Regarding the Nightmare on EHR Street
By Frederica Krueger
I find it ironic that the AMA is complaining about the fact that physician documentation in an EHR is "pure torment." Perhaps they believe in the “Hypocritic oath?”
The reason for this documentation torment is the need to record multiple pieces of information that the physician asked or reviewed but that don’t end up contributing to the synthesis of the clinical picture or the plan of evaluation and treatment. Cluttering up notes with such information is often made worse by the formatting afforded by the EHR. It also detracts from EHR usability and patient safety.
The irony is that the underlying cause of this nightmare is the E&M coding system used to bill for clinical services.
And, that the E&M codes are part of the CPT system that is developed and sold by … the AMA!
The E&M coding system was cumbersome and inane long before EHRs became readily available. In the past, it was just too much trouble to document everything that you actually did to meet the E&M requirements and too hard to keep track of all the arcane rules. But everyone naturally assumes that a computerized system should help remind you of these confusing requirements and facilitate recording of the irrelevant info that was already needed for billing purposes.
With EHRs, there is a much greater focus on appropriate recording and coding at the physician level. It’s not surprising that physicians attribute the documentation horrors to the EHR rather than the CPT.
If the AMA really wanted to do something about the torment of EHR documentation, it would:
- Stop developing (and selling) the CPT manual. In other words, the AMA should put its money where its mouth is.
- Advocate for a common sense approach to determine whether physician documentation is or isn’t "fraudulent" rather than the current Checklist Menu approach.
- Recognize that most physicians are just trying to do right by their patients, and that they could do this much more efficiently — EHR or not — without having to deal with the E&M coding system. The crooked physicians will figure out how to scam the system anyway, so why waste time and money and frustrate the rest of us with E&M codes?
Despite the fact that I’ve gone for 30 years of medical practice without joining the AMA, I would sign up in a microsecond as a way of expressing my gratitude if the AMA eliminated (and got insurers and CMS to eliminate) all use of the E&M coding system.
While they’re at it, it would be nice to get rid of the RUC, RVUs and the RBRVS system, but that is less relevant to EHR torture per se.