Intelligent Healthcare Information Integration 1/31/10

And In This Corner…

Boxing: the Sweet Science. Evidence of pugilistic contests can be found in ancient Sumerian, Mesopotamian, Minoan, and Egyptian art. The ancient Greeks record codified rules for fisticuffs and the onset of boxing as an honored profession.

Early pugilism in the more modern era had no written rules. It wasn’t until 1743 when Jack Broughton (Broughton’s Rules) and later John Chambers, in 1867, with the more widely known Marquess of Queensbury Rules, established some guidelines for what is to be considered “fair” when pounding upon another person that fist fighting began moving from bare-knuckled brawls to a sophisticated “science.”

These days, healthcare, and especially healthcare IT, could use some similar systematic set of statutes for what’s fair and what’s considered “below the belt.”

We are all only too aware of the titanic 15-rounder going on in Washington over healthcare reform. Some days it is difficult to tell who the inevitable winner will be … if any. But, in the subset of healthcare known as HIT, a couple of more sinister-appearing brouhahas are bubbling with just as much venom as that within the ring of the I-495.

As we move closer and closer to the onset of a digital national health Information network, the concern over who gets to play in whose sandbox broils more vigorously. This is a concern not only of those whose health information is being digitized for broadcast, but also for those who hold the dossiers.

As reported recently by Patty Enrado in Healthcare IT News, “Competition and lost revenue are keeping communities from participating in health information exchanges…” At the Regional Healthcare Stimulus Exchange Conference in San Francisco this month, one audience member argued that when it came to medical information sharing among healthcare providers and provider systems, “workflow issues [are] miniscule compared to the politics among providers.” Getting data-holders to share their data (play nice together in a shared sandbox) may not even be amenable to financial incentives. Tom Williams, executive director of California’s Integrated Healthcare Association suggested the state government may have to “’twist some arms’ and apply a stronger hand.” (Punch)

On the end user side of healthcare, consumers aren’t all that hep to trusting their personal patient portfolios to anyone, either. As Andy Greenberg noted in his recent article, The Next Health Care Debate, on Forbes.com this week, a study by the data privacy watchdog Ponemon Institute, shows that “Americans registered a deep distrust of anyone in either the federal government or private industry who might store digital health records…” Only 27% say they’d trust either the feds or a techno giant such as Microsoft or Google with their health records. Folks are much more inclined to let hospitals or their doctors store their info (71%) and are just fine with their personal doc having access to nationally stored data (99%). As Larry Ponemon commented, “There’s a lot of angst around centralizing this information, no matter whether it’s managed by private enterprise or government." (Punch, Punch)

This data will eventually be shared, I have no doubt. Systems and institutions will learn to “let my people” go and find ways to provide profitable healthcare services with mutually accessible data. Consumers will learn that the advantages to a reasonable sharing of their health data, in an as yet undefined and hopefully secure form, will lead to otherwise unobtainable individual as well as communal benefits.

Until that future day, I’m keeping my left up and my mouthpiece in. (Bob and weave)

From the trenches…

“To me, boxing is like a ballet – except there’s no music, no choreography, and the dancers hit each other.” – Jack Handy

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.

HIStalk Practice Interviews Neil Zimmerman

Neil B. Zimmerman, MD is a physician with National Hand Specialists of Baltimore, MD.

Give me a bit of background on your practice.

We, my partners and myself, have a very, very large hand practice. I think we might be the biggest in the country. In fact, I know it’s the biggest in the country at the present time. We’re affiliated with the National Hand Center in Baltimore. My office, which is nine physicians — we’re all hand surgeons.

“Hands” is a bit of a misnomer, but hand is the entire upper extremity, fingertips all the way up to the shoulder. We are a combination of orthopedic and plastic surgery specialists who just do upper extremity stuff, but that can involve arthritis, nerve compression like carpal tunnel, a lot of microsurgery or tissue transfers.

The way that the practice works is that it’s a very, very high volume practice; on a typical day starting at 8:30 a.m. until about 5:00 p.m., I see somewhere between 40 and 50 patients and I do that three days a week. My partners’ practices are similar.

