RE: FW: G on EHRs

[Guest guest]

Sounds good to me - I think we're all feeling a little more blunt these days : )I was feeling a bit blunt that day.Gordon  Healthcare IT NewsBeware of the EMR 'Ponzi scheme,' warns physician leaderBy   Pizzi, Contributing Editor09/19/08  http://www.healthcareitnews.com/ Healthcare IT does not necessarily make life easier for primary care physicians, says a leader in the movement to make medicine more efficient and patient-centered."When you put an EMR into a primary care practice, your life is hell for the next year," said L.Gordon , MD."EMR vendors aren't really giving us what we need. We have to make a distinction between a robust EMR with decision support tools, and one that is just being marketed as a way to improve coding. And we really need to get out of the E & M coding game." spoke Thursday at the 2008 Scientific Assembly of the American Academy of Family Physicians. He did not mince words when discussing the faults of contemporaryU.S. healthcare, and the subsequent burdens placed upon primary care physicians."Beware of the monolithic, expensive IT vendor, because there are always things they don't do well,"  said. "The whole thing can be a Ponzi scheme. The only ones making money from most of these products are the vendors selling them.""We just can't wait until 2010 for the rollout of the patient-centered medical home," said. "We need revolutionary change in our industry. Incremental changes will not work" has been intimately involved in the growth of the "Ideal Medical Practices Project," an effort to make efficient primary care practices that serve as "medical homes" to patients the core of medical care in the United States.He described the different components of an "ideal medical home," saying it was important for family practitioners to "get the foundation right." In order to give physicians "breathing room" to practice medicine in a patient-centered way,  said it was critical to reduce overhead and increase access to healthcare."Family practitioners should not be working for an organization whose main interest is increasing patient volume and just views primary care as a feeder system [for hospital admissions],"  said. He compared the experience of working for such an organization to running on a "hamster wheel."Even if practicing in smaller settings,  said it was next to impossible for primary care physicians to make a living in places like California or the northeastern United States, given the high costs of doing business and low reimbursement rates."These just aren't good places to practice primary care," he said. "Unless you run a patient mill, I recommend you not get into primary care in southern California."New reimbursement policies for primary care must be instituted,  asserted. These policies should encourage quality, but also be truly patient-centered."We need a system of quality measurement that works for all practices and not just big organizations," he said. "And we must take the patient's perspective into consideration when determining quality. If only 3 percent of the medical home model takes patient input into consideration, it's not really patient-centered."When developing quality programs and reimbursement models,  said policymakers must put an end to the "costly and perverse world of administrative trivia" which "divert physician efforts away from patients.""How long have these promises of increased payment been made to us?" asked. "Unfortunately, I don't think pay-for-performance is the answer for primary care, because the pay-for-performance checks don't go very far." 

[Guest guest]

Actually, I agree! Not too blunt!Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way' This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

[Guest guest]

I thought it was delicious..

Actually, I agree! Not too blunt!Lynette I Iles MD 301 South Iowa Ste 2Washington IA 52353 Flexible Family Care'Modern medicine the old-fashioned way'

This e-mail and attachments may contain information which is confidential and is only for the named addressee. If you have received this email in error, please notify the sender immediately and delete it from your computer.

-- If you are a patient please allow up to 12 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD

ph fax

[Guest guest]

Bit unbalanced .. some of us write EMRs to help document the

encounter, and improve our ability to deliver health care.

> I thought it was delicious

>

> ..

>

>

>>

>> Actually, I agree! Not too blunt!

>>

>> Lynette I Iles MD

>> 301 South Iowa

>> Ste 2

>> Washington IA 52353

>> Flexible Family Care

>> 'Modern medicine the old-fashioned way'

>> This e-mail and attachments may contain information which is confidential

>> and is only for the named addressee. If you have received this email in

>> error, please notify the sender immediately and delete it from your

>> computer.

>

>

>

> --

> If you are a patient please allow up to 12 hours for a reply by email/

> please note the new email address.

> Remember that e-mail may not be entirely secure/

> MD

>

>

> ph fax

>

>

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

[Guest guest]

True, Graham, but you and a handful of

others are the exception to the rule (particularly in the US market).

