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July 11, 2012
by Pete Rivera
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Unless you plan on adding two hours to your workday, you need to weave speech recognition into your workflow.

That’s the response I get from Specialist trying to adopt to a new EHR. Let’s face it; most EHR’s are designed for primary care physicians. The idea is to continue to grow the patient data in the record each time you see a patient. Eventually you end up with a robust history and clinical data that can be used to improve the quality of care. However, specialists get a patient referral, they see the patient two or three times and they are sent back to their primary care. This means that every patient is a new patient (outside of the frequent fliers).

 You have to treat a specialty EHR implementation different than a primary care. Your first step is to try to import all the electronic data that you can. The CCD export/import format is there for a reason. Insist that primary care physicians supply referrals with a CCD record on an electronic media. This will help reduce the staff’s time trying to build a record. Use or create an electronic history. Use your patient portal to get patient histories BEFORE they show up for their appointments. This should be done with discrete data, not a PDF or scanned document that gets stored with all the other images that never gets looked at.

 Once you have data, now you need to get a specialist to actually use a keyboard and mouse and try to see the same amount of patients every day. Unless you plan on adding two hours to your workday, you need to weave speech recognition into your workflow. Some EHR’s play better with dragon than others. The key is to develop the templates in such a manner, that the specialist can bounce around med lists, problem lists and other key fields without touching the keyboard or mouse. I know of some organizations that actually hire a scribe to follow the specialist around and complete the EHR note. Dragon will do this; you just need to find a good Dragon Slayer (Speech Recognition Analyst; I use Brian Mizell from HealthMagic) to build the profile, prompts and weave it into the template. Once you are done it will feel like they are dictating just like “the good ol’ days” before that nasty EHR. 



Let us toss out both sticks and carrots for a moment. Honestly 2-3% penalty for not wasting time is not as bad as implementing a flawed EMR. Anything more than that I will have to decide how much medicare and Medicaid patients I don't want to see..We are capable of passive resistance! There are no usable specialty specific EMRs that can adapt to complex workflow or reduce need for staffing.
A chronological pdf file is perhaps the most important medical and legal document for a physician practice. You can create a high tech office with connectivity that can beat the best of enterprise products in the market, with an investment of under $2000 that includes 6 computers. The process should be such that nothing is scanned or filed unless authenticated by doc. It allows easy communication, decent security, allows rapid patient evaluation with all data in correct order. Combine this with speech recognition, it is hard to beat this for 1-5 doctor practice. Unless an EMR implementation reduces staffing costs by 50% don't venture investing in one.
It is OK to use free Erx products to get what you can from the feds. Just follow their guidelines.In my case, I prescribe very few drugs and it is not a big deal one way or the other
If you feel it is impossible to run an office profitably,please make an appointment to spend a day with me and I will show you how I do it. The patient satisfaction with meaningful data exchange is hard to fathom.Just google my name!

This just in from National Coordinator Farzad Mostashar:

Key findings
• About three-quarters of physicians who have adopted an EHR system reported that their system meets federal "meaningful use" criteria.
• Eighty-five percent of physicians who have adopted an EHR system reported being somewhat (47%) or very (38%) satisfied with their system.
• About three-quarters of adopters reported that using their EHR system resulted in enhanced patient care.
• Nearly one-half of physicians currently without an EHR system plan to purchase or use one already purchased within the next year.
• In 2011, 55% of responding physicians had adopted an electronic health record (EHR) system.

Read my post about established EMR's in the Behavioral Health setting at: