Improving the Use of the Electronic Health Record

During this episode, Virginia Ferrari, content strategist for NHA, interviews Dr. Blake Busey, a family physician from El Paso, Texas, on the role of the EHR in healthcare. They discuss where the EHR brings value in today's healthcare landscape and how it can sometimes fall short of expectations for providers. Dr. Busey ends on his hopes for the future of the electronic health record, noting the impact that interoperability will make on the industry.

Read the Full Transcript:

Introduction:

Welcome to access on air from NHA. This podcast is dedicated to providing educators and employers of frontline healthcare workers with expert perspective on trends impacting and elevating the industry. These discussions can help you achieve your goals as you continue to pave pathways toward professional success for those working in allied health. Thanks for listening.

Virginia Ferrari:

Well, good morning. My name's Virginia Ferrari and I am a content strategist for the national health career association and part of my role and my responsibilities is the electronic health records specialist program. So I would like to introduce Dr. Blake Busey, who is on with us today who is going to be joining us for a conversation about electronic health records. So Blake, why don't you tell us a little bit about yourself?

Dr. Blake Busey:

Good morning. So, yeah, I am a family physician. I work in El Paso, Texas, and of course, anything I say is not a reflection of any of my employers or past or present. As far as my role, I've been everything from the patients that are medical home director, basically the champion for the military. And then as I got out, I became a core faculty for a university here in El Paso. So currently working to build a residency.

Virginia Ferrari:

Great. Well, thank you very much, Blake, and I really appreciate that. So let's get started in broad terms. How would you say the electronic health record has changed the practice of healthcare?

Dr. Blake Busey:

So it had, it had a huge potential to revolutionize healthcare because all, a lot of doctors don't have great handwriting. Unfortunately what it's done is it's become kind of like a tackle to us. We have to type so many words to meet criteria, to get billed and get the charges and approved by insurance and as opposed to making things safer for the patient, because we don't have the ability to share information between electronic health records. In most, most areas, it's actually made it harder to take care of the patients between primary care and specialists.

Virginia Ferrari:

So do you think that the roles and responsibilities between providers and support staff has changed with electronic health records?

Dr. Blake Busey:

Oh, absolutely. So we do kind of a shared process at the moment. So if you have a scribe with you, they're the ones putting in information as you're examining the patient they're typing, but most organizations can't afford a scribe. So it falls on the shoulders of the darker to not only correct any of the errors that were made by support staff, inputting histories medications, that type of thing, but it also lands on us to, to correct those errors, to read the note, find the note code, the note, everything.

Virginia Ferrari:

That's great information. So now that EHR and again, electronic health records and we'll refer to them as EHR throughout the conversation. So now that they're so prevalent, what is the most critical for all team members working in the EHR to know and understand? So that would include providers, administrators, support staff, just in general kind of a broad overview.

Dr. Blake Busey:

So for, for all of us, we all have to know that if you put information in, it has to be good information. One of the things from research is always garbage in garbage out. When it comes to somebody's health record, it is a legal document, a medical legal document. So you need to be accurate. The administrators have to understand that it's not just typing it. It's verification of data, it's obtaining labs, it's obtaining all those pieces and having a team with a common goal to, to make the note as accurate as possible. That's one of the things that I think is the fundamental component of understanding an electronical medical record.

Virginia Ferrari:

Okay. kind of expanding upon that a little bit, and we'll talk about some of the challenges. So we know providers are busy and they want their EHR is to make their lives easier and not more complicated. So let's talk about some of those challenges and I'd like to get your perspective such as quality of communication, maybe a poor quality system or billing issues I'm using copy and paste and some of those. So can you give us your insight on that?

Dr. Blake Busey:

Absolutely. So, and have used multiple electronic health records in multiple different situations, whether it be deployed in the army. When I was a medical student, I have had multiple chances to interact with electronic medical records. The ones that work really well are the ones that will have the infrastructure in place, where you get the information like routed to you, whether that be your lab orders and results, your radiology orders and results, consult notes. When all that comes in to the electronic medical record, notifies the physician that is there, that's when things run really smooth when those pieces that don't seem too difficult to the provider, when those pieces are missing, it makes your day terrible patient comes in here for my lab results. Well, first of all, that should have been a telemedicine visit. However, I don't have the lab results, let me scramble and find them where'd you get them done. It erodes the trust of the patient to the provider, and it just makes the clinic very frustrated.

Virginia Ferrari:

I understand that. And also leading up to some of our research, we talked to some patients and what their experience was with the electronic health record. And I think an important statistic was that there about 45% of patient respond, as I think the EHR has improved quality of care, but then roughly half are concerned about the unauthorized access. So we always are concerned about HIPAA, but then 21% reported that they were a family member have discovered errors in their electronic health record. What kind of feedback do you hear from your patients?

Dr. Blake Busey:

Oh, I, Oh, I hear a lot of feedback. Again, like I had mentioned before, garbage in garbage out the when there are errors, the patients get frustrated, they feel like they're not being listened to. As far as breaches and the healthcare record like security, it does happen. We all know that HIPAA is important, but unauthorized access by, you know, family members say somebody requested records and inappropriately got them, or staff that are just being nosy or administrators that are doing quality checks. Those are real potential is patient privacy. And it does feel like we should take it very seriously. As far as hackers, I mean, yeah, anything that's online is fair game at this point. I mean, we all believe it's safe, but it's not. I can understand why some people still stick with paper charts because it is easier to document. It's easier to do everything. And honestly, it is a lot more secure when you can lock it up and no one can access it. The problems with that though. Like I couldn't do work from home. I couldn't take my computer with me on, on the road and be able to access my patients' records so that I could provide them care virtually. And it really does like lock you into a given space.

