The Certification Commission for Health Information Technology focuses heavily on issues such as HL7 and interoperability. To run a small- to medium-sized practice of up to 10,000 patient visits per year properly, a doctor needs a lot of discipline, abundant common sense, proper document management, billing software and a decent note generator. It is nice to have an EMR if it meets patient needs. The best EMRs are not always the feature-laden or the most expensive ones. The current push toward e-prescribing and specific types of EMRs looks really fishy. This is particularly because people close to the Bush administration have a huge vested interest in these products. "Big Pharma," not usually known for its magnanimity, has even offered to fund e-prescription software and provide it free of charge! Someone needs to explain to the doctors in private practice why they should buy only CCHIT-certified products. The government should clearly state what it wants from the providers and then tie these issues to reimbursement. Top-heavy management will produce results similar to what has recently been reported from Walter Reed, VA hospitals and the United Kingdom's National Health Service.
In my own paperless office, I manage patients very efficiently and track outcomes data without a CCHIT-certified EMR. I tried a host of certified EMRs. They were not designed around our workflow and actually impeded patient care by needlessly tying us to the screen when we could be doing more tangible work. Many doctors like me have done tremendous work in our own practices to improve efficiency, reduce patient waiting times, provide cost-effective care, reduce error and also (unlike the VA) provide very secure portable records to patients and doctors. Because of poor-quality products that have flooded the market, many of us have resorted to designing our own software to suit our workflow and our specific needs. The proof of utility of electronic tools is a successful practice and a waiting list of patients who want to come in for consultation. It is not how much technology you have, it is how you use it that matters.
N. Murali, M.D.Gastroenterology Associates of OrangeburgDigestive Endoscopy CenterOrangeburg, S.C.To submit a letter to YOUR VIEWS, click here . Please include your name, title and hometown.