Dorothy and Toto follow yellow brick road to electronic patient records
NASHVILLE, TN--The audience tapped their feet to the electronic keyboard version of "If I Only Had a Brain" as the cast backstage prepared to follow the yellow brick road to the Wonderful World of Electronic Patient Records.
The Vision Players presented a two-hour dramatization during the Medical Records Institute's Toward an Electronic Patient Record '97 conference April 29. With family physicians in several coveted roles, the troupe illustrated ways to overcome impediments to replacing paper medical records.
After Uncle Toto (Gordon Black, MD, of Gulfport, MS) suffered a myocardial infarction, the administrative demands overwhelmed his doctor, Dorothy (played by Susan Jordan, of San Diego, the only professional actor in the show). She pushed Uncle Toto in his wheelchair to the land of Oz, where various characters attempted to counter the Bad Witch's threats of doom and gloom in a computerized world.
A Munchkin (Randall Oates, MD, a family physician from Springdale, AR), described the many types of TWITs (Third-World Information Troubles) that can plague the switch to electronic records. "The analogy is as follows: In third-world countries, there is often an inability to make any type of progress due to individuals who are in positions of power and authority who have a vested interest in keeping things in a backward state," he explained.
Reasons that TWITs may cite for their opposition to electronic records include: fear that a system will become obsolete, concern that they won't find a system that can do everything, belief that patients won't accept such a system, and computer-phobia. Even software company representatives can be TWITs, said Dr. Oates. They may install a system and then fight off other products, make inflated or misleading claims, warn you not to install another system because they are on the verge of developing a superior product, or point fingers at one another when problems arise.
TWIT management involves modifying behavior, coping with change, fostering trust and consensus, and promoting education and awareness. Here are some tips from Dr. Oates:
- Always be cognizant of the physician's fear of losing control.
- Research repeatedly shows that patients accept information technology much more readily than physicians do.
- Educating staff about electronic medical records must include realistic expectations, good leadership, quick rewards for change, and stress management.
- The medical information systems department shouldn't make evaluations or decisions without a lot of clinical input.
A major impediment to computerizing records is the perception that it's too costly. When Dorothy encountered the Tin Man, she learned his lament: "Machines are cheaper than people or paper."
The Tin Man (family physician John Dugaw, MD, of New Orleans) pointed out scenarios--such as a telephone prescription refill and a chart transfer for a Medicare patient--that bring in no revenue to the doctor's office. In each example, the electronic medical record saved time and money. Dr. Dugaw also broke down the costs of paper and electronic charting for a five-physician group for five years:
Paper charts--$200, initial paper purchase; $100 per month, continuing paper purchase; $175,000, transcription services; $80,000, medical records clerk; $3,000, dictation system; $10,000, copy machine; and $12,000, copier service fees. Total costs for five years: $342,000.
Electronic medical records--$150,000, initial costs, including training for the group's 10 employees; and $108,000, software support. Total costs for five years: $208,000.
"If FPs are to survive economically, we need the gifts of technology," Dr. Dugaw said.
The electronic medical record is to family medicine what the arthroscope is to orthopedic surgery: a technological advance that saves money and improves efficiency, he said. "This is technology that will make a substantial difference for family physicians. It will decrease the cost of obtaining and managing data and providing efficient services to our patients."
In her stroll through Oz, Dorothy also met other FP-characters, including the Scarecrow (Allen Wenner, MD, of West Columbia, SC) and the Lion (John Bachman, MD, of Rochester, MN).
She learned about buying an electronic medical record system, allowing patients to enter their own data, giving nurses an integral role in the system, and grappling with interface and standards issues. She also got a look at some evolving systems.
In the end, Dorothy realized that there's no place like home to implement an electronic medical record.
Above: Munchkin Oates
Right: Cowardly Lion Bachman struts his stuff, but then panics at the sight of a little mouse--a computer mouse, that is.
- FP Report is published by the AAFP News Department.