Needless to say, we were anxious — beyond anxious — to even make a transition into electronic medical records of any type, simply because of the volume. It is a complex practice; it’s not cookie cutter as far as these patients. A lot of them are second, third, fourth opinions. A lot of them are legal matters that require all these long reports that we have to write.

We were highly trepidatious about a lot of the programs that were out there. The physicians were totally maxed out as far as what we could do seeing patients. We did not have, physically, any face-time available for the patients.

My office manager, another person, and then myself looked at a lot of these different electronic medical records systems. Every one of them came in there and they said, “Well, here’s what we can do for you. We can do this template, and that template.” I said, “Time out, hold it. My job and what I’ve been trained to do, and what I enjoy doing and how I really make a living is not the clerical or support end of this. It’s my face-to-face time with these people and being able to listen to them and care for them and interact with them.”

I said, “If I’m just going to be doing a template here, there’s no way I can do what I want to do.” I said, “We need somebody who’s going to respect that.”

These folks from SRS came in there and said, “OK, our job is to let you guys do what you do. We’ll figure out the rest that goes with it.” It probably took nine months, six to nine months. We talked to the transition team. They called and we had conference calls. We dissected the way that everything in our office moved. From patients getting in the door until me seeing them and taking care of the notes. We were, at that point, doing regular transcription; and we discussed how the transcription came back and how it was routed it and everything.

I’m sure as every other medical group, we had one or two guys that were interested in making a change and seven guys who weren’t. Some of which were vehemently opposed to the electronic medical records of any type. We had long, extensive planning on how to move forward through this. Instead of trying to intimidate people into using it, we used the carrot approach. I started with the guy who sits next to me who was also upbeat and really up on the thing.

We went from having a group of nine people who didn’t even want to be in the same room with any electronic medical records to try and decide who would be next to get on the band wagon with doing this thing. It has worked out extraordinarily well for us.

We were real careful, as far as our integration, inasmuch that I didn’t want to do everything. I figured we could just get up and running with our EMR system and hold off on the e-prescribing. I’m an orthopedist mainly, so with additional radiography we’ve got coming this upcoming year, we just didn’t want to do too much for fear of breaking it down.

Among orthopedic practices, we had heard so many nightmares. It’s like, “Oh my God, I can’t see patients,” the doctors are saying. “We’re not doing this, forget it, I’m outta here. Just let me take care of patients and take the thing out of my office,” and that kind of stuff. So we were really worried about this thing, but it has worked out just great for us.

What is it that SRS did differently than the other programs that you looked at?

What they did is they looked better from my point of view as a physician. This sounds arrogant, but reality is that it has to be doctor-centric. It has to be based upon me being able to see my patients and take care of them without really changing a lot of what I do in order for me to continue to provide the care I wanted.

For me to sit down, sit in that room, and pull down a bunch of pull-down menus and click-in boxes and do all this typing — that’s not what I do for a living, nor do any other doctors that I know. A lot of people in the hospitals have EMR systems like that and the physicians all dread doing it. But I still carry my digital Dictaphone in my pocket. I see my patients, I crack out my dictation very expediently, and I’m in with the next one. Then my stuff comes back to me, all my paperwork and my labs and everything.

But I’m very, very mobile now. I never know when I’m done with surgery. Some days it’s 1:00 p.m., some days it’s 4:00 p.m., but I just said, “Okay, I’m out of here,” because I can take my laptop, or I can even use my home computer and just VPN into our system and I’ve got every piece of paper that I can if I’m sitting in the office. For me, it got me out of the office today — I was done at 1:00 p.m. — it got me out about three hours earlier because I wasn’t sitting doing all my stuff there, which I normally would be, or taking home all those charts.

How do you interact with the EHR? What type of information are you looking up? And what information are you actually keying in?

I’m keying in very little, looking up a ton. I have it with me at all times. I have a tablet when I’m seeing patients or when I’m in the operating room. I go and I look at it before I even talk to anybody, to review their medical history. I mean, I know what procedure I’m doing, but I don’t remember all the little details like who’s allergic to what or exactly what the numbers of their nerve studies were.

