France: Electronic Medical Record (EMR) "DMP" officially criticized

For the past two days, the French press is abubble with the unofficial leak by a weekly magazine "Le Point" of an official report, by the Inspector General's office or IGAS, concerning the DMP, the French electronic medical record. While numerous people had pointed out since the very beginning that the project was ill launched and insufficiently funded, this is the first official report recommending, in essence, that the project as it is be re-booted as it were, from scratch. So far, all the articles about this are in French.  Why? What is the problem in France? 

My French-language blog provides more detail. To sum it up, the reasons are quite similar to those in the U.S. 1) Patients are not generally pushing physicians to be computerized; if anything there are privacy concerns on the individual level. 2) physicians are busy and integrating emr's takes time and investment. 3) public hospitals in France (and they are the majority) are moving ahead on IT, but they have other priority problems to solve, such as staffing.  Basically, while in theory  EMR's are a plus, in fact, adopting EMR's slows down healthcare professionals, in the transition period, without bringing them direct benefits.

Comments

[David Price]

Guess we need a hole in the head, doc.

If you get the physicians and staff to buy into the project, a good EMR will make you more efficient in many, many ways. Electronic verification of insurance, in batches the day before the visit, for example will save your front desk staff on average 6 minutes per patient. Pulling and filing charts will save equal or more time. A good system (and you'll argue this because you probably use a poor one) will allow you to chart most of your common and routine encounters more quickly than handwriting or dictation.

More importantly, we're bringing medical records from the 18th century technology you're used to (with paper charts) into the 21st century. Think of your own Personal Health Record (PHR). If you're not using a PHR (like Healthvault) your records are scattered among a few different Primary Care and specialty practices. In an emergency who has all your pertinent info? Every other industry in our country has taken advantage of technology to move away from paper and become WAY more efficient. Why shouldn't medical practices do the same?

I recently had a visit to my Primary Care doctor for an annual physical. I'm 50 and have had PSA screening every year since my early 40's due to family history. This year the lab forgot to run the PSA. What's worse, is when they took more blood and ran it, the doctor’s office never called with results. After numerous attempts to get my results, the doctor finally called and left a message saying the number, without the decimal! Needless to say, I called three times over the next four days seeking clarification. That's staff time.

Had he been using a decent EMR, the PSA would not have been missed, the callback timely or better yet, I would have been notified by email that my results were available online through the patient portal. That would have saved that clinic at least a half hour of staff time with all the calls, tracking results, pulling the chart again when I questioned the results, etc. I'm just a single patient, think of how much time is wasted on each patient, and what eliminating that wasted time can do to streamline your practice. Regardless of specialty, there's incredible time and money wasted, information lost or not processed, and it all has a negative effect on our countries ability to deliver quality healthcare.

Furthermore, do you often wonder how much you lose between contractually agreed upon reimbursement and your actual reimbursement? Would that data help you come time to renegotiate (or force the payers to live up to their agreed upon reimbursement rates?) If implemented well, with support of the staff, a good EMR and integrated Practice Management System will not only make your practice more efficient, it will add significantly to your bottom line as well. Multiply the 15 minutes of staff time savings by your patient count, and then figure out how much you pay your average staff to see how much your losing just in productivity. Then consider that automation of charge entry eliminates missed charges (which means giving away services.) Force the carriers to pay what they’ve contractually agreed to pay. I'm telling you that your office cannot afford NOT to go to a good EMR and Practice Management system. Your chart notes, which are not only legible, but also reportable and easily uploaded to a PHR. This will only improve the delivery of healthcare and streamline every provider’s ability to see a patients complete health record. Is there a productivity loss during the transition? Absolutely. But this can be minimized by a well thought out and executed plan. Kicking and screaming and basically promising yourself that the EHR is a bad idea will lead to a self fullfilling prophecy, and prevent your practice from ever reaching it's potential. Again, I say you cannot afford not to have a good EMR and integrated PM system.

[James Biggerstaff MD]

How true! We need EMR like we need a hole in the head.