of this cost containment [with meaningful use], I just don’t buy it. We’re taking an entire multi-billion dollar industry and moving it into something that there was zero thought into it, which I think is going to markedly increase costs. I’m just frustrated by the fact that there’s this Laissez-faire attitude about medicine. [It's like they're saying] EHR is going to make medicine more cost contained – it’s stupid, it’s not.

Can you discuss your practice EHR v the hospital system you use part-time?

READ MORE: CA Health System Begins Cloud-Based Epic EHR Implementation

I have embraced computers and electronic documentation and believe in it, there are certainly various people who hate it and I completely understand that. I’m someone who enjoys that I document through the computer with digiChart. Though, I hate [the hospital EHR system] and wish I could go back to the regular hospital chart. I can’t find information and can’t stand it. So it depends on which [EHR system] you’re looking at. But the theory that now I’m now a better doctor and giving better care to patients because of it, that’s baloney. Just because I drive a Mercedes Benz doesn’t mean I’m a better driver than when I had my Hyundai.

I don’t think [the hospital that I work at part time] a user-friendly system, it’s difficult to navigate and find the information that you need. The beauty of a hospital paper records is this, when I went to hospital A and hospital B, which is a completely different hospital, I knew exactly where to find those hospital charts because they were organized similarly. Now, with [the system] it has totally thrown that out the window. The way that I’ve been trained for 10-15 years to look at a patient’s chart to know if they have an allergy or surgeries they’ve had, I can’t even find that in the chart anymore. That’d dangerous to me because now I have to rely on a patient to tell me what surgeries they’ve had and patients are the worst historians. They’re like me, I can’t remember what I had for lunch yesterday.

What do other physicians say about major EHR vendors?

That’s the biggest complaint that I hear from physicians, that hospitals are strong-arming us into utilizing these system yet they give us the most non-user friendly systems available. The other issue is that at 3 a.m., I do an ER surgery and now I have to type in what happened whereas I used to dictate it before and now it takes five years longer. And there are times where it doesn’t let me put orders in because of a glitch or my password was changed. Hospitals are saying we’re taking the secretary away and expecting you to be the clerical person as well as the doctor now.

Valerie Carter, practice manager 

READ MORE: McKesson to Sell Several Ambulatory EHR Products to e-MDs

Could you talk about your role in EHR adoption? How did it go when you implemented 10 years ago?

When you have that new system, you have to completely build it and the profiles, diagnosis codes, all procedure codes and add them into your practice. So yes, it was quite the process but it went very smoothly.

How will the ICD-10 transition affect your practice?

When we first started with digiChart, they have access to the CPT and ICD-9 code books and then you pull them into your practice codes. So you can modify your practice on the codes that you already use. With digiChart everything is updated through their system so anytime there’s any updates to any of the books – coding, diagnosis or procedure coding – it is updated there and automatically updates our system.

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Related Articles:

Physician series: EHR requirements for OB/GYN

Physicians Series: Massachusetts healthcare and EHR

Physician series: Louis McIntyre, MD

Physician series: Louis McIntyre talks meaningful use

Finding an EHR fit for specialty practices

Adopting OB-GYN EHR technology

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