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Subject:  Re: OT: Career crisis Date:  10/15/2005  4:48 PM
Author:  xraymd Number:  212581 of 312945

Greetings, bleplatt, indeed you may use my example under the cloak of identity protection (omit the xraymd!). Take note of how brief the first paragraph was in describing how I've documented on paper. Then again note how LONG the subsequent paragraph was in describing documenting on EMR. I am sure you already "got" it and realized that the length of effort it took to describe the differences is a direct correlation to the length of time it actually takes to DO the documentation by these different methods.

Horribly designed or no, there are docs succeeding on it. I am just not one of them. Interestingly, last November I attended a user's group meeting of other physicians and practices who have adopted this system and spoke at length to one of the superstar physician users of it in a New York State practice. I also spoke at length to the actual physician DESIGNER of the system. Both of them heard how I was asked to use it and both shook their heads to say that the system was NOT designed for real-time capture of information in the way my practice intends for it to be done - in fact, the system designer offered our practice a free two-hour solutions session to see how the modules could be customized for easier face-to-face use, and the management DECLINED to take him up on his offer (too busy to spend time customizing the modules!).

The point is that since the maximum number of docs in our practice HAVE adapted (no matter the compromises to their level of prior detail), I am the odd man (woman) out and thus require an extra level of "coddling" to get me in line. I am not very good at capitulating to the demand that I decrease the amount of information to input, given what I USED to be able to capture that served me well later in case I needed to rely on prior observations important to document at the time. In fact, I have already been subpoenaed in one Worker's Comp hearing that focused on what was recorded on the electronic document compared to what was actually told to me by the defendant. There were gaps and I was asked about why I had not recorded in greater detail what she'd said 6 months before. That was hard to defend - it could only be said that I had recorded what I deemed the essential complaint she had at that time despite all the other level of detail she says she'd gone into. And the management of my practice KNOWS about this instance yet still demands EMR data entry from each of the docs in spite of its potential for deficiencies or incompleteness.

The newest doc in the practice who has already adapted to EMR freely admits that he does not record info for future reference. He says he will just "reconstruct" the history from hearing about how the patient is doing weeks to months later. I don't think I want to rely on my memory to be able to do this, nor do I believe I would be any faster at trying to do this than if I'd written it down timely and in full. Yet he is easily seeing his 23 patients a day and encoding at least 14 of them and leaving the office by 6:30pm - so however imperfectly, he is apparently doing it. He acknowledges that even if he shows me HOW he does, that I might not opt to mimic him if I would prefer to capture a greater level of detail. He is in no way a better, nor worse, physician than I am, but he has been able to record less because it suits his comfort level. It does not suit mine. And that fact alone may indeed spell the end of my present job.

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