I go to the computer, I look at their name, and I remember what their nickname is. If they’re allergic to something. And then I go out there and I look like I’m a genius. They’re like, “Oh, you remembered I go by Cookie” or something like that. So I make all these little notes to me.

Then when I’m done with my surgery, I dictate my notes. That will come back within a day. Then all I have to do is just quick-sign it because I dictate it to myself. I don’t have to proof it. Some of the more complicated reports that I do, like medical/legal stuff, have three or four pages. I have these IMEs that come with a list of questions from attorneys or insurance companies. I do a bunch of those. I see them in the office and I dictate my report.

A couple days later, it comes back into the SRS system and what I do then is I open up the document, and it opens up into Word, and I edit it. I mean, the regular routine carpal tunnel or kid with a wrist fracture stuff, I don’t need to edit. But these legal ones that someone’s going to be looking at with a yellow highlighter, I go through it word by word and I edit it and do all my other stuff. Then I take the edited document, I send it to my secretary or whoever, who sends it to whoever wanted it. But I can do all that stuff at home now, which is so much better than sitting there doing it on paper.

What practice management system do you use?

We’re using Misys now. We have all kinds of different Misys systems. Do you want to hear how we got to the SRS thing? Because we originally were going to do the Misys EMR. Misys scared us because we were a real early adopter or accepter of their practice management system. They said, “Oh, a couple years we got coming down the line with EHR, you’re going to like it.” They brought it in. I probably looked at it three times. Every time they brought that thing in there it wouldn’t work.

Then they kept saying, “You can do this, you can do this, you can do this.” I said, “I don’t want to do this.” I said, “I want to do what I do.” He was like, “Well, if you use this you have to make a template and do all this stuff.”

Then we went and looked at a couple other practices that were using that system successfully, but it just wasn’t fitting for us. I’m sure it’s fine for some people or for some kind of practices. But surgeons in particular, I think — again this sounds bad; forgive me — there’s a little bit of the personality … it’s a little more of an aggressive personality. It’s like OK, I’ve got to operate on these people, this is the way I want to do it rather than kind of ‘I’ll go with the flow’ thing. I mean, you wouldn’t want a surgeon that came in and said, “Well, I think I could fix this.” You go, “I can fix it.” It’s the same kind of thing. They want the system to work the way they did it.

So anyway, that’s our long story. We’ve been up and running now for 15 months, I think.

Do the SRS and Misys systems integrate?

It’s been great. It was far less of an issue than I thought. It downloaded the demographics from the practice management system. We’re buying a digital radiography system. I looked at a lot of them, but I wanted one that SRS would stand behind. They are marketing one now called Fusion. Reason being that as much as it just totally integrates and slips into that thing and the startup was so good with the EHR thing, I said, “If we’re doing it, these people did such a good job before. This is the one I want to go with.” Next couple weeks we’re changing — some of us are changing — to Dragon as far as with digital dictation. That’s going to be a change for me though.

Did it concern you at all that the SRS is not CCHIT certified?

CCHIT, what’s that?

CCHIT? I guess it didn’t concern you if you’re not familiar with it! It’s a certification that will likely be required in order to get economic stimulus money.

No, and I’ll tell you why. I thought about that, at length, and the information that you’ve got to provide to get that stimulus. First of all, I don’t see how I could ever do that in my private practice because one of the requirements is that I have to be able to distribute to my patients information about preventative care.

It’s like, that’s just one of them, but the information that would be required for me to provide would require probably, a substantial part of another employee, which would override the $40-some-odd-thousand that we would make, if we even get it back, from that stimulus money. So I said, “Forget it.” I said, “It’s a good idea, but it’s cheaper for me to not worry about that and move forward than to try and comply with what they wanted out of that.” So, no, that does not bother me one bit.

I was concerned at first. I go, “What the hell is this all about?” Then I realized and I did some more checking and I go, “No, I don’t want to do that anyway.”

What kind of return on investment have you seen so far?

