EHRs in gastroenterology: Burden or boon?

EHRs are an integral part of the healthcare transformation taking place, but they spark a contentious debate. Four practicing gastroenterologists share their thoughts on whether or not EHRs are beneficial to GI practice.

Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses.

Next week's question: What is the best strategy for keeping up with quality reporting requirements in GI?

Please submit responses to Carrie Pallardy at cpallardy@beckershealthcare.com by Wednesday, June 18, at 5 p.m. CST.

Elliot Ellis, MD, Team Lead, EMA Gastroenterology, Modernizing Medicine: Yes and no. It depends on the EHR system. Many one-size-fits-none EMR systems aren't intuitive and don't easily fit into the GI workflow. For example, if my staff and I have to take time to customize an EMR system by programming in our most commonly seen diagnoses, that's not beneficial and in fact hurts our practice. Also, systems that require physicians to turn our backs to patients do more harm than good.

But, I think that the industry had to start somewhere, and newer models are much improved. I feel fortunate to have had the opportunity to create an EMR system built specifically for gastroenterologists. My colleague, Dr. Julie Servoss, and I learned how to code software and program our medical knowledge into it, so EMA Gastroenterology comes out of the box complete with what our peers need and it remembers individual physician's preferences. Even better, it comes with ICD-10 codes built-in, so we're ready when October 1 comes along.

Larry Good, MD, FACG, founder, CEO Good Pharmaceutical Development, CEO, Compassionate Care Center of New York: Electronic health records are now part of our medical culture. In most practice circumstances, they are a practical necessity. In realty, although they are excellent for extracting billable information from medical records and meeting level of care criteria, they are often inaccurate, voluminous and lacking in content. One frequently sees 40 page progress notes in a hospital chart that has simply cut and pasted all previous records onto the note. The impression and plan of the note writer is often absent, or, in the least, inscrutable. EHR programs area, also, often too rigid and the menus and drop downs make certain orders or treatment changes difficult. Finally, many EHR systems are incapable of communicating with out of institution systems making the prospect of electronic communications between hospitals or practices a chimera.

Procedure reports are also influenced by EHR. Template reports often result in loss of detail or clarity. Individually typed or dictated reports are more detailed and accurate and can be incorporated in the EHR. The EHR is a step forward, but its promise had not yet been fully recognized.

Jonathan Schreiber, MD, Maryland Endoscopy Center (Towson, Md.): This is a question that elicits passionate, often diametrically opposed responses from doctors in general and gastroenterologists in particular. The medical record used to be a concise, useful representation of the patient's history and the doctor's analysis. Many EMRs have transformed notes into bloated documents, which bury important information in an avalanche of verbiage.
Much of the blame for this situation lies with the developers of the software. Some falls to the government's meaningful use program, which increases data recording without providing any clinical benefit. The current reimbursement scheme also sabotages useful electronic record-keeping (for example by paying to include a family and social history in every follow-up note).

On the other hand, my personal response to the original question would be in the affirmative. Yes, EMRs have been very beneficial to my practice.

As a self-employed gastroenterologist in a small group, we can make choices that allow us to use an EMR to our advantage. For example, after an initial couple of years of participation in meaningful use, we no longer do so. We are willing to take a cut in compensation in return for increased productivity (seeing more patients) and more time devoted to improving the quality of care. No more filling the chart with data that we don't need and which obscures the truly useful clinical information.
We chose an EMR, Amazing Charts, which is user-friendly. It allows us to create notes, which are accurate representations of the patients' medical history. They are both useful to us and meaningful to referring providers. Charts are always legible and are never lost. Finding old colonoscopy reports, for example, generally takes seconds, no matter how old the report may be. We are more efficient and our patients receive better care as a result of the EMR.  

There are challenges, to be sure. The EMR should make it easy to demonstrate the metrics that must be documented if "pay for quality" remains the payer mantra. Meanwhile, the right EMR, used in the right way, is a benefit to gastroenterologists and their patients.

Jessica Trevino, MD, Seton Healthcare Family (Austin, Texas): First and foremost, electronic health records are beneficial to all of medicine. It allows for more efficient and accurate healthcare, allowing "any time" access to patient medical records. It eliminates the confusion of misinterpreted handwriting and allows for precise details of order entry and medication delivery. It allows the healthcare provider to trend vitals, laboratory values and transfusions.

For GI practices, it is a great tool to simply and quickly read and analyze previous patient visits. Symptom review, improvement and medication trials are easily documented. Physicians and mid-level providers can monitor surveillance times for procedures such as colonoscopies. EHRs keep organized records of prior procedures, current and old lab values and, in many instances, communicates with radiology software so that images can be reviewed directly. More importantly, many EHRs now have the ability to quickly send consult notes to a referring MD. Several have patient access portals that allow direct and private communication with staff members or MDs, cutting down on non-urgent phone calls and allowing patient and physician to communicate on their own time.

Additionally, these records cut down on unnecessary, duplicate procedures. Many patients do not remember dates or exact details of prior procedures or diagnoses. For patients who need repeated procedures, EHRs allow for ordered, quick reviews of previous radiologic and endoscopic studies. They also make sending records easier in regards to patients who are seeking second or third opinions or changing GI practices when relocating. As many GI patients have urgent presentations that require ER or in-patient evaluation, EHRs permit quick access for healthcare providers in these settings to access accurate and up to date medical records. The reverse is also true, giving an updated summary of what occurred inpatient to physicians continuing outpatient care for their gastrointestinal complaints.

More articles on gastroenterology:
EndoChoice IPO yields $94.9M: 3 facts
7 GI physicians making headlines – June 5, 2015
GI financial playbook: 3 experts on revenue cycle management for endoscopy centers & GI practices

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