Letters: Readers comment on Medical Economics stories

The dawn of EHR scribes

Dr. Stephen Levinson and his colleagues are right on target in stating that "automation is not documentation" ["The perfect storm," April 3, 2009]. In our pediatric practice, we have addressed concerns about integrity of data by having a scribe enter information into the patient's electronic record during the visit.

Our practice has the following simple code of ethics for our physicians and scribes:

2) Document everything that has occurred in the patient visit-no more, no less.

3) Bill with a code that reflects the work that you properly did and that was properly documented.

Pediatricians are notorious for undercoding office visits while actually giving high levels of care. Children often present with apparently minor chief complaints and are found to have more complicated illnesses to be treated or ruled out during the HPI and physical examination. With the help of an independent scribe, our pediatricians are confident of a far higher level of integrity of the data recorded in the EHR than in practices where physicians enter the information by themselves.

As Dr. Levinson states, medical organizations, EHR software vendors, and physician training institutions should be concerned enough about proper data entry and coding to develop policies to address the problem. An independent scribe can be part of an effective solution to the widespread misuse of EHRs that Dr. Levinson describes.

PETER KENNY, MD
Northampton, Massachusetts

Editor's note: For a doctor's perspective on the problems with EHRs and E&M-based payment systems, A simpler solution to our EHR problem.

Tech-savvy and scared

My partners have frequently warned me to document less so that we do not spend two extra hours a day documenting the content of our patients' conversations with us. Their words are deemed superfluous to the goal of a good note. Can you imagine me defending myself in a courtroom with the horridly templated notes produced by the EHR we have already spent $14 million on? "Debacle" is the word that comes to mind.

I want out of this litigious mess. By the way, I was trained in the use of EHR as a resident, and I'm more computer-and software-savvy than 99 percent of physicians out there. The emperor is naked!

ROGER PAFFORD, MD
Cedar Rapids, Iowa

Impossible cure

The authors of "The perfect storm" have made the correct diagnosis of the EHR problem, but have recommended the wrong treatment. As chairman of the expert panel responsible for the Health and Human Services report quoted in the article, I agree that EHR systems provide tools that are frequently misused intentionally and unintentionally to provide documentation that is inappropriate, sometimes fraudulent, and often clinically unhelpful and even harmful.

However, the proposed solution of employing compliance experts to help evaluate systems to ensure they contain no potentially non-compliant functionality is self-serving and impossible to do. Any EHR system can and will be used to produce clinically unnecessary levels of documentation as long as physicians are paid according to what they document, rather than for the outcomes they produce.

DONALD W. SIMBORG
Nevada City, California