Virginia Ferrari:

Well, that's certainly important and I do want to talk about that as we get closer to the end of our discussion, but I kind of wanted to focus on also about the quality of communication. So when you're communicating with your EHR, are you using dictation? Are you typing?

Dr. Blake Busey:

Both. it depends on if there's other people in the room with me if there three people dictating at the same time, there's, there's no way that you can focus and it makes it difficult to hear, or it makes it difficult for the dictation software to go back and forth or interpreted appropriately. However, I do have to say that when we use our dictation software and it has a error when you read back on those notes, sometimes that's the only levity you get through the day.

Virginia Ferrari:

Right. So is that some of the where maybe it's phonetically correct, but is nonsensical.

Dr. Blake Busey:

Yes. so it is fun to read. Like how did, how did that become that? And you have to read it out loud a few times and it's a game of mad libs. You're like, Oh, there it is. Got it.

Virginia Ferrari:

Okay, great. Billing issues, upcoding fraud. How does the EHR, you know, factor in to that concept and that discussion when we're talking about coding and billing?

Dr. Blake Busey:

Yeah. So when we talk about coding and billing, it's all based on elements on a computer. And then also how your coders are able to pull pieces out of your note. If you have one of the EHR that's click based where you just click a bunch of symptoms it's easy to have a function that's, you know, reviewed all and it'll put a full review of systems. I've been in both types of electronic medical records. That's nice for some things, but we know that you're not asking the review systems like to that degree every single time, there's no way it would take 20 minutes just to go through a review of systems that's complete. So that's a big concern that always has been for me, but it's the standard at the moment. The the other component is for other electronic medical records, you can do dot phrases or macros.

Dr. Blake Busey:

So like dark dot ROS can input an entire review as soon as symptoms in there. And essentially you don't even have to think which is a big problem because if you don't, if you're not thinking you're not double-checking same thing with physical exam, people can do dot phrases for those. I've even created dot phrases for common things like low back pain cough, sore throat allergies, because really I go through the same things with my patient every time when it comes to those things. So that's an easy, I went over these things and if the coders tell you, you have to modify it to have this much like yep. Designate your time. You can, you can do that. Which getting that feedback is always fun.

Virginia Ferrari:

That's really interesting and informative feedback there. So that's great. So I kind of want to touch on just a little bit about combating human errors, because we're all human, we all make mistakes. So do you, or your administrators, or what kind of practices do you have in place to combat some of those human errors?

Dr. Blake Busey:

Oh, I think the biggest one is we have our coders going through and reviewing all the notes. But they, how can you double check on a, on an encounter? You weren't there, you didn't watch it. We do audits, but from the nursing side where they look for specific things, I need to know to make sure that we've hit every piece that we need to, to be in compliance. We have a compliance office filled with administrators that scrutinize the note. I get emails all the time regarding you didn't put complications none in your note. And I go, okay, but I have left unstable condition, no issues at this time. They're like, no, it has to say complication none. Okay. So in that way, some of these things are kind of silly but they have to be there based on insurances or whatever guidelines they're putting out through our billing and coding department.

Virginia Ferrari:

Okay. I kind of wanna shift towards the end of our conversation today. And you had mentioned earlier that some of the good features that you like about the EHR is that you are able to take it on the road. You can work from home, or if you're traveling and things like that. So let's end on a little bit of an optimistic note. And w w what are you optimistic about for the future of EHR? And I'll throw this one in what would be on your wishlist?

Dr. Blake Busey:

Oh yeah. So I still have great hope for electronic health record. I really think that this is a pool, like anything else. So if I can take care of my patients remotely, if I can take care of their needs without having to physically be there that's fantastic. Especially right now with going on, it's been phenomenal. And being able to access records from home, keeping people safe at home decreasing the exposure risks and still being able to take care of people. The things I liked the most about the EHR is that you can send medications electronically. You can wait at work so you can review labs very easily. Radiologist studies come in, you can go through them in my perfect scenario, though, I would love to have a fully integrated electronic health record. There are a few of them out there that we all as physicians like drool over because it's like, that's amazing.

Dr. Blake Busey:

It's just, you know, the organizations can't spend so many millions of dollars to get them. But they are fully integrated. You're able to not only send orders, you can receive the images back, you can receive the labs back, you can have communications with the specialist all those things. The other things that I'm really excited about with electronic health records is the ability to feed from them. So if you can extract the data well and utilize it to teach the next generation of students, this can be a very powerful tool. If so for me, it's still hopeful. My hope, my dream originally was having a centralized system that was, you know, double backed up or something like that, that every, every clinic, no matter where you're at, was able to get and interact so that you don't have silos of information at every site. If a patient went to a specialist that updates the simple site, and then when they go back to their primary care for other things, at least you, you know, what happened as opposed to waiting for the patient to tell you, Oh yeah, I had the surgery, which surgery, okay. Let me request records.

Virginia Ferrari:

Right? Well, maybe that push towards interoperability is going to get you to a little bit of your wishlist. So in closing, I don't have any more questions. I just wanted to touch base with you today. If there's any remarks you'd like to make great, if not, I want to thank you for your time. It's been really informative, and I hope we can do this again soon. And I do thank you for your participation, not only today, but during the process of our interviews for our printed documents and articles as well. So thank you, Dr. Busey.

Dr. Blake Busey:

Well, thank you for having me. I know it sounds like I'm always negative. I just identify all the, all the negative so we can fix it later, but we can, and again, thank you so much. Yeah, of course. Have a good day.

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Improving the Use of the Electronic Health Record

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