Wednesday, September 29, 2010

EHR Innovation and Health Reform: Grassroots Reactions to Federal Actions on Electronic Health Records

Newton’s third law states, “For every action there is an equal and opposite reaction. “ So much for the laws of physics. Health care is not physics.

Instead, with health care, the reaction to the federal actions for universal EHRs, which call for the expenditure of $27 billion, which is not chump change, is and has to be more fragmented and unequal.

As nearly as I can tell, the reaction includes a series of innovations.

• Placing an electronic record system on IPad (Clear Practice, Inc.).

• Developing a “free” EHR funded by advertisers rather than doctors (Practice Fusion, Inc).

• Using speech recognition to allow doctors to enter narrative summaries via voice rather than key strokes (Nuance, Inc).

• The use of “scribes,” assistants following doctors and entering their findings on laptops (Legacy Health, Portland, Oregon)

You might call these innovations the “humanizing of EHRs,” or “There is more one way to skin the electronic health records cat ”

Whatever you choose to call it, clearly grassroots physicians on the ground, and entrepreneurial innovators, are adjusting to federal demand for EHR installments.

Doctors and their entrepreneurial counterparts see the need to remove doctors from in front of computer screens and to put them before patients.

On the scribe innovation, there is another human benefit as well – teaching prospective medical students the ins and outs of medical care in the real world.

At the Legacy Health System in Portland, Oregon, these students follow a doctor from patient to patient with a rolling computer, taking notes on everything the doctor says. Scribes free doctors to spend time with patients, and scribes gain invaluable medical experience while being paid $8 to $10 an hour along with recommendations for their medical school applications.

To overcome 30% productivity losses secondary to EHR use, Northwest Acute Care Specialists, the emergency physician group that serves five Legacy hospitals in Washington and Oregon have turned to training scribes. About 30 scribes work with its 140 physicians, nurses and physician assistants.

According to companies that train scribes, about 200 hospital emergency departments employ them.

In Portland and nearby Washington, in addition to Legacy, Adventist Medical Center and Southwest Washington Medical Center have scribes.

If you’re an ER doctor seeking productivity, and time for enhanced patient connectivity, hire yourself a note-taking scribe, to follow you around and to document what you do and prescribe. That will satisfy the EHR’s need for objectivity and free you up for patient-related activities.

Source: "Medical Scribes in Oregon Learn the Ins and Outs of Health Care While Easing Doctor's Record Keeping Load at Legacy Health, The Oregonian, September 29, 2010