1) Bioethicist Daniel Callahan: “Are we going to continue funding programs for the elderly at a time when so many people have no health coverage?”
My take: Uh, yes. Increasing funding for primary care and geriatric physician access will lower health care costs in the long run. Ensuring a strong generalist base is essential before tackling universal coverage. Otherwise, you will have millions of newly insured patients without a doctor to see.
Focusing on coverage first before costs is doomed to failure, as Massachusetts is learning first-hand.
2) Speaking of Massachusetts, Senate President Therese Murray suggests an infusion of $25 million per year to help fund electronic medical records.
My take: Laughable. It’s not nearly enough, considering cost estimates exceed $500 million. Unless electronic medical records are fully funded, the majority of independent practicing physicians do not have any incentive to make the switch.
In fact, the individual physician rarely sees the investment return of electronic records. They pony up the initial capital while the cost savings go to the government and health insurers. It’s a lose-lose proposition.
3) Medicare will continue to cover CT-cardiac scanning.
My take: Curious move. The technology is still in the investigational stage, without any studies that show a mortality benefit. I’m not sure this is the wisest way for cash-strapped Medicare to spend its money.
Read the rest of “my takes“.
Related posts:
- The low adoption rate of electronic records
- Pie in the sky and electronic records
- Funding electronic medical records and bailing out the Big Three automakers
- It’s time for every physician to adopt electronic medical records
- My take: Electronic records, limiting care, Jarvik, loan forgiveness
- Op-ed: Why doctors still balk at electronic medical records
- Electronic records and economic sense
{ 12 comments }
“.. My take: Laughable. It’s not nearly enough, considering cost estimates exceed $500 million. Unless electronic medical records are fully funded, the majority of independent practicing physicians do not have any incentive to make the switch.
In fact, the individual physician rarely sees the investment return of electronic records. They pony up the initial capital while the cost savings go to the government and health insurers. It’s a lose-lose proposition…”
You cannot be any more wrong concerning this. No basis in fact for these comments. Well-implemented EMR systems provide excellent financial returns and improvements in quality of service. Financial returns on the order of 25-200% annually. Many good EMR systems available, some “free”, i.e. no software licensing, some minimal cost (AmazingCharts which another poster to your blog referred me to), most relatively inexpensive. The worst action that could be taken is to throw money at physicians to try to induce them to adopt systems. All of that money will be wasted and in fact represents a “moral hazard” in that the money will be wasted because it is “free”. Consistent with one of the fundamental problems of the healthcare system that physicians are never presented with a budget that will induce them to innovate to reduce costs and improve quality. They complain about too low compensation – ridiculous and baseless – so politicians fork over more tax-payer money that they use poorly.
Wendell Holmes, your comment rings of self-promotion and seems at odds with findings from physicians and insurers regarding the costs and ROI for electronic medical records, namely that they don’t yield a positive return and that their costs to doctors and practices are substantial and inhibiting. Please explain why we should believe you and not them.
I am presently experiencing the transition to EMR and it does indeed diminish productivity both of the doctors and the ancillary staff. For practices that already had good documenation and coding practices, the benefits are even less apparent. I forsee a transition period where intake of information will be less efficient than a paper system that will extend beyond one year, and possibly indefinitely, and where the productivity losses will not offset the supposed efficiency gains. And we are using a product from an industry “leader”, tied into a practice management software product in the same class. Even electronic prescription writing, something that I think really is a clear improvement with this kind of charting has serious limits: all our local pharmacies, branches of national chains, will accept only paper renditions of prescriptions, not electronic, and not with electronic signatures either.
For a practice without the need for chart sharing between many offices, with small numbers of doctors and little opportunity for extramural electronic information sharing, I would agree with the critics who say the benefits accrue to the entities that bear none of the costs: insurance companies and the federal government.
I disagree completely with your comments regarding EMR. I switched nearly two years ago and have found that I am more productive, my records are more complete, and my billing is increased as my documentation is more complete and the coding of the chart is more accurate.
Obviously, the quality of the EMR software is important. I purchased a top-line program, at that time A-4 and now Allscript. In EMR software, the adage you get what you pay for is dead on.
The biggest problem with EMR is the customization of the software to the individual practitioner and practice. My partner and I spent a significant time to set up the program and it works great. I would recommend the vendor strongly.
I have polled my colleagues. Of the 9 who have switched to EMR, 8 of them strongly regret it. 1 of them is neutral, citing some real advantages, but not quite enough to justify the costs. Each year, I actively evaluate to see if it is of benefit to our practice and to our patients in any way to switch to EMR, and so far, the answer has been NO. However, we do employ some very advanced computerization in our office including internal instant messaging between MD and staff and an in-house Wiki to keep updated on our protocols and policies. I have met with five EMR different vendors and none of them have come close to presenting a valid advantage for us to switch. Some of them have been honest enough to admit it at the end, when I asked them point blank.