Probably minimal to none, and I think that I’m about as busy a private practice as you can get, I think. I think the reward is going to come later, but if you’re really honest with the money that you’ve got to put into an EHR, it’s going to be a negative investment for quite a while.

We have not eliminated any employees. We’ve transitioned filers to scanners. We’re going to redo our office, at some point, to have more patient care space, which I actually think is going to translate into money. I’ll tell you what will eventually translate into money, but it’s somewhat non-tangible, and that is that our billing efficiency has gone up, I think in part due to this because we no longer have to play where’s-the-chart to do the billing.

I was worried when I started this that I wouldn’t be able to see as many patients, but my productivity actually went up. But it’s really hard to quantitate that, and that wouldn’t apply to all practices. But we’re lucky enough to have to turn people away. So if we could see more, it’s great. But if we weren’t running ‘at mass’ appointments already, it wouldn’t ever come to be.

Last question here – why do you feel that EMR adoption continues to be so low among physicians?

Honestly, physicians are scared to death; and we’re scared to death about the healthcare thing coming down. We don’t know whether we’re going to get cut big time, or we’re not going to get cut — temporarily. A lot of physicians feel very much under fire. This is the first time in my 23 years of practice that I’m looking at a pretty dismal outlook for the upcoming year as far as income. Even if I see as many patients, I think I’m going to make less money with the same productivity level. That’s the number one reason.

But if you want to turn the clock back to before that whole stuff started, the main reason is it’s expensive. We’re nine people. It’s a nine people, high-volume practice and it costs us a lot of money. I think that’s something awfully large to bite off for a private practice. Especially if you’re really honest and say, “What’s the short-term return? What’s the long-term return?” It’s huge, just because of your productivity and not filing your stuff. Right off the bat, nobody’s writing you a check; you’re not going to see anything back on it. It’s a long-term bond.

I could tell you what some of my partners said. It was, “I’ve been doing this for 30 years. I’m not changing for anybody what the hell I do.” I mean that was a real common one. It’s like, “Screw this. What do I have to spend money for?” Those of us that prevailed said, “OK, long-term, in order to store our files, we’re going to make more money. It’s going to be more lucrative if we do this thing electronically.” But they’re looking for a check that’s not coming.

I hope I don’t hurt anybody by saying that about the return on investment, but that’s the truth. The return on investment is short. I’m not going to tell you you’re going to make a lot of money on it right away, but eventually — maybe.

News 1/28/10

From Willie Morris: “Re: keynote speakers. We have been planning our annual user conference and, in brainstorming about possible keynotes, I wonder if you or your readers might have recommendations on someone new and different to help inspire and entertain our clients this year? We’re obviously looking for someone with understanding and background in HIT/PM/EHR, but the ability to generate laughter doesn’t hurt either!” Interesting question. I’d nominate Mr. H, but he’d have to do it behind a secret screen and use a voice changer. Suggestions, anyone?

Steve Jobs and Apple unveil the new iPad, which Jobs calls a device that sits between the laptop and the smart phone. Jobs claims the iPad is better than the other devices for such things as browsing the Web, reading e-books, and playing video. The iPad will run most of the 140,000 (and counting) applications currently available for the iPhone and will be priced between $499 and $829. At 1.5 lbs, 10 hours of battery life, and a 9.7 inch screen, it won’t be too difficult to carry around all day. It’s too soon to tell what kind of impact the iPad will make in healthcare, but I am sure plenty of vendors are itching to check one out.

Dermatologists and medical oncologists are more likely to communicate with patients online than their peers in other specialties, or so this Manhattan Research report claims. Overall 39% of physician use e-mail, secure messaging, or instant messaging to communicate with patients, which is a 14% increase since 2006.

Duane Reade drugstores and Continuum Health Partners (NY) say that their joint program to place physicians in Duane Reade pharmacies is a success. For the last two years, Continuum has provided physicians for in-store clinics at four Manhattan-area Duane Reade pharmacies. The arrangement does not include the exchange of any money between the company and the health system. Instead, Duane Reade benefits with increased retail sales and Continuum is able to schedule future appointments at one of their own facilities. Officials say that their model is a success, in part because physicians provide the services, rather than PAs or NPs. Look for the opening of another 20 clinics over the next year.