My “ponzi scheme” comment was

actually about the embarrassing “exhibitor show” in which vendors

hawk products purported to raise revenue for starving practices (“Buy

this gizmo, use it on your patients, and you’ll earn $$$!!!”). I

expressed my sentiment that such gizmos were likely to generate lots of revenue

indeed, but for the vendors.

My EMR comments were aimed at the

overwhelming experience of those in the US market where such tools are built

with almost the sole purpose of enhancing documentation to win at the Cartesian

game of E & M coding – a game with no benefit other than to the legions

of clerks employed in the coding life cycle.

G

From:

[mailto: ] On

Behalf Of Graham Chiu

Sent: Saturday, September 20, 2008

3:49 PM

To:

Subject: Re:

FW: G on EHRs

Bit unbalanced .. some of us write EMRs to help document the

encounter, and improve our ability to deliver health care.

[Guest guest]

I thought it was great. Wish I

coulda been there to hear you in person. You are getting some great

coverage on your lectures, Gord, as expected. Great!

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From: [mailto: ] On Behalf Of L. Gordon

Sent: Saturday, September 20, 2008

11:05 AM

To:

Subject:

FW: G on EHRs

I was feeling a bit blunt that day.

Gordon

Healthcare

IT News

Beware

of the EMR 'Ponzi scheme,' warns physician leader

By Pizzi, Contributing Editor

09/19/08

http://www.healthcareitnews.com/

Healthcare IT does not necessarily make life easier for

primary care physicians, says a leader in the movement to make medicine more

efficient and patient-centered.

" When you put an EMR into a primary care

practice, your life is hell for the next year, " said L.Gordon , MD.

" EMR vendors aren't really giving us what we need. We

have to make a distinction between a robust EMR with decision support tools,

and one that is just being marketed as a way to improve coding. And we really

need to get out of the E & M coding game. "

spoke Thursday at the 2008 Scientific Assembly of the American Academy of Family

Physicians. He did not mince words when discussing the faults of

contemporary U.S. healthcare, and the subsequent burdens placed

upon primary care physicians.

" Beware of the monolithic, expensive IT vendor,

because there are always things they don't do well, " said. " The whole thing can be a Ponzi scheme. The

only ones making money from most of these products are the vendors selling

them. "

" We just can't wait until 2010 for the rollout of

the patient-centered medical home, " said . " We need revolutionary change in our industry.

Incremental changes will not work "

has been intimately involved in the growth of the

" Ideal Medical Practices Project, " an effort to make efficient

primary care practices that serve as " medical homes " to patients the

core of medical care in the United States.

He described the different components of an

" ideal medical home, " saying it was important for family

practitioners to " get the foundation right. " In order to give

physicians " breathing room " to practice medicine in a

patient-centered way, said it was critical to reduce overhead and increase

access to healthcare.

" Family practitioners should not be working for

an organization whose main interest is increasing patient volume and just views

primary care as a feeder system [for hospital admissions], " said. He compared the experience of working for such an

organization to running on a " hamster wheel. "

Even if practicing in smaller settings, said it was next to impossible for primary care

physicians to make a living in places like California or the northeastern United States, given the high costs of doing business

and low reimbursement rates.

" These just aren't good places to practice

primary care, " he said. " Unless you run a patient mill, I recommend

you not get into primary care in southern California. "

New reimbursement policies for primary care must be

instituted, asserted. These policies should encourage quality, but

also be truly patient-centered.

" We need a system of quality measurement that

works for all practices and not just big organizations, " he said.

" And we must take the patient's perspective into consideration when

determining quality. If only 3 percent of the medical home model takes patient

input into consideration, it's not really patient-centered. "

When developing quality programs and reimbursement

models, said policymakers must put an end to the " costly and

perverse world of administrative trivia " which " divert physician

efforts away from patients. "

" How long have these promises of increased

payment been made to us? " asked . " Unfortunately, I don't think pay-for-performance

is the answer for primary care, because the pay-for-performance checks don't go

very far. "

[Guest guest]

Blunt is goodSubject: RE: FW: G on EHRsTo: Date: Saturday, September 20, 2008, 4:09 PM

I thought it was great. Wish I

coulda been there to hear you in person. You are getting some great

coverage on your lectures, Gord, as expected. Great!

