Diana Manos, Senior Editor
Diana Manos is Senior Editor for Healthcare IT News. Located in Washington, D.C., she covers policy and legislation issues surrounding healthcare IT. Follow Diana on Twitter @DManos_IT_News.
Do doctors have to be typists to get MU incentives?
WASHINGTON | May 3, 2012
There's a snag in the proposed meaningful use Stage 2 rule, and it concerns whether or not doctors need to be good at typing. Depending on how the final requirements for Stage 2 play out, they might have to be.
The HIT Policy Committee on Wednesday was divided over a measure in the Stage 2 rule that would allow licensed professionals or scribes to enter data into a patient’s electronic health record on behalf of a doctor.
The difficulty is this: If a doctor doesn’t enter the order, he or she will not be able to see the decision support built into the EHR system that appears at that time. Decision support is supposed to help with the prevention of medical errors and is, according to federal officials, one of the reasons for the EHR incentive program in the first place.
Most electronic health record systems only show decision support once, as the computerized physician order entry, or CPOE, is typed into a system, according to Paul Tang, MD, chief innovation and technology officer at the Palo Alto Medical Foundation and vice chair of the HIT Policy Committee. The problem is, most doctors do not type in their own orders. Nurses often enter medication orders or clerical persons type in hand written physicians’ orders, later to be “signed off on” – or approved on the computer – by the physician, often in groups of multiple orders at the end of the day.
As the proposal stands now, the physician is required to use his or her personal log-on to open the record, and he or she is the person responsible for the electronic record. The physician is also responsible for approving any information entered by someone representing him or her in a clerical sense. If doctors want to see decision support, which includes warnings about dangerous drug interactions and other health preventative and safety warnings, then the doctor must be the one to type in the information.
Some members of the committee felt the rule was never intended to make doctors into typists. And even if they are good typists, they shouldn't be required to spend their time doing it. It prescribes too much for a doctors’ workflow, and is not what the proposal framers intended.
A serious discussion arose over the CPOE subject, scribes and decision support – labeled by Tang as “the single most important objective of the entire EHR incentive program.”
Last month, the committee discussed if there were other ways a clinician could have something recorded, then take responsibility for it. A physician might want to have a licensed professional enter the CPOE and then have someone else do the clerical task of entering the progress notes. Tang urged the committee to be more specific about who can enter non-CPOE entries.
Some members of the committee were in favor of scribes entering non-CPOEs, some were against, with the major consensus among the group that the physician is ultimately responsible for what is recorded.
Showing 7 Comments
Ken Congdon say: There Is A Way To Do Both
May 11, 2012 | 09:55 AM GMT
The important thing here is that the physician see the order as it's entered in real-time, so he or she (and the patient) can benefit from decision support tools. There is a way to accomplish this without the physician actually being the one typing in the order.
For example, ENT Specialists of Northwestern Pennsylvania, a 9-physician specialty practice based in Erie, PA, has accomplished this through a "remote scribe" solution it has devised using simple networking technologies.
Basically, each physician is assigned a scribe that sits in a designated office in the practice. This scribe's sole responsibility is to enter information and orders into the EHR. The doctor goes from exam room to exam room to see patients and communicates with this scribe via a headset telephone. The EHR screen is displayed on a 32-inch monitor in each exam room so the physician can see exactly what the scribe s entering into the EHR as well as the decision support.
It's obviously a bit more technical than this. To gain a full understanding of what's being implemented, read the case study I wrote on the subject at http://www.healthcaretechnologyonline.com/doc.mvc/Remote-Scribes-Put-The....
Long story short - this ENT has developed a system that removes the data entry burden from physicians while still allowing them to see the order entered in real-time. Moreover, the ENT has been able to show a measurable ROI in its use of this "Remote Scribe EHR." Truly fascinating stuff.
Jill Marciano say: Physicians should see patients - not computer screens
May 07, 2012 | 20:50 PM GMT
Physicians need to be seeing patients, making direct eye contact and having meaningful conversations with those patients. While I can certainly say that I can see the real benefit for everyone having some keyboarding skills, the real purpose of the in-room experience is about the medical visit itself. I work as a "scribe"/Clinical Information Specialist. The patients never mind me being in the room. The doctor is more productive, our day is more efficient and the workflow is much improved. Everyone wins. When the CMS institutes MU and offers incentives, the practice should be allowed to use that incentive money however they see fit. (Hence paying a scribe salary).
The real question here is "is a scribe documenting the visit ethical?" YES. It is as ethical as a resident physician or a mid-level provider seeing a patient. The scribe is only putting written information that she/he hears into a chart. The doctor reads it, approves it and order necessary studies, etc. The doctor has the ability to change whatever he feels necessary.
It really is that simple.
Judith Elam say: do doctors have to be typists?
May 07, 2012 | 10:03 AM GMT
where does improved voice recognition fit in this scenario? perhaps that might be a viable alternative for physicians, esp since they are more accustomed to dictation as a form of documentation.
Joe Weber say: Physicians should not need to type orders
May 03, 2012 | 20:48 PM GMT
Perhaps it’s not clear to the Committee that scribes (or what we call “Medical Coordinators”) document the clinical notes and enter the orders in real time, from a remote location. The data appear on the exam room screen as they’re entered. So the physician can authenticate them in the same way and timeframe as if the physician had done the actual typing.
The advantage to this approach is that the physician can now focus on the patient, rather than on entering data into a computer, thereby increasing productivity...and likely quality of care as well. You can see how this works at www.valadoc.com.
Dmanos say: physicians and keying
May 03, 2012 | 14:31 PM GMT
I definitely hear you on that. What I hear over and over in the industry is how the new generation wouldn't consider practicing medicine without computers and without keying in their own information. Sooner or later, times will change.
pjoseph say: Importance of keying
May 03, 2012 | 13:02 PM GMT
Do doctors have to be typists to get MU incentives? was the title of the article that analyzed MU incentives and the limitations when someone other than the physician entered the data.
Here's my back-at-you question: Does an adult need to key in order to work at almost any job in the US in the 21st century? The answer is YES.
If a physician is unable to key in info because of some physical limitation, that's one issue that affects a few providers, but one that must be dealt with nonetheless.
If, however, a physician is unwilling to key in info, then he/she does not have the skills needed to be a physician in the 21st century and should not be licensed. Another profession calls.
sherry roth say: Scribes, MU etc
1. Not sure what you mean by "scribe," as you seem to use it interchangeably with "clerical" person and contrast it with "licensed professional." A scribe is a particular profession, and my impression is that they transcribe details of an office visit in real-time (or close to it), not enter orders. If they're entering visit notes, then I'm not sure where the issue of MU comes in, in terms of CPOE and DSS.
2. Maybe the issue of having decision-support alerts popping up should not occur AT THE TIME OF ORDER ENTRY, if the provider is not the one doing the order entry. Maybe the DSS alerts should pop up WHEN THE ORDER IS PULLED UP TO BE SIGNED by the provider. That way, the provider would have the benefit of the DSS and be compliant with MU.
3. No, doctors should not have to type. It's a waste of their time and they're not very good at it anyway. Improvement in voice/speech recognition software would probably go a long way to helping, but if anybody has ever seen "Damn You Autocorrect," and how speech-to-text can be mangled, you know...this could be a problem. Once you hit that "send" button...