Sure I can envision an advantage for practices with multiple locations or special circumstances but it is wrong to make a blanket universal claim that EMR is beneficial for all practices. And even for those that it provides a slight benefit, is it really worth the cost?
Got the records of a pretty girl from her pediatrician for the year 2007. I wanted to know her current medication. The record was a half inch thick, for less than a year of care for a healthy girl. I never found her medication. But, I was relieved to learn, she had normal female genitalia. The penis was anatomically correct, and the testes had descended. I thought, silly mistake. However, three other dates contained the same entry. If the record had to be used in a legal setting, its credibility would be nil. How do we know if any of it was written or read by the doctor?
I would argue that state laws requiring the maintenance of a medical record had been violated by the repeated nonsense. If it was a simple error, how many times will the simple error repeat itself unless the doctor had not made the record of a real examination?
I don’t know psych doc 9:08. Did you do a physical exam? I’ve seen stranger things.
I asked. I took her word she was all girl.
But consider a differential diagnosis where acuity makes a difference in management, say, anemia, iron deficiency or internal bleeding? Could you trust this record’s assertion of rosy cheeks a week ago after seeing that entry?
Nobody who automates anything is ever happy in the beginning. In any line of business!
Probably the best thing to do is to assume that EMR is coming. You can start looking at products and thinking about a transition. The more you know what is available and what you want then the better decision you can make.
Perhaps small offices who hold out will find that eventually the big players will come along and fold them in.
Certainly looking at your paper records with some knowledge/thought about how those would be converted to EMR could help position a small business for the eventual transition.
GingerB:
You are assuming that something is actually being automated. This isn’t factory automation. We are merely substituting media, pen and paper, for keyboards and bytes. The data acquisition is not being digitized, merely the repository of the data. And for practices that already do an efficient job and don’t share a lot of data or need to make that data available over a wide distance, the process is not one that is time saving or efficient. In fact, it may never replace the efficiencies of the paper chart.
“Wendell Holmes, your comment rings of self-promotion and seems at odds with findings from physicians and insurers regarding the costs and ROI for electronic medical records, namely that they don’t yield a positive return and that their costs to doctors and practices are substantial and inhibiting. Please explain why we should believe you and not them”
It is Wendell Murray. It is not a question of belief, it is a question of facts. My comments reflect my experiences and the experiences of many practices who have successfully implemented a fairly wide range of EMR systems, not self-promotion. That is an offensive comment, but typical of the response that one hears from those who do not know what they are talking about.
In any case, the returns on investment in out-of-pocket cost and opportunity cost are substantial, both in dollar amount and in practice quality improvement.
Productivity gains vary by size of practice and current practice management procedures. A low level of productivity gain is usually a function of lack of changes to how physicians schedule their workflow and how they utilize resources, such as other clinical personnel and often more importantly patients themselves, many of whom hunger for electronic interaction with their physicians. The biggest productivity gains in primary care primarily accrue in the form of electronic prescribing that occurs with the pressing of a button on a tablet PC and the ordering of lab or other tests from outside the practice. This must also be at the press of a button to achieve material productivity gains. Many other areas of lesser productivity gain, but all together can be substantial. Financially better documentation almost always leads to higher coding levels and therefore higher revenue for the same volume of work.
In general I have found that physicians in almost any size of practice tend to think that they can select a system, negotiate terms to acquire it and install the software on their own without knowledgeable advice. The point is that they almost universally cannot, even if one or some of the physicians involved has some or even substantial technical expertise. That is almost always (but not always) a recipe for disaster. The expertise and assistance are not all that resource-consuming, but are a necessary ingredient to successful implementation.
There is no reason for a physician to adopt EMR except if you want to give the insurance companies, and especially medicare another way to deny paying you.
I know very few physicians that find any usefulness of this scam, besides funding some IT-people nad making people's medical records easier to read for "experts" like Wendell&CO.
EMR won't solve our problem with too few doctors in the system and a situation that is bound to collapse.
Let Murray take his EMR with him and start seeing the patients. Then he can submit the claims to CMS and be all happy, lol.
Karl O Marx
Why thank you Mr. Marx. I am a long-term of yours by the way.
Many problems awaiting resolution in medical services and healthcare more generally, including the discouragement of many primary care physicians.
Nonetheless, digitization of clinical records can be done very cheaply, with minimal effort on the part of most physicians and their staffs, but with small to large results to physicians and patients alike from doing so.
If you among others want to keep your “head in the sand” regarding the issue, not much I can do about it.
My perspective at the moment is that widespread use of computer information technology by physicians will take a generational change for that reason. We’ll see.
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