EMR - How To Kill Your Doctor For Fun And Profit!
By Janr Ssor
Published 3/16/14 By Janr Ssor At SmashWords.com
Copyright 2012 by Janr Ssor and Dr Joseph A Ross, 93 McManus Road South, Patterson, NY 12563 .All rights
reserved.
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Authors Note: This story is a composite of TRUE Stories! Names have been changed to protect
the people in the story but the essence of the story is quite accurate. There is no “one” doctor’s
office represented here but a somewhat fictitious one based on my personal experience as a
doctor installing EMR and those who have been kind enough to share their private experiences
with me by email, text, phone conversations and lunch meetings. My personal experience is with
MVE, MyVisionExpress, and so I use that EMR software company’s name here as I did start
with it and am still a user. I would suggest that MVE is a viable EMR program certainly as much
as any other especially since they have made significant efforts to fix issues lately that others
may not be as committed to do. As such I am not criticizing MVE here but the whole EMR
concept and the challenges it creates. Even as a composite of several doctor’s stories, this story is
accurate enough to describe what happened with MVE and most other companies. Other doctors
I have met with have had very similar experiences with their EMR software. The financial losses
EMR vendors have caused us fit my office and others. Am I embarrassed by sharing a semblance
my financial and professional pain with others? No, not if it helps you avoid a similar trap or if it
helps organize doctors to prevent this abuse .…. Dr Joseph Ross, Author/editor
--- the story………………..
Just before they killed him, he was the brightest, kindest doctor I have ever met. His name was
Dr. Paulo Magnifico; I can judge I am a specialist who has dedicated my life to people too!
When my wife broke her rib lifting a heavy stone planter he made a diagnosis with his mind that
others could not do with millions of dollars worth of technology. He had, years of dedicated
study, ethics, courage, intelligence and clearly a love for his patients; something corporations
with their high tech scanning MRI machines did not and perhaps why the “new” American
Medical Reform will fail. He was active caring part of our community and known to everyone at
his church. How did he die? His death was slow and painful much like those in WW II prison
camps. This is the story about more than one kind of death, death camps and the delusions of
people, who like the German’s, ignore those around them being sacrificed by the “powers that
be”. It culminates in a new enslavement and forced labor disguised under the supposedly
compassionate banner of EMR. There are those who may argue with this but if they do, note
their financial involvement before buying their story.
For many years before EMR and the medical reform, Paulo had dark black hair, sparkling eyes
and a sense of humor that made you feel at home. A few years into the subtle start of the reform
era, Paulo had white grey hair, bags under his eyes and bitterness in his voice. His dreams for
his family, his life and the love of his life, his patients, had been stolen! He was imprisoned in
work camp where could not use his skills or his compassion and treat his patients like human
beings as he had done before. He was an employed slave to those with the power to control
him and his family. In essence his dreams had been stolen before his life was to be ended. This
began just as EMR was being introduced and was more the impact of HMOs and Managed
Care, so lets jump a few years into the future (to now) and see what EMR has done and doctors
who are too proud to fail, will not share publicly (with this written exception, and perhaps more
soon).
Mr. Obama signed the laws congress wrote in his honor. The American people nearly
Unanimously opposed it. Congress, risking looking like Marie Antoinette, excluded themselves
from it. Congress was sure the American populace did not have the courage to guillotine them
and even if the people caught on, congress could use the media to lure them into frightened
complacency! In his honor it is called ObamaCare (and named affordable health care to hide its
real nature). Its centerpiece of empowerment is EMR. EMR, is a way for big brother to follow
every move and thought your doctor makes. It is supposed to make your records available
anywhere and everywhere to your benefit but does it and is it a financial panacea? You tell me!
So back to the story as it started about 2 years ago for most doctors who chose EMR....
This morning, my office manager reminded us we had to install EMR. These were tough times
and 20 years of reduced fees starting with Hillary Clinton, had put many doctors (mostly medical
doctors) into bankruptcy, that and other issues had made Dr Paulo Magnifico into an emotionally
beaten employee. EMR was the new law of the land and if we followed congresses demands
they would pay us for Meaningful Use (MU) and help fund the cost of the Required EMR, that
might otherwise financially drain our office. We had shopped for over a year and seen nothing
that made sense; but MVE, MyVisionExpress, seemed like the best of the worst. I should know,
I am a doctor, programmer (with over 30 years of off and on experience), writer of Sci-Fi and
essays , and lots more that 42 years after college have allowed me to achieve. So as vision
care specialists, we signed on for EMR from MVE. It cost us over $15,000 in software and
hardware just to get started.
