Dermatologist Stacia Poole, MD employs four at her independent practice in Melbourne, FL. She attested for Stage 2 of Meaningful Use last year as a DrChrono end user.
How is your practice using health IT to improve care? How has its use evolved over the last several years?
Health IT applications are useful in our medical practice to track metrics and historical patient information, as well as for maintaining medication lists, sending electronic prescriptions, and enabling secure electronic communications with patients. Our EHR vendor is continuously refining and improving the features of its program to facilitate practice efficiency.
How have your patients embraced the use of technology as part of their care? Do they ask about apps, portals, etc.?
Unfortunately, in my geographic location and with my older patient demographics, there is a steep learning curve with regard to use of the portal and other patient-accessible features of the EHR. A limited number of patients take advantage of the patient portal, and those who do seem to find it convenient and easy to use. However, we do spend time with our patients walking them through the check-in process and helping them input their information or transferring their information for them into the EHR. I find that I do not use it as fully as I could, because of the limited number of patients who show an interest in utilizing that method of communication. I’m sure our experiences in a small town in Florida may differ greatly from those in a technologically more savvy part of the country or in a practice with younger demographics.
What are your thoughts on the role of telemedicine in dermatology practices?
Telemedicine is an emerging utility in my field. I believe its use in my area is still rather limited. I do believe that this will become a popular option for care in some capacity in the near future, but I foresee some difficulties in carrying out fully electronic consultations. Some features that are clinically useful to aid in diagnosis of skin conditions cannot be fully appreciated via electronic media – for instance, texture and subtle variations in color and thickness of lesions. This could result in less accurate diagnoses or potential delays in appropriate treatment. I have not yet taken the initiative to incorporate this technology into my practice but would consider doing so in the next one to two years.
How do you anticipate this administration’s policies will impact your practice’s ability to provide care?
It’s very difficult to predict the changes that we are likely to see in healthcare delivery and healthcare policy, but certainly the primary role of government and private insurers to determine what constitutes good quality care is troubling. The concept of “pay for performance” is an extremely difficult standard to define, let alone to implement. The numerous performance metrics outlined, many rather arbitrary, demand tremendous time on the part of the physician and the staff, and detracts from resources that should be directed toward face-to-face patient care and interaction. This is a very frustrating, as assuredly the time and effort required to complete these functions does not translate to an equivalent value to the patient in terms of increased quality of care.
Somewhere along the line there has been a decision that more information is better, but certainly it is not helpful to see page after page of non-critical data reflected in a medical record. A concise, to-the-point account of a patient’s symptoms, findings, diagnosis, and treatment plan needs to be displayed in the medical record, and it should be the physician, not the insurance company or an administrator, who decides what information needs to be collected in order to formulate this plan. Medicare requirements, protocols, and audits are actually more difficult to navigate than the ACA at present time, and unfortunately, this is not a focus for legislative change.
What health IT innovation has you excited? What’s on your health IT with list?
I would be excited to see more practical ways of digitizing, cataloguing, and tracking photos of patient lesions. I would also be very enthusiastic about the ability to have more control over customization of EHR format and features to suit the needs of individual providers and specialties.