A. Eads, M.D. Pinnacle Family Medicine, PLLC phone fax P.O.

Box 7275 Woodland

Park, CO 80863 www.PinnacleFamilyM edicine.com

From: Practiceimprovement 1yahoogroups (DOT) com [mailto: Practiceimprovement 1yahoogroups (DOT) com ] On Behalf Of L. Gordon

Sent: Saturday, September 20, 2008

11:05 AM

To: Practiceimprovement 1yahoogroups (DOT) com

Subject: [Practiceimprovemen t1]

FW: G on EHRs

I was feeling a bit blunt that day. Gordon Healthcare

IT News Beware

of the EMR 'Ponzi scheme,' warns physician leader

By Pizzi, Contributing Editor

09/19/08

http://www.healthca reitnews. com/ Healthcare IT does not necessarily make life easier for

primary care physicians, says a leader in the movement to make medicine more

efficient and patient-centered. "When you put an EMR into a primary care

practice, your life is hell for the next year," said L.Gordon , MD. "EMR vendors aren't really giving us what we need. We

have to make a distinction between a robust EMR with decision support tools,

and one that is just being marketed as a way to improve coding. And we really

need to get out of the E & M coding game." spoke Thursday at the 2008 Scientific Assembly of the American Academy of Family

Physicians. He did not mince words when discussing the faults of

contemporary U.S. healthcare, and the subsequent burdens placed

upon primary care physicians. "Beware of the monolithic, expensive IT vendor,

because there are always things they don't do well," said. "The whole thing can be a Ponzi scheme. The

only ones making money from most of these products are the vendors selling

them." "We just can't wait until 2010 for the rollout of

the patient-centered medical home," said . "We need revolutionary change in our industry.

Incremental changes will not work" has been intimately involved in the growth of the

"Ideal Medical Practices Project," an effort to make efficient

primary care practices that serve as "medical homes" to patients the

core of medical care in the United States. He described the different components of an

"ideal medical home," saying it was important for family

practitioners to "get the foundation right." In order to give

physicians "breathing room" to practice medicine in a

patient-centered way, said it was critical to reduce overhead and increase

access to healthcare. "Family practitioners should not be working for

an organization whose main interest is increasing patient volume and just views

primary care as a feeder system [for hospital admissions]," said. He compared the experience of working for such an

organization to running on a "hamster wheel." Even if practicing in smaller settings, said it was next to impossible for primary care

physicians to make a living in places like California or the northeastern United States, given the high costs of doing business

and low reimbursement rates. "These just aren't good places to practice

primary care," he said. "Unless you run a patient mill, I recommend

you not get into primary care in southern California." New reimbursement policies for primary care must be

instituted, asserted. These policies should encourage quality, but

also be truly patient-centered. "We need a system of quality measurement that

works for all practices and not just big organizations," he said.

"And we must take the patient's perspective into consideration when

determining quality. If only 3 percent of the medical home model takes patient

input into consideration, it's not really patient-centered." When developing quality programs and reimbursement

models, said policymakers must put an end to the "costly and

perverse world of administrative trivia" which "divert physician

efforts away from patients." "How long have these promises of increased

payment been made to us?" asked . "Unfortunately, I don't think pay-for-performance

is the answer for primary care, because the pay-for-performance checks don't go

very far."

[Guest guest]

EMR vendors try to produce products with features that their

customers want.

The EMR products that sell to large hospital systems and HMOs

put out products that focus on complete control of physician referral patterns

and on full integration between inpatient and outpatient care.

The EMR products that sell to medium-sized physician groups

focus on efficiencies in integrated scheduling, workflow improvement (within

our very sick system) that integrates billing, scheduling, messaging, order

entry, and lab, radiology, and consult tracking.

The EMR products that sell to small practices or solo doctors

focus on generating notes, and try to keep their systems intuitive because

training doctors and tech support of complex systems is very expensive, and

they need to keep their systems affordable to small practices.

The fact that the E & M coding system is complex and rarely

relates to the actual work of taking care of a patient is not the fault of the

EMR vendors. Doctors still need to get paid, and unless they go

into direct practice arrangements with patients or become purely capitated,

they need to “play the game” so that they can get paid.

