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VBCR - October 2014, Volume 3, No 5 - Rheumatology Update
Kyle C. Harner, MD
Managing Partner
Carolina Arthritis Center
Greenville, NC

My first experience with documentation outside of a hospital was at a small internal medicine office in Richmond, VA. I was a fourth-year medical student, and the supervising internist ran a small, but very nice office near Stuart Circle. He spent a lot of time with each patient and very little time dictating a few sentences about each encounter for the patient’s medical record. When my supervising internist was done seeing patients for the day, he went home. I am sure he was getting paid by the prevailing insurance providers of the day. After all, he did have a nice office in a very nice part of Richmond. I often think of that month in Richmond as I spend my entire lunch hour, and up to several hours after our office closes, typing and clicking boxes. This is to make sure my notes meet all the requirements for not only a Current Procedural Terminology code 99214 office visit, but also for Meaningful Use. This is also because we would like to keep our nice office in Greenville.

This begs the question, what is all this clicking about? What is all the Meaningful Use data being used for at the Centers for Medicare & Medicaid Services (CMS)? For answers, I turned to the source that everyone uses: I Googled it. Using the search “How does CMS use Meaningful Use data?,” I was rewarded with hundreds of hits about how I can meet Meaningful Use specifications, but absolutely none about what the bean counters at CMS are doing with the data we are providing. I cannot say I was surprised by this, but some explanation would have been nice. I did not call CMS because I did not want to hear a vague answer about quality.

In our quest to meet Meaningful Use standards, our office has gone through an initial electronic medical records transition, followed by multiple updates, the most recent of which is to accommodate changes stemming from Meaningful Use Stage 2. Each update brings changes in workflow and more boxes to click. More boxes mean either less time with each patient or more time documenting after the clinic closes. I can only hope that electronic medical records evolve into systems that no longer hinder conversation between providers and patients, but I am not going to hold my breath waiting.

Is there anything that the medical community and our patients can do about the loss of the doctor–patient relationship, or is it too late to turn back? I certainly do not have an easy answer to this question. Doctors are historically poor at advocating for themselves, but many states now have strong medical societies and even rheumatology-specific societies that lobby for the interests of their membership. Organizations like the National Organization of Rheumatology Managers (NORM) are also vital. Through NORM, managers and physicians can work together to advocate for what we consider quality care. Finally, patients likely are the most powerful lobbyists. As consumers of medical care, patients have the most to win or lose when physicians look at computer screens rather than them.

I think we have come full circle on this issue, because in the end quality care takes place when a physician and patient get to spend more time together, not when a physician gets to spend more time clicking.

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