McKesson and HP announce they are collaborating to accelerate EHR adoption among independent physician practices. The companies are bundling McKesson clinical and PM applications with HP solutions and including training, implementation, and local support. The program will be executed through HP distributor Tech Data. Good move, I’d say. McKesson seems to recognize that most practices, unlike hospitals, lack the internal resources required to coordinate the technical aspects of an EHR installation. And, despite how popular SaaS is becoming, there are plenty of providers who still insist on an in-house server. Offering a turnkey solution is going to appeal to a large constituency. HP is also a winner here because it’ll have a chance to increase its footprint in the small physician office space, a market where they’ve not been much of a player.

Speaking of McKesson, they just released their Q3 numbers:  revenue up 4%, EPS $1.19 vs. -$1.12 (although most of that prior year’s loss was because of their AWP settlement). That beats Wall Street estimates. Technology Solutions didn’t do so great, with profits down 11%, although some of that was due to amortization of its revenue management product that went GA during Q2.

As healthcare moves into a digital era, physicians are wondering how much medical record data to provide patients. The debate stems from the fact that patients often don’t understand what they are reading and its context. Patients can become needlessly upset by routine “abnormal” lab result. Providers argue that information to patients should be filtered to  reduce the need to interpret the details for the patient. Of course consumer groups believe patients have a right to see everything. And the debate will continue.

Day Kimball Healthcare (CT) selects athenaClinicals and athenaCollectorM for its network of 200 physicians.

Greenway Medical says that over the last year, more than 30 healthcare systems, PHOs, and IPAs have selected its PrimeSuite for their employed or affiliated physicians. New clients are  include the 1,400-member IPA Genesis Physicians Group (IP), Detroit Medical Center, and Bloomberg Health System (PA).

HHS is encouraging the public to comment on the latest proposed Meaningful Use criteria. Some comments have been posted and I’ve read through most of them. Here’s a sampling of what’s out there:

We are a small rural health clinic with eight providers but have been very aggressive in using information technology. We purchased and installed Practice Partner electronic health system in 2002. All of our providers have been using and completing their progress notes in the EHR since 2004 when we quit pulling paper charts. We have lab interfaces from the external lab vendor and the local hospital. I have only read the first 103 pages of this proposed ruling and have been focusing on what we will have to do to receive incentive payments as an early adopter in 2010. I find myself discouraged that we will ever be able to comply with this meaningful use definition. I also reflect on the last eight years of using the EHR and wonder how a new user of an EHR would qualify as well. Just installing and getting everyone using electronic records is a difficult task. So I believe that this version of meaningful use is too aggressive for the first year. Plus many clinical areas will need IT infrastructure like cabling, networks, servers and workstations installed multiplying the complexity of the first year adoption of the EHR. So, I would like you to consider making the first year measures the use of the EHR with items like Electronic RX, In-Clinic orders (not 80%), Vitals for over 50% of visits and use of the EHR to the point of not using paper charts for the majority of patient visits. Then slowly increase, at an increasing rate, the requirements over the next years. If the goal is to get the majority of clinics using EHRs and to provide incentive funds to help the economy then the first step of incentive payments must be easy to obtain.

All and all, a very thoughtful and compelling post. On the other hand, some of the comments were short on specifics, but straight to the point. Like this one:

This is a steaming pile of crap. If one could imagine what the worst possible outcome of the process of creating these rules could be, this is it. These are rules that only a bureaucrat could love and will not help increase the implementation of EHR. 556 pages?! You are out of your minds if you think this is helpful or necessary. What a waste of time and money… This is so disappointing I almost cried.

I had to smile.

E-mail Inga.

