The other day, I caught a piece in FierceEMR which brought up an important point. In the article, the writer summarized comments by a medical practice manager and cardiologist who argues that the tight connection between billing and EMRs makes them less valuable for clinical use.
The article quotes Ira Nash, senior vice president and executive director at North Shore-LIJ Medical Group, who contends that “nearly all of the things that doctors dislike about [EMRs] are features designed to capture information needed for billing purposes.” In other words, he says, EMRs are focused on documenting with doctors did for or to the patient, not about how the patient was doing.
The bottom line, Nash suggests, is that fixing EMRs requires changing the way we pay for care:
Like so many other things that doctors hate about the current health care environment, the flaws of the current crop of commercially available EMRs are a consequence of how we pay for care. Since we are paid for “doing stuff,” we are constantly being challenged to prove that the stuff we are doing is justified, and that we actually did it. We are getting killed by the focus on process. We ought to be focusing on outcomes.
While it’s hard to argue that Dr. Nash is wrong — that a focus on billing for “doing stuff” turns EMRs into billing software — my question is, what is the alternative? Or rather, what is the best alternative (as EMRs will inevitably have some connection to the billing process even if my colleague John Lynn asked us in 2010 to imagine an EMR world without billing)?
After all, billing does need to be done correctly; if that doesn’t happen, the healthcare organization loses money, or may even face a CMS or private health plan audit, and nobody wants that for their practice. So where do we go from here?