Doctor claims firing for poor EMR use

A case from Illinois has risk managers wondering just where to draw the line when an employee can't keep up with new technology. The answer might be different in each case, experts say, but there has to be a point where dismissal is an option.

Steven Kottemann, MD, was placed on a paid leave of absence for deficiencies including a failure to adequately use the electronic medical record (EMR) adopted in the past year by his employer, Memorial Health System in Springfield, IL, according to information provided by Memorial. The 63-year-old doctor was a family physician at Family Medical Center of Lincoln, part of the Memorial system.

Kottemann did not respond to requests for comment by Healthcare Risk Management, but he told The State Journal-Register newspaper in Springfield that he had "no computer skills" before Memorial went live with its EMR on Jan. 12, 2011. When he fell behind on handling electronic records for his patients, Memorial told him he was creating "a liability for the clinic," he told the newspaper.

Patients have rallied to Kottemann's defense and launched a Facebook page to support him. (The Facebook page is at http://tinyurl.com/88l9vq9.) In material on the Facebook page and in the newspaper article, Kottemann says he fell behind because the new system wouldn't always accept his dictated notes and sometimes deleted notes after dictation. The doctor also says a minor stroke in 2008 makes it hard for him to write or type for long periods of time.

A spokesman for the health system, Michael Leathers, tells Healthcare Risk Management that the doctor was suspended for more than just the allegedly poor adoption of the EMR. The hospital CEO, Ed Curtis, declined HRM's request for an interview.

Though the facts are in dispute, a healthcare employer is right to draw the line somewhere regarding an individual's ability to learn and use new technology, says Grena Porto, RN, MS, ARM, CPHRM, principal with QRS Healthcare Consulting in Hockessin, DE, and former president of the American Society for Healthcare Risk Management (ASHRM) in Chicago. "I think it's perfectly reasonable to expect a physician to use an EMR. This is the 21st century, after all," Porto says. "I suppose one question could be how hard they worked with him, but if every other member of the medical staff adopted the system and he can't, then he just doesn't have a key occupational qualification, and they're within their legal rights to tell him he has to find somewhere else to work."

Adapting to new technology can be a challenge for some healthcare employees, but employers should not lower their expectations, Porto says With nearly everyone using computers at home and at work, an employer is not asking too much by expecting employees to learn a new computer system, assuming you provide adequate training, she says. "This has been a problem in the past, but I think we've gotten past the point where it is a serious reason for someone not to meet your performance standards," Porto says. "The systems in use today are fairly user-friendly, and I don't think we're asking too much of people."

The health system claims that it worked with Kottemann to help him overcome his difficulties with the EMR long before placing him on leave. To keep his job, the physician should seek intensive training on his own or hire an assistant to handle the EMR data input out of his own pocket, Porto says. The alternative would be maintaining a separate paper record system for this physician, which would be unsafe and unreasonable, she says.

Any lingering difficulty from the doctor's stroke would not change the expectations for the doctor, Porto says. The Americans with Disabilities Act requires employers to make reasonable accommodations for disabilities, but education is the only reasonable accommodation for adopting the new technology, she says. Allowing the physician to only partially use the EMR system or not use it all would be a reasonable option, she says.

"It sounds to me like they've met their obligation to help him get on board," Porto says. "There comes a point where it is not reasonable to expect more assistance and, if this is a bona fide occupational qualification, if you can't get it, then you can't work here."

Sources

• Michael Leathers, Spokesman, Memorial Health System, Springfield, IL. Telephone: (217) 788-3000. E-mail: leathers.michael@mhsil.com.

• Grena Porto, RN, MS, ARM, CPHRM, Principal, QRS Healthcare Consulting, Hockessin, DE. Telephone: (302) 235-2363. E-mail: gporto@qrshealthcare.com.