MVE warned us that it would take doctors 2 weeks to learn the software and then be able to
provide patient care at the usual speed. They told us it would be wise to cut patient volume in
half for two weeks. They also said the front desk would require 4 weeks to learn as the
insurance companies required lots of detailed accurate data entry or we would not get paid. Our
practice grosses nearly $800,000 a year but nets less than you would imagine since we actually
spend time with our patients. Each month earns about $70,000 gross and so two weeks at half
speed would lose us about $17,000 plus the $15,000 investment in software and hardware
upgrades. Our first MU government check would be for about $18,000 so we would not be out
too much money, it seemed like the best plan and a needed investment. I later learned that lots
of my colleagues made the same calculation. What proud doctors will not admit (and why I
am writing this) is how stupid they (we) all were to believe congress and those making money
off their new laws, the EMR industry. As it turned out it took us nearly 3 months to be able to
use this EMR software and even then, as doctors across America report, you will always be
about 20% slower than with paper! Three months at nearly half volume for two doctors cost us
about $100,000.00 A lot more than MU will ever repay. To make it worse, like several of my
colleagues who have shared their experience, nearly 90% of my patients are pre-appointments.
As such, this hole in our appointment book would follow us to the next year and so create a
second smaller but significant financial shock wave.
MVE quickly learned that we were easy to deal with and tolerant of bugs. We gave them lots of
excellent feedback because I am a programmer and could easily notice and report issues in a
meaningful manner. They were also very responsive to fixing issues, something I NEVER saw
with OfficeMate and why I left them. I did not yet know that we were basically their beta testers
(in my opinion). When I wrote software, I tested it on every platform before a release so that I
would not get bug reports. But, as any programmer will tell you, you never have bug free
software that is current. Only old code is bug free and then not very useful. So I expected some
bugs. It was not some it was lots. Other doctors had very similar experience with all the EMR
software I have heard of they and are still dealing with them. I had officeMate before MVE, but
not as EMR, just for billing and recalls, it never was worth the money, as cheap as it was, and it
had limited features as well as a bugs. I chose not to go with them. I chose the Cloud to limit the
expensive hardware I would need for the 12 computers we use in my office. I also installed
MIFI cards (two of them from TruConnect) so that if ComCast went down, I would have a back
up. TruConnect costs $5.00 / mo. per card and only charges you a fee for data when you are
using it. That fee is not unreasonable. It is slower than ComCast as it is 3G but two cards can
run 10 computers in some semblance of functionality. This has been helpful when storms took
down the Cable. So if you use the cloud and do not have DSL as a back up, this is a somewhat
reasonable alternative. Now with 4G cell phones, that is even better if you can use yours as a
MIFI card. Some do not allow it.
Shortly after my EMR install, I met with an OMD from a nearby town for lunch. I have several
OMDs I work with most in a friendly manner. This doctor is exceptionally open to MD OD teams
and easy to work with. We work well together and meet periodically to seek new opportunities or
just to renew our relationship. Over lunch I told him how it has cost me about $50,000 by the
time we had met and he said that was great! He said his conversion had cost him over
$120,000 in investment and loses and he had started at about the same time I did. I have yet to
ask him how much it ended up after a year and don’t think I will or should either.
As for MU, yes we got paid but by now you know it is not as significant as it seemed. The dream
of easy communication with other physicians, is non-existent for now. Though our EMR will
generate a nicely formatted report with pages of what was not found ( but detailed to meet
insurance company needs) it still gets sent by fax and attached to someone's record much like
dusty files buried in an aging accountants office. In other words, it is pretty useless since it does
not integrate into the live viewable data that EMR is supposed to provide. This is what others
have shared too, so far. Will it get better? I hope so but I have my doubts. If it will work, I am
sure MVE will make that so as they are very dedicated to working with consumers and very
creative. A contractor came into my office the other day and told me about a multi-billion dollar
government project he was working on to create the purest water in the USA. I was a huge
treatment plant with the latest of every technology. It was being built in White Plains, NY to
serve NYC's water needs. He was happy to be part of it as it kept his family in food and clothing.
