The Misconceptions About EMR Based Documentation

When considering office based practices, there is much dispute regarding the ability of EMRs to add to practice productivity. Where large hospitals and medical groups have been successful in driving improved outcomes, small practices have struggled to develop consistency. This disparity can be attributed to the limitation of resources in case of smaller practices.

Documenting patient encounters electronically or otherwise is often regarded as a killjoy in the medical profession. However, physicians recognize its importance in providing better care. EMRs are largely promoted as a quality assurance check, with their built in clinical decision support systems allowing physicians to work more fluidly. In practice though, most providers end up reporting productivity losses in the year of implementation. Vendors will be quick to suggest a learning curve for effective use and while this carries weight, the general provider consensus regarding electronic documentation is that “it’s just not efficient enough.”

A health IT expert explains why physicians and other medical professionals find it exhausting to document electronically, “It’s the perception. Physicians expect automation to relieve them of their documentation responsibility.” He adds “when they are comparing, they use the time it takes to compose a self written paper note with the time it takes for them to document it electronically.”

When introduced EMR documentation merely provided physicians a platform to input and store information. However, technology has brought these solutions to a much more advanced level. Template based documentation has become a norm for majority of the vendors today. A number of these vendors offer intuitively designed templates that allow physicians to customize their clinical workflow and documentation, based on their preferences. Templates can be pre-configured to allow physicians to document similar cases by tweaking just a few items from previously recorded notes.

One physician talks about the overall impact of EMRs on the practice workflow. “There are improvements in workflow transition which has decreased the collective effort. Information is more transparent which ensures that we are on the same page.” He added, “Our billing has also improved tremendously and my biller goes home on time.”

Paper based documentation is no longer relevant in a rapidly evolving healthcare industry. The emergence of Accountable Care Organizations along with the need for accessibility and interoperability has made EMR based documentation a necessity to pave the way for quality care.

Read more: 9 Steps to Successful EHR Implementation

About Frank Quinn

Over the past twenty years, Frank Quinn has contributed significantly on standardizing, interconnecting and institutionalizing care delivery through health IT, helping eliminate barriers to accessibility, quality and adoption. EMR, practice management, eRx, patient portal, medical billing, compliance, privacy and security are his areas of expertise. For more information, please contact Frank at frank.quinn@curemd.com
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