Behind the Digital Door

Choosing the right system on a limited budget takes time and can be frustrating and stressful, says Deborah Wasser, wife of Kenneth B. Wasser, MD, and administrator of his solo rheumatology practice in New Jersey. “I’ve been investigating a lot of different EHR programs and talking with vendors,” she says. “You feel like you’re dealing with a used car salesman. They try to sell you stuff you don’t need.”

Wasser initially conducted a three-month trial program of an EHR system offered by the company that already provides the practice’s e-prescribing software. The system proved to be cumbersome and too generic to allow for enough customization.

“I would say after the first month I knew that we wouldn’t go with this program and that we would have to actually put out a lot more money and go with something else,” Wasser says.

She ultimately chose an Internet-based “cloud” service that maintains records on a remote server offsite. Assured by the vendor that it meets meaningful use standards, she expects to pay about $15,000 up front and a monthly maintenance fee thereafter.

Customization Options Lacking

Dallas-based rheumatologist Thomas D. Geppert, MD, wanted to upgrade his EHR system to a level that could improve accuracy and efficiency for the 10 physicians in his Texas practice while meeting meaningful use guidelines.

“I’ve always thought that the real advantage to computer programs is that it would help me avoid making a mistake, that I could write rules that would say that if this happens and this happens, I should be reminded about this,” says Dr. Geppert. “Well, my program is not that good about that kind of stuff.”

Wasser and Dr. Geppert complain of a lack of customizable software to help rheumatology practices gather meaningful use data. Typical programs that require doctors to click a series of boxes to generate notes may work for primary care physicians, but this method falls short of the needs of rheumatologists. It simply takes too long to find the proper symptoms for rheumatology patients with complex conditions, and to sift through numerous medical terms and conditions that don’t apply to their specialty.

The requirement to provide patients an electronic summary of each visit poses another challenge for rheumatologists attempting to meet the first of three stages for meaningful use objectives. To generate a document of helpful guidance without extraneous information, Dr. Geppert says that physicians in his practice will have to adapt how they write patient notes to the nuance of the computer software.