I asked if it was really going to achieve its lofty goals and he smiled and said yes! However he
said, “the water once purified to the highest levels of the world, then exited the treatment plant
into an open pond, where birds shit in it, before it went to NYC.” He laughed and said, “and that
is what you can expect from bureaucrats.” It does give me pause but then there is always NASA
and the moon….even if it was 50 years ago.
So by now you have a composite story of the installation experiences of several doctors. You
will be happy to learn that over the year, in all our experiences, things got better thanks to very
available MVE support people (though never as easy as the systems we had evolved on paper).
By the beginning of this year, I had even recommended MVE to some of my colleagues as it
was working better than other systems I had feedback on (though I admit my information was
skimpy). In fact some things MVE created like the Copy Forward with edit feature and the
Patients Portal are darned good. As they evolve they will add some benefits that we could not
do with paper. Shortly after New Years the story changes however. This is when it occurred to
me that we were all hostages to what I call EMR Terrorists! I sat at my linux computer (I am a
computer nerd and have to know all the tech I can) and used the free GIMP graphics program to
create something that described the anger in my heart and feelings of frustration that EMR was
now causing me and one colleague who shared a similar experience. The result of that half
hours diversion looks like this:
What does this mean? Well consider that if you have a busy office, as I do, and you see lots of
pathology, as I do, you need to work quickly efficiently and accurately to stay in business.
However, the new release of “upgraded” software is dropped on you like a bomb by your EMR
provider. Suddenly you are back at day one when you installed the software and yet you know
that you cannot see less patients to learn and debug the new release. What does it look like.
Here are some pictures to share. You are writing a diagnosis and the screen says “Not
Responding.” You stand there staring at the screen with perspiration coming down your arm pits
and brow and your patient wondering what is wrong? You look like a fool when you need to
instill confidence in the new patient who came for a second opinion about their recently
diagnosed glaucoma but you cannot! You have to explain that the cloud based software has
stopped working as you frantically email tech support. Everywhere across your office work is
stopping and groups of your employees gather around a computer trying to write a receipt for a
patient who is now waiting over 20 minutes to get one. Finally we ask them to “trust us” and tell
them we will have it for them when they return….. sure made a good impression! This is not just
about MVE this is what other EMR providers dropped on their customers too! Fortunately MVE
is very interested in resolving the issues that you can have 3 different support people working
on issues at our 14 computer locations. They do try.
I could go on and on and describe literally over a hundred bugs that were released into busy
offices by EMR programmers but what is the point? You get the picture. You have spent your life
creating a professional environment where your patients learn to know, like and trust you. After
years of practice you even look and speak in a manner that earns respect. It is inevitable if you
are an excellent doctor. After all, getting a patient to listen to you and follow instructions is
dependent upon the hypnotic process of earning their trust. Trust me on this, I am also a
certified Hypnotist. In your professional manner and environment you earn trust by the hypnotic
effect of all you have created. Well you might have until EMR makes you look like a fool!
Why is the terrorism? They have you hostage! Can you just say, “Okay, I will switch to a new
provider.” Not on your life! It will cost you big bucks and you will have to learn new programs
that will probably make your staff want to quit! I have seen mine come close and others have
lost employees. This is terrorism. Each day you come to work not knowing what will explode as
you walk through the minefields of your new releases code. This is an issue for every EMR
software company I have heard of, not just MVE.
So if you are new to EMR or experienced. You now have a view of what you are in for or a
perspective of what some of your colleagues have experienced as you have. I am awaiting
more emails to see what more I can share and not be too verbose. For now lets go back to the
beginning of the story and find out how other forces are destroying the lives of medical doctors,
especially in my community. The story of Dr. Paulo Magnificio.
Paulo had created a group practice with 2 other doctors. Paulo was the doctor other doctors
went to when they were sick because he could make a diagnosis without a machine telling him
what it thought. He was not terrified that a lawyer might sue him for not taking an MRI because
he used intelligence, common sense and his education to draw conclusions from patient history
and make a diagnosis the expensive technology could never accomplish. Not that he was
averse to technology, he just didn’t need it most of the time. He also knew he had his patient’s
trust. Especially since he avoided dangers tests and medications and clearly explained this to
his patients. He was by training a gerontologist but did not share that publicly as he knew he
would quickly be overwhelmed with patients who were not profitable to see, seniors who were
very troubled by old age and its associated miseries.
