At age 19, TEPR is maturing quickly. Once a showcase for lofty ideals and future hopes and dreams, the 19th annual edition of the Toward an Electronic Patient Record conference has become a bustling marketplace for legitimate, functional and user-friendly clinical information technology.
"Today, we may have reached the tipping point," Medical Records Institute CEO C. Peter Waegemann said at the May 12 opening session of the 2003 TEPR conference in San Antonio. He cited increased national and international activity in government, standards organizations and professional societies working toward computerizing patient records.
The Medical Records Institute is an electronic medical records advocacy group based in Newton, Mass., that puts on TEPR.
"On the vendor side, there's really been a coming of age," says Barry Blumenfeld, M.D., corporate manager, clinical informatics research and development for Partners HealthCare System in Wellesley, Mass.
Blumenfeld was one of two physicians who hosted and provided commentary for a highlight of TEPR, the Clinical Documentation Challenge.
Now in its fifth year, the challenge puts EMR vendors on the hot seat, making them prove that physicians can use their products to document a simulated patient encounter in front of a live audience.
In the early years, part of the entertainment was to see which systems would melt down under pressure.
This time around, only one of the 10 entrants had any sort of computer glitch, and that was hardware-related. All presenters finished in the allotted 10 minutes.
"As a rule, (EMRs) are getting better," says Thomas Sullivan, M.D., president of the Massachusetts Medical Society, who performed the exam that each participant documented.
"The people up there presenting are more comfortable," Sullivan says. "These systems have evolved tremendously. There is much more usability and technical features."
For the first time, users were required to demonstrate clinical-decision support and rules engines. Most also showed e-prescribing functions. None relied on voice recognition technology, though many of the products do support it.
PatientChart from Noteworthy Medical Systems warns users if the documentation generates an ICD-9 code that won't be paid. It also includes a patient-education database.
MediNotes Corp. incorporates graphics into the display of its ChartingPlus offering.
"That's something that tends to be very useful in some specialties and not so useful in others," says Blumenfeld.
For all the advances in commercial EMR products, skepticism still lingers. One audience member complained that in a true clinical setting, many physicians only have 10 minutes for the entire patient encounter, much less documenting the visit while giving full concentration to the computer.
Allen Wenner, M.D., is vice president for clinical applications design for Primetime Medical Software, a Columbia, S.C., company that automates the recording of medical histories.
He noted during one of the educational sessions at TEPR that it took as long as six minutes for the physician-user in the challenge to get past the input of basic patient information and to the subjective history part of the documentation.
Other session presenters gave case histories of successful and unsuccessful EMR implementations.
Following the rollout of its EMR, the Texas Children's Clinical Care Center, a massive building in Houston housing 55 ambulatory clinics, saw a $1.9 million reduction in bills not sent to payers for lack of documentation between February 2002 and February 2003, according to John Joe, M.D. Joe is medical director for informatics at Texas Children's Hospital, part of the Baylor College of Medicine.
Jon Huttman, M.D., a healthcare consultant with Medical Business Advisors, Los Angeles, says it will take "front-end education" of physicians to drive EMR adoption.
Playing "blame the doctors" for the slow uptake of clinical information technology has been a failure, he says.
Taking home the TEPR ware
Award winners, nonhospital categoriesPractice management systems for physician offices
Wireless solutions for physician offices
MR systems for small/solo practices (1-14 physicians)
eClinicalWorks: eClinicalWorks EMR
EMR systems for medium/large practices (15 or more physicians)