News 1/26/10

Several Florida physicians, lured by a reseller’s promise of ARRA-funded billing software, complain of unauthorized charges and a training session that lasted only one day. The reseller says the doctors “are all in a clique together” and sends cease-and-desist letters to prevent them from going public with their gripes. His trainer says the doctors didn’t know how to use computers and seemed scared to use a mouse. Even one doctor whose got everything free because she’s a former TV reporter was so unimpressed that her promised product endorsement wasn’t enthusiastic enough for the reseller, so he denied her access to her patient records on his server and sent her a software bill. The reseller doesn’t sound like he’s ever heard the term “the customer’s always right.” More importantly, I doubt  these docs did their homework before buying their system and thoroughly checked out both the software and the vendor. And, likely no one handed the contracts to a lawyer for review before signing any agreements.

The American Academy of Family Physicians says the latest meaningful use guidelines pose hurdles to small and medium medical practices and their ability to earn incentive payments. The organization supports the overall goals for meaningful use, but believes the administrative requirements may be too much of a burden for practices.

Sage North America Healthcare appoints Betty Otter-Nickerson as it new president. Otter-Nickerson was most recently COO for the LiveStrong Foundation, aka the Lance Armstrong Foundation. Before that she served in executive roles at various software companies. Speculation had been brewing for months that Sage was looking for someone to lead the healthcare division, so perhaps the segment will now have the opportunity to shift the focus back to its core EHR and PM business. I might add that I like that Sage has put a woman in this top role, since the HIT vendor world seems dominated by men.

Digital Healthcare announces that over 1.2 million diabetic patients received Retasure eye health assessments in 2009.

NextGen launches a Certified HIT Consultant Program, which will provide training certification for implementation consultants. Reading between the lines, it sounds as if NextGen is trying to improve its position in light of the upcoming Regional Extension Centers. The RECs will help end-users with product selection and provide free EMR training. NextGen figures that  if doctors know there’s an option for free training on NextGen, they are more likely to buy the NextGen product. NextGen may lose some revenue on training, but will still have a shot at selling software licenses.

As of the end end of 2009, the iPhone offered 1,900 different applications, which is about 1,600 more than the second place HTC Pro. Experts say that most doctors will select a phone based on the available applications. Just like with EMRs, however, doctors should also consider what they primarily want to use the phone for and its ease of use supporting those primary functions.

RCM solution provider ZirMed achieves full accreditation with the Healthcare Network Accreditation Program from the Electronic Healthcare Network Accreditation Commission.

EHR and HIE vendor Soren Technology selects MedFile as its exclusive PHR vendor. Soren, by the way, says its suite of EHR products is offered at “virtually no charge” and offer “Meaningful Use components.” I have no reason to believe Soren is not a solid product. However, I stand by my advice above that buyers do their homework to avoid potential misunderstandings and frustrations.

If you need a bit of inspiration, read this Partners in Health report of the collaborative efforts to save a Haitian newborn in Port-au-Prince. Along with a team of other heroes, an orthopedic trauma surgeon from Grand Rapids, MI draws 60 ml of his own O negative blood into a regular syringe in order to help save the baby. The baby was stabilized and eventually transferred to an American military hospital. Sadly, PIH Medical Director Joia Mukherjee predicts the situation in Haiti will get much worse very, very fast.

Educators at the University of Illinois at Chicago College of Medicine believe most medical school curricula do not adequately prepare students to diagnose and treat patients using an EHR. The research professors found students had difficulty finding the information they needed and recommend incorporating training in EHR skill.

Later this week we will post another one of our physician interviews. When I asked this latest doctor if he was concerned because his EMR was not CCHIT certified, his (totally serious) response was: “What’s CCHIT?”  I had to laugh a bit at myself and the situation. It served as a great reminder to me that just because you are a clinician doesn’t mean you are living and breathing meaningful use, CCHIT, interoperability, and the like. By the way, we’re always looking for interesting interview subjects, particularly physicians using technology in their practices. If you or someone you know would like to participate, drop me a note.

E-mail Inga.

Intelligent Healthcare Information Integration 1/23/10

PAPER and EMR: An Intimate Conversation

Perhaps within a post enchilada and black bean quesadilla dinner dream, but somewhere, I swear, I overheard the following chat, mostly in whispers, very, very late one night …

PAPER: Pssssst…psssssst…hey, you, digi-boy…you awake?

Electronic Medical Record (EMR): Huh? Wha…? Yeh, guess I am. The newbie musta forgot to log out. What’s up, P?