When I last saw him in his private practice he told me that he was being forced to join a large
medical group. His fees were being squeezed and now his referrals were being cut off as his
network of referrals were being taken over by the large group, choking off his practices lifeblood!
I asked how this could happen but he did not share it. Then a colleague of his did choose to
explain to me what had happened, in his opinion He explained that the large group had started
with a few PCPS who put up the money and legal work to start and own a medical group. They
then had brought in a specialist or two and blocked referrals to local specialists while inviting the
now struggling outside specialists to join them and have lots of referrals. This had worked. They
had a system, that like the Borg in Star Trek, said “resistance is futile!” Repeating this process
over and over had helped them expand to unimaginable size. They did provide benefits such as
billing services which took away the issues doctors hated to deal with that insurance companies
had created. They also managed to get better fees as they grew, so the groups ownership
became very wealthy and powerful. Most doctor employees did well enough as some of the
profits were passed along to them. The group finally got so big that it took over several counties.
Is this good or bad? I am not to judge. However I can see the impact on the special people who
were absorbed by the group, like Dr Paulo Magnifico.
When he could practice the way he dreamed of and not worry about following a uniform and
maximally profitable procedure, his eyes had sparkled and the energetic spirit of youth shown
from his face. He loved his patients, his practice and they loved him. Now in the group, he had
to follow procedures that maximized profits as dictated by careful accounting and analysis. He
was another average doctor doing what all average doctors do, ordering MRIs to protect against
lawsuits and maximize profits. Referring to specialists in the group because their fees are higher
and it avoids “risk” for the group. Does the group work? Does it help patients? I cannot say it
does not; but, the real question to me is, if it works at what cost to excellent health care? I just
saw a great doctor become burned out and average because he now had no free choice. He
was now part of a system run much like that of socialized medicine in England or Russia in that
excellence was not rewarded and uniqueness was discouraged. Is this the only option in a
financially challenged America? I hope not! However the new coming ACOs and PCMHs will
define the next evolution. The problem as I see it is the killing of spirit in exchange for uniformity.
EMR will likely impose further uniformity that could turn medical practice into something akin to
the cloning of doctors into a medical vision of The Matrix if we are not careful.
I read once that Benjamin Franklin said, “Sadly men are born and live to the age of 21 and
buried at 65.” This kept coming to my mind each time I saw doctor Magnifico. He seemed to be
getting old too fast! He is still practicing in his group, though I have stopped seeing him. It
cannot be a good situation when you hear from the groups employees about how patient visits
are being cut shorter and shorter. The latest news is about how doctors are being limited in how
many Medicare patients they can see due to the low fees. Not the groups fault as far as I can
see.
So how did Paulo die? He died as Benjamin Franklin explained. He died spiritually from a loss
of the freedom to be excellent and be rewarded for achievement. The coming ACO’s are all
about making doctors accountable in financial terms. This potentially could give opportunity to
reward excellence. Unfortunately the cloning of doctors by EMR standardization may be a big
issue unless doctors can organize to dictate to EMR. The determination of financial rewards by
jumping through hoops set by pharmaceutical companies and other large entities such as
hospitals can also stifle excellence. Like Wall street companies who dance to the tune of
quarterly earnings, rewards for “good outcomes” where the patient shuts up about their
complaints are most easily achieved by drugging away symptoms not solving problems at their
root cause. If this new medical “reform” is to have any value perhaps it will be by making all
players accountable on a LONG TERM basis. This means not just doctors but patients, drug
companies and medical entities like hospitals. It is too easy to make a quick profit and then let
someone else deal with the implosion! Putting patients on cholesterol lowering drugs but not
holding them accountable for weight loss. dietary modification and lifestyle changes may
produce rewarding numbers on blood tests but hardening of the arteries, strokes and heart
attacks later. A system that holds only doctors accountable to outcomes defined by financial
interests is a concern. A system that rewards uniformity and stifles creativity and excellence is a
concern. A system that destroys independent practice and like the HMOs of the past creates
gatekeepers puts the power of excellence in the wrong hands. The system killed Dr Paulo
Magnifico, a new system is evolving. The question is how can we keep it from killing the best of
the rest of us?
Dr Joe Ross, Author / Editor
------ Credits ---I thank the small group of doctors who were kind enough to trust that their names and personal
history would never be exposed in this publication, for sharing their personal experiences,
financial issues, and pain. I hope more of you will do so and as such expand the validity of this
story and its value to our colleagues.