Page 3 - Winter 2020 Castle MD

Dear Colleagues,
Communication, communication, communication... These days, communication is the buzzword that fixes everything in the business of healthcare – from patient satisfaction to physician engagement. In large part, I agree. One place where we’ve lost our focus on communication is the medical record. I want to use this space to encourage all of us as health care professionals to reflect on our use of the medical record and how we might improve for the benefit of our patients.
The medical record. So much potential good, so painful in its execution. It can be such a benefit for our patients and our work, but it’s such a source of pain in the form of medical staff suspensions and crushing long hours of work not dedicated directly to patient care. The anxiety and sometimes overwhelming burden of the medical record has taken away our focus of the true importance of our charting – the benefit of our patients.
Medical records serve three purposes: billing, legal protection, and communication with providers. Emergency department billing is based on E/M codes, which themselves are based on the number
of items in the history and physical examination, and then additional points
for complexity. For most of us that means macros that we add or subtract from with varying degrees of accuracy. Next, for liability purposes, you need to add all of the statements demonstrating you made appropriate diagnostic and treatment decisions. For many physicians, that has led to the use of cookie cutter macros. They’re pervasive in emergency medicine. Your patient has abdominal pain? Use this macro that looks like it was written by
a lawyer as your MDM. These methods physicians use to control the madness
are laid into overwhelming charts loaded with unnecessary and often inaccurate information automatically brought
into the chart. Impossible to verify or review thoroughly, the auto-populated information might be more of a liability than a benefit to the provider and patient.
Here’s the solution I hope we all consider while the makers of our EHR torture devices work to make their systems more clinician and patient friendly.
When I see a patient return for a second ED visit or come back after a recent hospital discharge, I hope for two things. First, please let the dictation summary, consultant note, or ED chart be done! Second, please let there be a dictated
few sentences describing what actually happened during the stay and what the professionals involved in their care thought was wrong! It is so beneficial to your patients when their future providers know what you’ve done and why you’ve done it. Don’t let your frustration with your EHR limit the full scope of care you provide.
None of this is to diminish the legitimate frustrations we all have with our EHRs and the changes that need to be made. EHRs need to be more user friendly and, with technology, information entry needs to be more accurate and less time intensive. We can all take it upon ourselves to improve what we’re doing for our patients by remembering who we’re charting for. It’s easy to get lost in the frustration that it’s for our hospital and coders. In the end, we’re doing it for the people we’re caring for.
While electronic health records have exacerbated the problem, any physician over the age of 40 remembers having to go down to the medical records offices to be handed a stack of manila folder patient
charts to sign off on or dictate missing records. The true problem with our medical records systems is our systemic focus on the medical record for liability and billing purposes, rather than the most important purpose – to convey the patient’s course of treatment for future care.
Mahalo,
William Scruggs, MD
Chief of Staff
WINTER ‘20 · 3