Ok, so you probably guessed I don’t own an EMR (because I am the Principal/CEO of Patient360). However, I have worked on more than nine in the last twenty plus years in medicine both in and outside of hospital systems. The expectations are the same in-house or on your own in the private sector. EMRs should improve care, save money, and help all healthcare providers better communicate with improved data capture.

Ok, so you probably guessed I don’t own an EMR.  I have, however, worked on more than nine in the last twenty plus years in medicine both in and outside of hospital systems. The expectations are the same in-house or on your own in the private sector. EMRs should improve care, save money, and help all healthcare providers better communicate with improved data capture.  Truth is, when the rubber meets the road, the demands of the mother with the screaming kid or your schedule being an hour behind takes precedence over where the EMR programmer —no matter how thoughtful or well-intentioned—decided you should or could click a box to make a quick notation of the quality metrics or clinical adjustments.

When time is of the essence, it’s far easier to type or dictate in the EMR’s free-form section.  This does not optimize data collection but does organize the note the way you like and hits the key elements to support billing.  Documentation is used to record the encounter and get paid.  Nothing more nothing less.  Yet, nowadays—if the bureaucrats and salesmen are to be believed—it magically collects all the data you need to prove PBM compliance with each insurer, follow hypertensive or asthmatic or pain algorithms, and provides comparative analytics to improve care and save money.

It as if Oz himself delivered utopia in your laptop. Well, the great and powerful Oz was a sham as is the expectation of the EMR’s utopian ambition to optimize provider performance under Merit-based Incentive Payment System (MIPS) Quality Payment Program (QPP) metrics.

Want to learn more? Check out this HealthAffairs article: What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology

In the Quality Payment Program, EMRs are only allowed/able to report around 64 of the 240+ QPP metrics. If your subspecialty is highly specialized it’s a virtual guarantee that the EMR’s offerings will not only fall short, they simply don’t exist.  Moreover, unless you follow the exact same programmer (not clinical) thought process of where quality metrics should be logically located in the EMR, your efficiency is shot.  I called our recent EMR support line to ask about their metric population—just out of curiosity—and was told where to find the metrics.

First, as a pain management specialist, there were only one or two measures I might be able to use.  Regardless, I wanted to see it so I tried it out.  The time it took for each to be populated was 30 seconds in and 30 seconds out.  It was like losing a golf shot out of bounds and you add one stroke for going out and one stroke going back in play.  Same thing here, but I needed to go to 4 areas and that didn’t count clicking the check box or adding the digital data.  That was 90 seconds per metric.  At two metrics per patient, that’s three minutes per patient.

Let’s do the arithmetic on say, twenty patients per day over a five-day work week. 

       100 patients per week times 3 minutes = 300 minutes or 5 hours

       4 weeks per month (i.e, 48 annual weeks assuming 4 weeks off per year) times 5 hours means 20 hours per month of 240 hours per year

       Generating conservatively $400/hour in payments that means $8,000 per month or $96,000 per year in lost revenue because of the time lost when I could have been seeing patients


Further, after losing $96K in annual payments, my EMR fails to provide real time feedback on my performance. In other words, if I cannot see how I am performing against benchmarks for the selected measures, how (when necessary) can I improve? This is not just about lost money from QPP bonus $$ or wasted time during the clinical day… although avoiding such loss is desirable. More importantly, if my outcomes are not meeting (preferably exceeding) the performance of my clinical peers, I want to know how I can modify my clinical care to improve patient outcomes. The EMR reporting option only affords year-end performance submission… and even that is not always guaranteed as P360 is inundated each year by EMR reporting providers who realize their EMR vendor said they were “all set” with QPP reporting only to find they are not.

More germane here is the data.  The QPP program like its predecessors (i.e., Meaningful Use, Physician Quality Reporting System, Value Based Modifier, etc.) is about optimizing outcomes to improve patient care and drive down expenses to the health care system. A doc or any eligible provider must know each patient’s data to make clinical changes to improve or suffer fiscal consequences.  EMRs were designed to standardize clinical data capture, clean up doctor handwriting, and get data cross-linked to the billing side of the house.  Efficiency is still challenging, but most do these three things.

However, optimizing QPP was not part of the original EMR programming schematics. The EMR you think has your back, may not.  It’s not that the EMR product does not have QPP capture functionality. It just wasn’t designed to do it well or following a process necessarily based on how a doc thinks and works.

The path to hell is paved…yeah, that good ole saying. Simply stated, EMRs cannot do what they need to do in the Quality Payment Program; i.e., they cannot help providers in real time modify clinical behavior to improve outcomes.  As always, the bottom line is money.  Most EMRs, even the big ones, are on thin margins and it is so damn much work to just be an EMR how could they possibly be awesome at quality reporting too?  The short answer is, they can’t.

I enjoy the craps tables but don’t know how to play poker.  However, I enjoy gambling at poker by playing blind.  The dealer deals, I have a system and most nights it works out pretty well.  That is entertainment—something to do for fun.  Do you really want to use that same strategy for QPP by using a system not designed to maximize QPP, devoid of real-time reporting with comparative analytics, and be limited in what metrics you can use?  If you say yes to EMR QPP reporting, you are gambling.

Gambling blind with your business’ money is foolish, fiscally derelict, and avoidable. Instead of using EMR to guesstimate QPP performance, control what is controllable.  Avoid gambling and find a registry or Qualified Clinical Data Registry (QCDR) targeted to support your specialty so you optimize your performance and your patients’ health outcomes.