Amit Paranjape’s Blog

Why Doctors Hate Electronic Medical Records (EMRs)

Posted in Healthcare & Medicine, Information Technology by Amit Paranjape on June 22, 2010

Having studied the Electronic Medical Records (EMRs) space for a few years now, it’s clear to me that EMR adoption is a huge challenge. Even in developed markets like the US, successful implementation rates are pretty low (especially in small clinics). In spite of a huge Federal Government Incentive Program, the progress is gradual (at best).

In India the picture is a lot worse. My assessment is that EMR adoption here is in low single digits.

There are many theories and observations about why doctors dislike Electronic Medical Records (EMRs). One often discussed observation is that doctors are ‘technophobes’. I personally don’t think that’s true. On the contrary many doctors, whether in US or in India are ‘gadget freaks’ (when it comes to devices like new smartphones, laptops, cameras, etc.).

The primary issue is that of software usability. Many traditional EMR systems are quite complicated and difficult to use. These systems at times resemble heavy duty ERPs (Enterprise Resource Planning IT Systems) that run the operations of large multi-million dollar corporations.  A small clinic doesn’t need all this complexity. These EMRs may actually end up hurting the efficiency of a clinic, rather than improve it. Also many of these systems do not enable interactions with patients for chronic disease management, e-consultation, telemedicine, etc.  Doctors are looking for simple systems that can improve their productivity, as well as support better patient care. In absence of these, they are perfectly ok going back to their old paper notes based methods.

I recently came across an excellent article in ‘The Journal of Surgical Radiology’ by Shahid Shah, Column: Why MDs Dread EMRs”. The author has done a great job of summarizing the major reasons that are hurdles to effective adoption. I encourage the readers to go through this article for a detailed insight into the real issues.

Issues With America’s HealthCare System – A Patient’s Perspective

Posted in Current Affairs, Healthcare & Medicine by Amit Paranjape on April 14, 2009

I had the misfortune of suffering from an extended illness in America and experienced firsthand the many problems and issues with the American HealthCare system. In this brief article, I will try to list some of the major ones that I can recollect from my personal experience (See list below – points are in no particular order).

 

Please note that I still believe that the American HealthCare system is amongst the best in the world; especially when it comes to treating really tough medical conditions, and performing complicated surgical procedures and emergency medical services. It still retains some of the best doctors and other medical talent in the world.

 

My issues are more systemic and process related. In the end, one would expect a little more from world’s most advanced and expensive healthcare industry! Note these are my personal observations – whether some of these points can be generalized further needs more data points from other patients and consumers of this healthcare system.

 

1. Cost of HealthCare Insurance – The cost of healthcare has undergone a major increase over the last decade. The increasing insurance premiums have forced many private sector companies (that offer health insurance to their employees) to increasingly pass on a bigger chunk of these costs to the employee. This increase has been significantly more than the rate of inflation, and has resulted in no perceptible change in the service quality.

 

2. High costs for the un-insured, and the under-insured – This issue is extremely critical and has already been discussed ad nauseum in every media outlet, by numerous experts.

 

3. Insurance Claims Processing – Even for patients that have some of the best insurance coverage, the process of settling claims is far from perfect. Discrepancies and errors are common. In certain cases, interpretation of ‘what’s covered vs. what’s not’ is not clear. The 3-way communication across, Doctor’s Office – Insurance Company – Patient, further adds to the process complexity and mismatches. I personally had to deal with many of these claims related issues. To resolve these, often times you end up spending hours on the phone with the insurance company.

 

4. Impact of ‘medico-legal issues related complications’ on behavior? – I am not a legal expert and cannot pass explicit judgments here, but sometimes one gets a feeling that the entire medical staff’s (not just the Doctors, but also the Nurses and other support personnel) interactions with a patient are biased by a ‘medico-legal’ angle. Most answers are very generic, vague and filled with ‘disclaimers’. I understand that this is a big issue, but it is a bad trend if it affects the medical staff and patient communication. This communication channel needs to be one of those most ‘open’ ones!

 

5. Accessibility of a doctor – Most doctors work during the regular office hours and are not available on evenings and weekends. Hence seeing a doctor often times results in a forced half-day vacation during weekdays for many patients. Evenings and weekends are out of bounds and if you are in urgent need to see a doctor, in most cases an Emergency Room is your only option.

 

6. Difficulty in getting to a specialist – Often times it’s very difficult to schedule an appointment with a specialist. Many are booked out weeks into the future. And if you can’t see them right away, and are in some serious trouble, the standard answer that you might get is ‘Go to an Emergency Room!’

 

7. Difficulty in asking any simple follow-up questions to a doctor – If you have the most mundane follow-up question, it is still very difficult to directly ask your doctor. Even if you call during office hours, your call is routed to a nurse who often has no background about your particular case (except for some case-papers). Typically, the nurse is very busy and answers a simple – ‘I will get back to you’. If you call outside office hours, then your best bet is an answering service! I agree that many times it is not feasible for a busy doctor to directly talk to the patient. But some intermediate solution needs to be worked out. After all, I think that the most expensive healthcare system in the world should have at least some ‘personal touch’.

 

8. Information Technology in Healthcare – I get the impression that the Healthcare industry hasn’t leveraged IT to the fullest extent as compared to many other industry sectors. This can be seen in hospitals as well as in doctor clinics. From basic things like Electronic Medical Records (also referred to as Electronic Health Records), to a better integrated hospital management system (across billing, insurance, clinics and service providers) a lot of improvement is needed. Even today, there’s hardly any electronic data interchange of a patients reports, health records and doctor’s notes across practices and hospitals.

 

I have had to fill in volumes of paperwork every time I went to see a new doctor. Why can’t there be some automation of a patient’s insurance records and medical history? Why does a new patient have to arrive at a new doctor ’15 min early’ to fill out reams of paperwork, many times when he is not in a mental/physical condition to be dealing with this? A patient has to maintain an increasingly heavier load of files, and paper documents, and make it accessible to any new doctor that he might be seeing.

 

9. Difficulty in Scheduling Simple Procedures – Even simple diagnostic procedures (e.g. Ultra-Sound, Endscopy, etc.) can sometimes take days or even weeks to schedule. I don’t really know why this happens. Is this merely a scheduling problem or a supply scarcity of resources?

 

10. Newer patented drugs are regularly being introduced and are prescribed in many cases. Not sure if the incremental benefit that some of these provide over the existing older (and still under patent) or off patent/generic drugs can be weighed against their exorbitant costs. I am not an expert and cannot make this judgment, but do think that this is something that needs to be researched further. Again – since the US consumer is supposedly the ‘richest in the world’ he has to pay the highest (in most cases) for the patented drugs compared to other developed countries. This is another issue that has been a big point of contention, with lot of discussions in the media.

 

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