concerns voiced by Dr. King in TMA’s comments about the revised rules. He wrote the section “may be confusing to physicians” and that the phrase “non-biographical populated fields” could potentially be the biggest source of confusion. TMA suggested changing the pro-
vision to refer to “all populated fields containing clinical information” with- in the record. Although TMB published that
portion of the proposed rule as origi- nally drafted, it did decide to take TMA’s suggestion to publish a list of frequently asked questions (FAQs) about the new rules, particularly ad- dressing which fields fall under the “non-biographical populated fields” category. TMB will publish the FAQs on its website,
www.tmb.state.tx.us, in the future, TMB spokesperson Jarrett Schneider says. The rules clarify physicians must
maintain an adequate medical record of each patient, “regardless of the me- dium utilized.”
FOCUSING ON PATIENT CARE Dallas orthopedic surgeon Wynne Snoots, MD, whose term on the medical board expired this year, was instrumental in the proposal of the new EHR rules. Dr. Snoots says the changes were a “reactionary measure” to adjust for the way governments, in- surance companies, employers, and hospitals are driving the development of health information technology. Dr. Snoots says those entities are
more interested in “population statis- tics” and the particulars of a patient encounter that pertain to physician payment than in the information that helps the physician treat the individ- ual patient. “What they’re after is the support
for the [medical] bill … so the phy- sician’s caught in the middle,” Dr. Snoots said. “He has to fill out a spe- cific set of data elements, page af- ter page of stuff, in order to get paid. That’s why he looks at the computer when he’s seeing you, instead of being
56 TEXAS MEDICINE July 2015
able to listen to you and look at you and touch, and all the other things im- portant for a meaningful patient-phy- sician relationship. And the computer does not let us use natural language or text to provide an outline of what was really done to provide the basis for the decisionmaking. And also on the EMR side, there’s really no emphasis to un- derstand the outcome.” The changes to the rules, Dr.
Snoots said, are an effort “to be sure that the content we need to make a decision about the care of a patient is based on fact, not on just guessing.” The data that pile up in a patient’s
EHR can create a headache for doc- tors who are primarily interested in the information that pertains directly to a patient’s care. For example, Dr. Murray relayed a story of receiving a recent patient from another emergen- cy department (ED) after a two-and-a- half-hour stay. “That hospital is on an EMR, and
my hospital is on an EMR. But be- cause those EMRs don’t communicate with each other, the patient record is printed and sent with the patient when he or she is transferred,” Dr. Murray said. “That particular record was 50
pages long. And out of those 50 pag- es, only two of them had the clinical information that I needed in order to assume care of the patient at that point. The volume of information that’s captured in an electronic medi- cal record is impressive, but much of it is not clinically useful. It was really a burden to sort through the volume of information I received to find out what happened in that two-and-a-half hours in the other ED. And that hap- pens every day.” Dr. Schneider says EHRs “give us
the ability to make mistakes — new kinds of mistakes that we probably would never have done in the paper world.” A TMB position statement on
EHRs states that the widespread im- plementation and use of EHRs has compromised the board’s ability “to
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