Why Doctors Are Unhappy with Their EHR and Not Their Medical Billing Software

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Daniel Schwartz throws light on the challenges physicians face with their EHR systems and the difference in reception between EHR and RCM systems

EHR implementation has been ratcheting down incrementally, with over 75 percent of hospitals in 2014 reporting that they had a full EHR system in place. As the level of adoption spreads, challenges arise and dissatisfaction breeds. Many physicians are completely up in arms regarding their qualms with EHR adoption, not the least of which is that they feel like their revenues are being held for ransom unless they comply.

Yet, at about the same pace, we have seen a tremendous growth in the adoption rate of clinics, hospitals and other provider institutions that have switched to a software-based or automated revenue cycle management (RCM) system. Many provider CFOs and executives cite RCM as their primary solution in mitigating challenges like ICD-10 implementation, collections problems and declining revenue margins across the board.

So why such a strong contrast? The difference in sentiment between these two systems has a tremendous amount to do with the design of the software, the nature of its intent and the circumstances surrounding adoption. Exploring these differences in greater detail could reveal a new direction for systems adoption to take — or, at the very least, explain the polarity of opinion.

In that light, here are the key differences between EHR and RCM systems that could be leading to their dramatically-different receptions:

#1: RCM Isn’t Compulsory

With millions of dollars hanging in the balance, providers are feeling the lure of the carrot and the sting of the stick as they are herded towards EHR adoption. Government organizations and healthcare thought leadership profess significant gains as a result of EHR implementation, but while these glowing examples certainly exist, not everyone is swallowing this evangelical praise.

Regardless of their opinion, though, providers are expected to already be part way through an EHR transition, with Meaningful Use Stage 2 criteria already coming into effect. And, naturally, as implementation becomes deeper and more widespread, so, too, do the complaints and criticisms.

While the majority of these criticisms certainly have merit, there is something to be said about not wanting to be forced into something. People who consider themselves authority figures or decision-makers typically resent being commanded by someone other than their direct superiors.

RCM, in contrast to EHR, is seen as completely voluntary. Physicians that end up not liking their RCM system can dismantle it and wait as long as they want for a replacement — perhaps forever. While this scenario is unlikely, the possibility of freedom of choice is a prime culprit in why RCMs are better received.

#2: Medicine Isn’t Numbers

While clinical diagnoses and treatment all involve heavy doses of chemistry, calculations and complex lab result interpretation, there is a distinct human element in the practice of medicine. In other words, there is an art to the science.

Many physicians have spent years honing their exact style of documentation, dictation, diagnosis and treatment as they perfect their craft. Subtle interactions, intuition and often simple guesswork all come into play when trying to cure people or keep them healthy.

Many EHR critics feel as if all of this esoteric magic is destroyed when EHR systems are involved. Writing for the MIT Technology Review, retired Pathologist Dr. Richarde Reece somewhat-hyperbolically suggests that “humanity withers when it is dissected and typed into an EHR.” He goes on to quote a more to-the-point Jerome Groopman, who observes that EHR’s style of “clinical algorithms can be useful for run-of-the-mill diagnosis and treatment […]but they quickly fall apart when doctors need to think outside their boxes, when symptoms are vague, or multiple and confusing, or when test results are inexact.”

Perhaps this phenomenon is why 45 percent of provider respondents in a national survey stated that their “patient care is worse” following EHR implementation. The demand EHR systems place upon users to find a square peg to fit in the square hole simply does not work when all the symptoms turn up round. Many users — including physicians — end up finding the next best fit, leaving blanks or “fudging the numbers” just so they can complete the record entry and move on to the next step of their day.

#3: RCM Workflow Is Straightforward by Nature

Vamping further off the last point, handling finances is almost the polar opposite of treatment and diagnosis. Every transaction gets handled in only one of a few ways, and each exception usually only means a few extra minutes of work.

This smooth, predictable workflow exists for the same reason that the erratic, idiosyncratic one of medicine does — it has evolved that way over time. Those who work in finances can crunch numbers, fix errors and solve billing problems quickly, while errors and hold-ups in patient care often lead to regrettable outcomes.

Because of this stark difference, financial and billing concerns are better fitted to rigid, algorithmic systems. If anything, the rigidity and automation allows for providers to brush aside one of the areas of medicine that they are least passionate about — billing — which brings them to RCM adoption with open arms.

Conclusion: EHR Is Flawed, But Not Doomed

The differences and issues with EHR outlined above all equate to a system that was not as well-conceived as a billing systems. Without sufficient input from providers, many vendors obfuscate workflow through EHR rather than making it simpler. Vendors also have trouble grappling the variability and nuance that is often required in documentation, an issue not present in the more predictable RCM functions.

As EHR implementation progresses and matures, vendor competition should iron out these discrepancies and allow providers to practice medicine effectively through EHR systems, not in spite of them. In the meantime, expect a smile on their face when they take a look at their RCM dashboard, and a frown when they have to log onto their EHR system yet again to make an adjustment.

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