PAPER: I couldn’t sleep.

EMR: Well, no wonder. You get to nap all day long, whenever you want. Some of us get pointed and clicked on all day.

PAPER: Whoa…hold it, pal, I still have my moments of value. You haven’t taken over everything in this joint, yet. Remember, last week when the power went out? Only me, some cloudy daylight, and a few emergency-powered lights were around to keep the patients percolating through the practice. You closed up shop just as fast as your little UPS could shut you down.

EMR: Yeh, well…

PAPER: And, remember last month when your Internet pipe pooped out? Lotta good “Web-based” does you when the road to it gets washed out.

EMR: I know. It does keep me a tad edgy being so dependent upon somebody’s wires or satellites. Still, for as hard as I work and as much as I can do, I think I more than make up for my weaknesses. Criminetly, you can’t even do your work unless somebody’s holding your hand. You’ve never had the common courtesy of letting someone access you from afar.

PAPER: Yeh? Well, your short-term memory doesn’t hold a candle to mine. All I need to do is see something once and it’s mine. Somebody pulls a plug while you’re listening to a long monologue and that info hits the ethers. Whoosh. Vanished. Shoot, you could even forget a whole days’ worth of data should the nighttime backup fail and some zitz hit your RAID.

EMR: Maybe my memory has a few less-than-solid links, but my cousin has this “fail-back” or “fail-over” or “fail-something” thing that keeps his memory even sharper than yours! Everything that goes into him is retrievable from moment one; you ever try to translate some of that scribble jibberish you call “data?”

But, that is so like you…mentioning the unlikely as if everything should be based upon that. Remember the fire of ’04? Your short-term memory didn’t do anybody any favors that day. Hector’s pup, even your long-term memory was a crispy little critter. Me? A new PC body and my recall was total, complete.

PAPER: OK, fine, I’m sorry. I didn’t wake you to start a squabble. It’s just that all I seem to hear these days is about how wonderful you are, about how you are the future. It has me a little concerned for the practice.

EMR: OK, I’ll bite. How so?

PAPER: Don’t get me wrong; you’re a heckuva nice guy. You’ve got loads to offer and are just built for the 21st century. I know I can’t hold a candle to your overall prowess. But, I’ve done this for years, you know. I remember when we used to always see 30, 40, 50, and sometimes more, patients per day. Sick folks needed our help and we were there to provide it – when they needed it. Now, since you’ve taken over most of the grunt work, we’re lucky to eke out 25 visits…on a good day.

EMR: IT’S NOT MY FAULT! I CAN FLY! It’s these pokey point-and-clickers and those two-fingered typists who are so infuriatingly slow. You know how fast I can run with a full load!

PAPER: I know, buddy, I know. But, regardless of who’s the rate-limiting step, the practice is slowed down; less people are getting cared for and the Accounts Receivables fellow said the cash flow has taken a real hit. I’m worried.

EMR: So what do you think we should do? (Though I’m not sure we have a say in the matter.)

PAPER: Maybe if we work together, maybe if we get them to incorporate a part of me with a part of you…at least for a while until they can get their skills and this whole workflow readjustment thing under control…

Honestly, I know my days are numbered. Shoot, when you’ve been around for a couple thousand years, I’ll bet you won’t look so spry. But, still, while I still can, I want to help. I care about these issues, this practice. I want to help, as best as I can, for as long as I can. I think I still have a few useful services you haven’t outpaced, you know.

EMR: I know you have, Paper, old pal. Maybe we can work together to help the practice find a better middle ground. Use some of your familiarity along with my connectivity to keep things snappy while we work on your retirement plan. Think we could get the organics to listen?

PAPER: Who knows? They’re kind of trendy, faddish, even. Getting them to think as clearly as you and I may be nigh on impossible.

EMR: (Sigh) Don’t I know it…ssssssssshhh…I think I heard footsteps.

From the (dreamy) trenches…

“Coming together is a beginning. Keeping together is progress. Working together is success.” – Henry Ford

Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or doc@madisonpediatric.com.