Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Monday, September 29, 2014


The Electronic Health Record
I have been following the development of the Electronic Health Record (EHR) for at least ten years and, although it is scheduled for an implementation date of 2015, it appears to me that there are several reasons to expect another delay.  This is especially true in the implementation of the dental component, which is of great interest to me.
Part of the reason for lack of progress is the pure complexity of integrating the various electronic services that have been cobbled together to satisfy very specific needs, defined by specialty, compensation, and broad, disparate delivery models.  This has resulted in a lack of a standard platform for data interchange.  There appears to be some recent progress in the process.  In dental Henry Schein has seized market share with their Practice Management software, Dentrix®, And in Medical a product called Epic® is dominant with their software for groups from small group practices to major hospitals.
And there are some obvious forward steps that are likely to improve healthcare delivery, while controlling healthcare costs.  I dental there is the implementation of what have been called “reason codes” of diagnostic codes embedded in the ICD-10 series of medical codes.  These will allow for development of Best Practices in dentistry by allowing Outcome analysis.  The likely result of such analysis will be a redistribution of healthcare dollars spent on dental services to increase preventive services and decrease cosmetic and unnecessary services, such as crowns on asymptomatic molar “cracked” teeth.
In medicine the trend seems to be a shift from paying for specific services to paying for health improvement.  The developing model is sometimes referred to as an Accountable Care Organization or ACO, a model that has save literally millions of dollars in Medicare costs since its adoption by CMS several years ago. 
One of the more intriguing developments of the HER is the arrival of an entirely new employment opportunity in the health field, which is the subject of this Post:  Scribes.
Medieval Scribe
The term is of ancient origin, at least as far back as the rise of the Egyptian civilization, where people educated in hieroglyphics and later the cuneiform alphabet, found themselves marketable to those less fortunate but wealthier.  Later, in medieval times, those who were literate were called upon to write books, specifically The Bible, until the advent of the printing press.  The story is that one scribe from that time, encouraged the Abbot to go to the original document instead of copying the copies.  The Abbot returned from his research dismayed that the word originally was “celebrate” and not “celibate”; a lesson in the value of editing.
Physicians have dictated their chart notes for years, partially because their handwriting was unreadable to other physicians.  What has changed, with the advent of the HER is that everything must now be electronically transmissible.  Even with voice recognition, the process is innately redundant.  Solution? Have an entry level Scribe shadow the physician and capture the conversation with the patient.  There are security concerns, and technological restraints, but these are being worked out.
A recent WSJ article discussed the blossoming opportunity for the field.  In 2010 there were 700 employees.  That number doubled by 2013 and is expected to peak at some 30,000 in the next few years.  Cost doesn’t seem to be a problem, since the physician’s time is a mitigating factor.  Training may be another issue.  I could find no standardized program, but I find that my granddaughter, which is studying to be a Court Stenographer, may have inadvertently found her future career.
I wish her the best.
PBS recently did a two-piece on Mark Twain.  In my next Post I will share how Mark Twain has intersected through my life and why his history is worth another look.  Please join me.

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