Five spine surgeons discuss what the most challenging part of switching to an electronic medical record was. Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: In which spinal technologies do you see the most potential to positively impact patient care?
Please send responses to Heather Linder at hlinder@beckershealthcare.com by Wednesday, March 20, at 5 p.m. CST.
Jeffrey Goldstein, MD, Director of Spine Service, NYU Langone Medical Center's Hospital for Joint Diseases: Initially changing to an EMR will slow you down. However, not only is it a requirement in order to meet the meaningful use standards, but also it should make your documentation more complete. Be careful not to become complacent. It is useful to take the time to build templates to help you document the work that you do and to help you communicate to your colleagues. Templates can help to remind you to query your patients for information and complete parts of your examination and evaluation. Ultimately, an EMR will help you to be more efficient and complete. It will also give you the opportunity to document the full extent of the work that you have completed and the complexity of the decision making processes you have utilized and elevate the care you provide to your patients.
Vincent Arlet, MD, Orthopedic Spine Surgeon, KneeFootAnkle Center of Kirkland (Wash.): Learning an EMR takes time, and you will need physician extenders to help you with it. The learning curve is long and, no matter your proficiency, can be a waste of time.
Jeffrey Wang, MD, UCLA Spine Center: The most challenging part is the most obvious one — learning a new way to do things that one has done in a different way for a long time. Those who are used to electronics, computers and navigation on a Web-based platform will adapt much easier. For those who have not embraced technology, it will be slightly more difficult. The first step is to accept that this is the way of the future. One cannot fight or complain too much. You just have to learn it. Once one accepts that this is needed, it is easier each day. From personal experience, I can say that one should try to keep an open mind and expect difficulties. When encountering those difficulties, embrace it rather than complain. It will be easier. You have to spend the time to learn it well.
Richard Kube, MD, Spine Surgeon, CEO and founder of Prairie Spine & Pain Institute, Peoria, Ill.: I believe it is the same challenge as with the rest of medicine or any other business – the staff. Whether you are converting from paper to an EMR or converting between EMR systems, this is an enormous undertaking. Folks usually concentrate on the technical components of these types of projects. Certainly there are challenges of finding the right system with the desired features and the right price. But it is also important to find the right people to implement the go live date. I think it is critical to remember that this is an enormous project, and it will stress many of your existing staff to second-guess what they are doing as your employee. This is a big picture change for your business and most employees are not in a position to have enough information to truly understand the big picture and how it affects their daily routine. Adequate training must be provided to increase staff comfort level with implementation. It is important to allow those individuals to see small wins as the system rolls out so that they can believe that the new system will make a positive impact on them individually. Then they can get behind your vision for change. This makes all of the difference when doing a project with staff engaged as a team of believers and supporters versus a league of saboteurs. You will need all hands on deck to implement such a program efficiently.
Ara Deukmedjian, MD, Neurosurgeon and CEO, Deuk Spine Institute, Melbourne, Fla.: Most physicians find themselves spending more time documenting and scanning after they begin using the EMR than they spent charting before the switch. Documenting the key components of the history and physical examination may actually take much longer with the EMR than using a chart. Many of our physicians found our clinics became less productive, and we saw fewer patients with the EMR. I have heard this same complaint from others. Our EMR system is Nextgen, a Medicare-certified system. Another problem was the cost of the system and maintenance of the database, HIPAA, upgrades, recurring monthly costs and license fees and more. It gets expensive very quickly. New versions aren't free either.
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5 Thoughts on Managing Online Presence for Spine Surgeons
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Outpatient Lumbar Discectomy Decreases Short-Term Complications: Study
Please send responses to Heather Linder at hlinder@beckershealthcare.com by Wednesday, March 20, at 5 p.m. CST.
Jeffrey Goldstein, MD, Director of Spine Service, NYU Langone Medical Center's Hospital for Joint Diseases: Initially changing to an EMR will slow you down. However, not only is it a requirement in order to meet the meaningful use standards, but also it should make your documentation more complete. Be careful not to become complacent. It is useful to take the time to build templates to help you document the work that you do and to help you communicate to your colleagues. Templates can help to remind you to query your patients for information and complete parts of your examination and evaluation. Ultimately, an EMR will help you to be more efficient and complete. It will also give you the opportunity to document the full extent of the work that you have completed and the complexity of the decision making processes you have utilized and elevate the care you provide to your patients.
Vincent Arlet, MD, Orthopedic Spine Surgeon, KneeFootAnkle Center of Kirkland (Wash.): Learning an EMR takes time, and you will need physician extenders to help you with it. The learning curve is long and, no matter your proficiency, can be a waste of time.
Jeffrey Wang, MD, UCLA Spine Center: The most challenging part is the most obvious one — learning a new way to do things that one has done in a different way for a long time. Those who are used to electronics, computers and navigation on a Web-based platform will adapt much easier. For those who have not embraced technology, it will be slightly more difficult. The first step is to accept that this is the way of the future. One cannot fight or complain too much. You just have to learn it. Once one accepts that this is needed, it is easier each day. From personal experience, I can say that one should try to keep an open mind and expect difficulties. When encountering those difficulties, embrace it rather than complain. It will be easier. You have to spend the time to learn it well.
Richard Kube, MD, Spine Surgeon, CEO and founder of Prairie Spine & Pain Institute, Peoria, Ill.: I believe it is the same challenge as with the rest of medicine or any other business – the staff. Whether you are converting from paper to an EMR or converting between EMR systems, this is an enormous undertaking. Folks usually concentrate on the technical components of these types of projects. Certainly there are challenges of finding the right system with the desired features and the right price. But it is also important to find the right people to implement the go live date. I think it is critical to remember that this is an enormous project, and it will stress many of your existing staff to second-guess what they are doing as your employee. This is a big picture change for your business and most employees are not in a position to have enough information to truly understand the big picture and how it affects their daily routine. Adequate training must be provided to increase staff comfort level with implementation. It is important to allow those individuals to see small wins as the system rolls out so that they can believe that the new system will make a positive impact on them individually. Then they can get behind your vision for change. This makes all of the difference when doing a project with staff engaged as a team of believers and supporters versus a league of saboteurs. You will need all hands on deck to implement such a program efficiently.
Ara Deukmedjian, MD, Neurosurgeon and CEO, Deuk Spine Institute, Melbourne, Fla.: Most physicians find themselves spending more time documenting and scanning after they begin using the EMR than they spent charting before the switch. Documenting the key components of the history and physical examination may actually take much longer with the EMR than using a chart. Many of our physicians found our clinics became less productive, and we saw fewer patients with the EMR. I have heard this same complaint from others. Our EMR system is Nextgen, a Medicare-certified system. Another problem was the cost of the system and maintenance of the database, HIPAA, upgrades, recurring monthly costs and license fees and more. It gets expensive very quickly. New versions aren't free either.
More Articles on Spine:
5 Thoughts on Managing Online Presence for Spine Surgeons
6th Annual Lumbar Spine Research Society Meeting Coming in April
Outpatient Lumbar Discectomy Decreases Short-Term Complications: Study