A somewhat dated, but perhaps still valid article published by the American Academy of Family Physicians in 2007 highlighted that a representative subset of providers see 24 patients per day. Based on a 10-hour day this works out to 25 minutes per patient.
On the presumption that visit times are constrained to 15 minutes instead of 25 and that at least 5 minutes are needed to write up notes after a patient visit, the math tells us that a provider has around 5 minutes to look at your chart to get up to speed on your healthcare status.
For sure, EMRs that are friendly and easy-to-use can help a provider with chart reviews.
So, we could say that, with an EMR, the quality of decision-making should improve, particularly if the EMR software being used incorporates decision-support facilities.
The one thing wrong with this analysis is that EMRs share with old paper charts, one very important common feature, which is “If it’s not in the chart, it does not exist”.
And herein lies the problem with EMRs – most EMRs consolidate about one-half of the information that used to be in paper charts.
Where is the other half?
Well, it’s either still in the paper chart, or, if the agency went “electronic” chances are your digital data is going to be in the EMR and any non-digital data (faxed materials, hand-written notes, etc.) will have been imaged to some 3rd party Document Management System (DMS) system or Enterprise Content Management (ECM) system.
You may not see this as an issue.
All the provider has to do, right, is look at your EMR and then go to the content management system and look up what is not in your EMR? Not likely, when the review time is five minutes, so you should see this as an issue.
The likely scenario is the provider will scan the e-chart and only refer to the DMS/ECM content exceptionally.
Since healthcare decision making relies on knowledge of both the distant past and the recent past it’s important during any look ups that the provider to be able to view consolidated content in reverse chronological order or, in some situations, content in reverse chronological order by episode.
Sadly, most EMRs plus DCM/ECMs cannot present their data to providers this way so decision-making suffers and since we are talking about you and your EMR, this means the quality of care you are receiving could be less than what it might be for no more money and probably for less time.
What to do? Not much, really, unless your provider and his/her agency happen to be in the market for a new EMR.
But, knowing what they probably don’t know, it certainly would not hurt to suggest that they look for an integrated EMR and Enterprise Content Management (ECM) software system.
Of course, all of the software vendor solutions are “integrated”, no matter how much haywire you find when you look under the hood.
Tell your doc the secret is to ask where the data is – if the data is in two places (not all IN the patient EMR database record) chances are the EMR in question is not an integrated EMR/ECM software solution.
Not close, no cigar.