If the system changed so that coding didn’t matter, then

the vendors would put their energy into building features into the system that

did matter to their customers. I spend quite a bit of time doing

EMR template design and template quality assessment, and I must say that the

least enjoyable part of my job is putting in the invisible markers in templates

that enable the system to advise the doctor how he or she could code for the

visit. It is lots more fun to put energy into making templates that

make the job of taking care of the patient better and more efficient.

dts

From:

[mailto: ] On Behalf Of L. Gordon

Sent: Saturday, September 20, 2008 4:02 PM

To:

Subject: RE: FW: G on EHRs

True,

Graham, but you and a handful of others are the exception to the rule

(particularly in the US market).

My

“ponzi scheme” comment was actually about the embarrassing

“exhibitor show” in which vendors hawk products purported to raise

revenue for starving practices (“Buy this gizmo, use it on your patients,

and you’ll earn $$$!!!”). I expressed my sentiment that such

gizmos were likely to generate lots of revenue indeed, but for the vendors.

My EMR comments

were aimed at the overwhelming experience of those in the US market where such

tools are built with almost the sole purpose of enhancing documentation to win

at the Cartesian game of E & M coding – a game with no benefit other

than to the legions of clerks employed in the coding life cycle.

G

From:

[mailto: ] On Behalf Of Graham Chiu

Sent: Saturday, September 20, 2008 3:49 PM

To:

Subject: Re: FW: G on EHRs

Bit

unbalanced .. some of us write EMRs to help document the

encounter, and improve our ability to deliver health care.

[Guest guest]

Well put Don.

Gordon

_____

From:

[mailto: ] On Behalf Of T.

, MD

Sent: Sunday, September 21, 2008 11:41 AM

To:

Subject: RE: FW: G on EHRs

EMR vendors try to produce products with features that their customers want.

The EMR products that sell to large hospital systems and HMOs put out

products that focus on complete control of physician referral patterns and

on full integration between inpatient and outpatient care.

The EMR products that sell to medium-sized physician groups focus on

efficiencies in integrated scheduling, workflow improvement (within our very

sick system) that integrates billing, scheduling, messaging, order entry,

and lab, radiology, and consult tracking.

The EMR products that sell to small practices or solo doctors focus on

generating notes, and try to keep their systems intuitive because training

doctors and tech support of complex systems is very expensive, and they need

to keep their systems affordable to small practices.

The fact that the E & M coding system is complex and rarely relates to the

actual work of taking care of a patient is not the fault of the EMR vendors.

Doctors still need to get paid, and unless they go into direct practice

arrangements with patients or become purely capitated, they need to " play

the game " so that they can get paid.

If the system changed so that coding didn't matter, then the vendors would

put their energy into building features into the system that did matter to

their customers. I spend quite a bit of time doing EMR template design and

template quality assessment, and I must say that the least enjoyable part of

my job is putting in the invisible markers in templates that enable the

system to advise the doctor how he or she could code for the visit. It is

lots more fun to put energy into making templates that make the job of

taking care of the patient better and more efficient.

dts

From:

[mailto: ] On Behalf Of L. Gordon

Sent: Saturday, September 20, 2008 4:02 PM

To:

Subject: RE: FW: G on EHRs

True, Graham, but you and a handful of others are the exception to the rule

(particularly in the US market).

My " ponzi scheme " comment was actually about the embarrassing " exhibitor

show " in which vendors hawk products purported to raise revenue for starving

practices ( " Buy this gizmo, use it on your patients, and you'll earn

$$$!!! " ). I expressed my sentiment that such gizmos were likely to generate

lots of revenue indeed, but for the vendors.

My EMR comments were aimed at the overwhelming experience of those in the US

market where such tools are built with almost the sole purpose of enhancing

documentation to win at the Cartesian game of E & M coding - a game with no

benefit other than to the legions of clerks employed in the coding life

cycle.

G

_____

From:

[mailto: ] On Behalf Of Graham Chiu

Sent: Saturday, September 20, 2008 3:49 PM

To:

Subject: Re: FW: G on EHRs

Bit unbalanced .. some of us write EMRs to help document the

encounter, and improve our ability to deliver health care.