Meeting with Dr. Wolver

We met with Dr. Wolver Dec 7.

She gave us an interesting perspective, focusing more on the primary care aspect of how EMR is changing the whole aspect of how medicine is practiced in the ambulatory world.  She mentioned lots of her work is done outside of the patient encounter even.  She spends lots of time preparing for a visit researching history and messaging.  All of this is made much more manageable by the EMR.  There is no need to hunt down a chart.

She also brought up an interesting idea: the Social Media EHR.  This is more than just a hospital having a facebook page, or twittering.  There is a push for an inpatient records to be updated continuously, by a tweet-like mechanism.  For example, the nurse gathers the vitals, she tweets is into the EMR.  The resident phones the family to talk about end of life decisions, he tweets it on the EMR.

On the first look, this appears fascinating and I got excited about ti really quick.  But then I thought about information overload.  That's a huge problem today.  I can find pretty much anything on google, but do I want to?  Having all these tweets about a patient would need to be organized...very well.  Where do you put the nurse's tweets, where do you put the resident's.  What actually gets put in a daily progress note?  do you even still have daily progress notes, or do you have a list of physical exams performed throughout the day that you can simply scroll through to see any changes?  This is exciting, but I am wary of some of the complications.

Then is the issue of how are you paid.  Do you bill for every tweet?  Can you bill for every tweet?  I presume not.  For all of the new ways of doing medicine to really catch on, the reimbursement scheme needs to change, too.

This leads me to Hello Health.  Dr. Wolver mentioned it and I just went to their website and looked it over.  I like the patient portal and some of the other features.  But what really caught my attention is they use many non-traditional ways of having patient encounters.  They have video, email, phone built right in to their EMR.  And they say they can bill for it.  I would like to know the details of that.

Another problem with all this change is that if the patients don't subscribe to it.  There will always be some who don't have email addresses, or don't use a computer.  Can you build your practice around electronic media if the patient doesn't use it?  Or can you simply adjust the way you do things for the small number of patients who don't use computers?

All in all, I look forward to continued changes in the way medicine is practiced, and the way it is documented.  EHRs are inevitable I suppose, and their utility is great.  Chris brought up a great point at the meeting, though.  With the various EMR programs out there, there HAS to be cross-talk.  We owe it to our patients to look for ways to be able to access their information regardless of where they have been in the past.  The companies need to see that not everyone will use their EMR, so they need to make it compatible with others.

Some talk of just getting a standard EMR for everyone to use.  I don't think I like that idea.  It would eliminate many compatibility issues, but introduce others of who actually develops it?  Who gets paid for keeping it up to date?  And not all hospitals and physicians can agree on one way to have an EMR.  Yes, I know it's very capitalistic of me to say this, yet I don't think I need to apologize for being capitalistic.  It is what has led innovation in many fields, and keeps us fresh.  Though we do have to put up with the money-hungry, but they will exist in any system.