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Electronic medical records and doctor/patient communication

View from the US: When I talk to family members or friends who are physicians these days, I hear a lot of complaints.
What seems to get US doctors I talk to most agitated is an aspect of Obamacare that gets relatively little attention outside the healthcare community:  the “forced” conversion of medical practices to electronic medical records (EMR).
Under legislation signed in 2009, physicians were given a January 2015 deadline to convert to EMR and show “meaningful use” of these systems or face lower reimbursement rates on Medicare physician fees – a penalty of 1 percent of Medicare payments, increasing to 2 percent in 2016 and 3 percent in 2017.  To help offset the cost of EMR conversion, the federal government is offering individual practitioners up to $44,000 in incentive payments under the American Recovery and Reinvestment Act.  With both a carrot and a stick in place, physician practices, large and small, have been converting en masse.  

For many US physician practices, implementing EMR software and converting paper patient records to electronic form has been massively disruptive, as well as costly.  My own primary care practice, a small physician group, cut back on the number of patients seen per day for several months while their doctors and staff learned the new system.
Even with the financial and administrative challenges, what some doctors find to be the most difficult aspect of the conversion to EMR is the way it impacts the daily practice of medicine by changing how they communicate with patients, and thus altering the doctor-patient relationship.  With increasing time pressures, some clinicians feel they need to type into their computer or tablet while talking to patients, their face buried in the screen.  Many  find this takes their focus away from what the patient is saying, and leads them to miss picking up on some cues, or gaining a more holistic understanding of the patient.  On the other hand, some believe the greater access to information through the EMR system, and elimination of the need to scan through paper records, improves patient care.

A 2008 study conducted by the Center for Studying Health System Change found EMR systems both help and hinder communication between doctors and patients, as well as clinician-clinician interactions.  As system designs improve and physicians gain increasing familiarity with the technology, the positives should outpace the negatives.  Certainly, for the new generation of physicians (like my daughter, who is a third year medical student), who are learning the practice of medicine with these tools, the use of EMR should be second nature.

As a market researcher, who has seen MR evolve from largely face-to-face to largely web-based, I wonder if there are parallels for our industry…  Is our evolving technology promoting or hindering engaging in dialogue with respondents?  It certainly is possible for researchers to be distracted by the “latest and greatest” technological innovation in MR.  The key is to be able to leverage our technology to gain richer insights and understanding, not simply more data.

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2nd April 2015


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