In response to Bill Bysinger's letter, I would very much like to know which electronic medical record technology has been shown to be both cost-effective and easily adoptable by primary-care physicians in solo and small-group practices. I have explored many and have yet to find one with a short learning curve if it truly contains all the features needed to fulfill the promise of EMRs. It may be time to give up on the "short learning curve."
EMR enthusiasts must keep in mind that the average primary-care physician is probably about 53 years old, graduating from high school in 1972, college in 1976, med school in 1980 and residency in 1983 (many are even older). It is likely that the average primary-care physician did not have a computer in the home as a child, computer classes in high school, college, med school or residency. The majority probably grew up at a time when computers were not nearly as ubiquitous as they are today and only use computers even now for e-mailing, word processing and a little gaming, and may not be as skilled or comfortable with computer use as are those 29- and 30-year-olds currently finishing their residencies. I would liken the task of integrating EMRs into the average primary-care physician's practice to teaching a non-English speaking physician to do rapid, complete and efficient medical documentation in English.
First this physician would have to become fluent in English and only then be taught how to document in his or her new language. EMRs, if full-featured, are complex and their use not always intuitive, especially to those already facile and comfortable with pen and paper. I think the training period needs to be long and adapted to the patient's need to have their physician fully available during the training period. I would be willing to go to training sessions on weekends until I am fully capable of and facile with the entire capability of any EMR that I purchased before attempting actual installation in my office. Even in the techophile city of Austin, Texas, there is no such training offered and I know of none close enough to my practice to provide ease of access. It seems to me that the vendors and the entire EMR community have written off any physician not already heavily into computers. This might include the majority of physicians over 40. I recognize that building lengthy training into the price of EMRs would make them even more expensive than they already are. The slow pace of adoption of EMR into solo- and small-group practice is the result of the calculation of many primary-care physicians that current EMRs are just not yet worth the time and money required to adopt them. Rapid spread of EMRs will come when there is a better product in which the price in time and money is worth the benefit to patients. The market has spokenthat day is not yet here. Unless the government or others act to force the adoption of the current crop of "not ready for prime-time" EMRs.
However, that day will come as vendors work on their product and better ways to implement its use, and when the vendors offer that product it will require no government intervention or incentives to force its wide and rapid adoption.
Everest "Tad" Whited, M.D.Family practitionerPflugerville, Texas To submit a letter to YOUR VIEWS, click here. Please include your name, title and hometown.