Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How EMRs can actually help physicians

Fred N. Pelzman, MD
Tech
September 12, 2019
Share
Tweet
Share

Collaboration is the key.

When I think about how hard it is to take care of our patients, and how many different people are involved in their care, it’s a wonder that anything ever gets done.

We need to simplify systems, and harness the power of the information systems available to us, as well as the promise of the electronic medical record, to improve the lives of our patients, as well as make all of our lives, all of our jobs, a little bit easier.

This morning we got a stack of paperwork on a patient who is followed in our practice, who really only comes to see us to get his home care forms completed. He sees multiple other specialists who are in our institution, who care for the various diseases and complications he has that require their particular expertise.

Not only did we have to sign one of those endless home care forms that listed dozens and dozens of goals that they said that the patient would achieve by being under their care, but we also had to fill out page after page of documentation for the durable medical equipment this patient requires.

Noted on their faxed request along with the forms was the statement, “You must include the last five progress notes” for the patient to be able to receive both his ongoing home care and the durable medical equipment necessary to safely take care of him in his home.

How did that become a rule? Who interpreted some regulation or guideline somewhere that said five different (potentially not very useful) progress notes must be included with each request for durable medical equipment?

This particular patient has a serious chronic condition (one that unfortunately will never “go away”) that has left him completely dependent on others and with many of the complications that can arise from this condition.

To better take care of him, we need to figure out a better way to collaborate, to share the responsibility, to make sure he gets what he needs, to do what’s right.

One of the requests was that we order some specialized catheters for him, and they told us we needed to give them all the details of the type of catheter, how they were used, and what supplies were needed to allow the home care nurses to safely insert them.

Unfortunately, we internists are not in the catheter business.

His urologist knows best which catheter he needs, and as far as we can tell, it’s probably been the same catheter he’s been using for the past 15 to 20 years.

Why does the durable medical equipment company suddenly not remember what he got last month, and instead makes us do what may be a significant amount of work just to get this patient what he needs?

There’s got to be a better way.

ADVERTISEMENT

As our institution moves towards a unified electronic medical record across its entirety, we have broken up into silos that look at how each different practice, from pediatrics, to surgery, to OB/GYN, to emergency medicine, all use the electronic medical record differently, and the EHR team has been seeking our opinions about what we need to optimize it, to take care of our patients.

During yesterday’s meeting, we were going over several forms that people have used or developed that they would love to have built into the system, to make their lives better.

One of these was a form that is sent to the primary care provider when a patient is undergoing bariatric surgery, and requires us as the primary care provider to fill out what diets a patient has used in the past, their entire weight gain and weight loss history, and then “certify” that we think this surgery is medically necessary for them, and that they are “medically cleared” to undergo it.

Interestingly, we often receive this form immediately before the surgery, when we have not been engaged in the process all along the way.

Wouldn’t it be better, when the original decision was being made to evaluate a patient for bariatric surgery, if all those with a vested interest and medically necessary parties were notified, and kept informed of all of the things that were going on as the process progressed?

None of the bariatric surgeons should be surprised that they need this form completed, but they tend to not involve us until the last minute.

Fill this form out, or the patient’s surgery will be canceled.

Implied in this is that it will be our fault that the patient’s surgery is canceled or delayed.

When this works well is when someone reaches out to us early enough in the process and says this is what needs to happen over the next couple of months, this is what you care for the patient for, and this is what we care for the patient for, how can we work together, how can we optimize the patient’s travels through this healthcare journey they are on.

I’ve written before about how some of my favorite surgeons request preoperative evaluations from me.

They will read my office note, see the patient in consultation, copy their own note back to me, and then send me a message in the electronic medical record: “Fred, I think this patient should have X procedure, if that’s okay with you I’m going to proceed. Any recommendations?”

Together we’ve gotten dozens and dozens of patients safely through surgery without a lot of extra hoops that needed to be jumped through.

This is how we take care of patients, more efficiently, more collaboratively, and without a lot of clicking of boxes and excess busywork created by someone who doesn’t really understand what’s going on, chores that never really benefit anybody, either the patients, or the rest of the team trying to take care of them.

Interestingly, there’s a model for how to do this in the electronic medical record.

Although I’m not an obstetrician, I’ve learned that the EMR is designed so that it considers pregnancy as a single event, which has a beginning, at the first visit, and an end, after delivery when the postnatal visits have been completed.

Everything along the way is attached to this event, with multiple participants who have clearly defined roles, and a standardized progression, a timeline with tasks, from beginning to end.

Wouldn’t it make sense for more things to work this way, for all of the care to be optimized in a collaborative way, so that we all knew what everyone else was doing, so that we all knew what we needed to do when we needed to do it?

What if, at the onset of the evaluation for bariatric surgery, everyone who ultimately needed to be involved was informed, and this timeline was created, assignments were made, expectations clarified, and no one was left in the dark?

I’m sure that every member of the team needed to get patients through bariatric surgery (from the surgeon doing the procedure to the nutritionist advising the patient to the sleep medicine doctor performing the sleep apnea study to the gastroenterologist doing the required scoping to the psychiatrist assessing the patient’s mental state) would all want to know and be involved, taken out of their silos.

And for the first patient I described above, what if all members of his team, including his home care nurses and the agency they work for and the durable medical equipment company and his insurer, all agreed on the fastest and safest ways to always get him everything he needs?

I envision a more efficient way of taking care of people where we all work together to move them from point A to point B.

With that key, we can open any door.

Fred N. Pelzman is an internal medicine physician who blogs at MedPage Today’s Building the Patient-Centered Medical Home.

Image credit: Shutterstock.com

Prev

Scent of a hospital: a medical student's perspective in a developing country

September 12, 2019 Kevin 1
…
Next

When physicians fear for their lives

September 12, 2019 Kevin 9
…

Tagged as: Health IT

Post navigation

< Previous Post
Scent of a hospital: a medical student's perspective in a developing country
Next Post >
When physicians fear for their lives

ADVERTISEMENT

More by Fred N. Pelzman, MD

  • Why electronic medical records should be standardized

    Fred N. Pelzman, MD
  • Can answers to after hours calls be automated?

    Fred N. Pelzman, MD
  • We have to do better than DNR tattoos

    Fred N. Pelzman, MD

Related Posts

  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • The risk physicians take when going on social media

    Anonymous
  • Physicians are trapped between patient satisfaction and unnecessary prescribing

    Richard Young, MD
  • Beware of pseudoscience: The desperate need for physicians on social media

    Valerie A. Jones, MD
  • When physicians are cyberbullied: an interview with ZDoggMD

    Monique Tello, MD

More in Tech

  • How I stopped typing notes and started seeing my patients again

    William S. Micka, MD
  • How AI is reshaping preventive medicine

    Jalene Jacob, MD, MBA
  • Why clinicians must lead health care tech innovation

    Kimberly Smith, RN
  • Why medical notes have become billing scripts instead of patient stories

    Sriman Swarup, MD, MBA
  • a desk with keyboard and ipad with the kevinmd logo

    AI in health care is moving too fast for the human heart

    Tiffiny Black, DM, MPA, MBA
  • Why AI in health care needs the same scrutiny as chemotherapy

    Rafael Rolon Rivera, MD
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How EMRs can actually help physicians
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...