Stanley Feld has been doing a series on why physicians are slow to adopt electronic records.
The common perception is that they are expensive or ludditic doctors are desperate to cling to paper charts.
The main problem is that the current crop of EHRs are simply not ready for prime time. I recently read a story where doctors have their staff print out a patient’s electronic record for every encounter, then handwrite a note and have the staff scan it back into the computer.
Furthermore, the EHR learning curve ranges from a few weeks to a months, depending on how computer literate you are. When revenue is based on number of patients seen, the loss of productivity, compounded with the cost of the EHR, is financially crippling.
What a deal.
If widespread electronic record adoption is to occur, the following needs to happen:
i) EHRs need to make the doctor’s life measurably easier, and accomplish what the physician currently does in less time
ii) the cost and loss of productivity during the startup period needs to be reimbursed 100%
Until those conditions are met, the dream of universal electronic records will never be realized.
Update:
Someone e-mailed asking me for my solution. Here’s it is.
Implement open-source VistA in every physician practice in the country, free of charge. This will also solve the compatibility problems caused by hundreds of EHRs permeating the market that don’t talk to each other.
Give a stipend to each practice, equal to one month’s average office revenue, to compensate for productivity loss during the transition.
Voila, problem solved.
Related posts:
- Electronic records and productivity loss
- Funding electronic medical records and bailing out the Big Three automakers
- Why doctors are reluctant to adopt electronic records
- Do electronic medical records raise malpractice risk?
- Op-ed: Why doctors still balk at electronic medical records
- Poll: Will electronic medical records really save money?
- The low adoption rate of electronic records
{ 16 comments }
I will consider an EMR when it makes my life easier. Right now the EMR’s increase patient cycling time in the office. They are also so clearly designed to maximize reimbursement by populating the record with old data (Family and Social History, etc.) and Review of Systems that are entered through forms, scanned in by optical readers and never actually reviewed by anybody. One startling example: A cardiologist’s office note had a Review of Systems that indicated that the patient was homicidal and suicidal with no comment or intervention by the doctor. I’m afraid that kind of record keeping isn’t doing anything good for the future of health care. Lawyers might find it a potential gold mine, though…
http://acountrydoctorwrites.wordpress.com
Your dead on regarding the necessary conditions for widespread adoption.
Unfortunately we don’t just need widespread adoption of EHRs. We need a universal EHR with complete interoperability. One of the reasons our computer systems work so well today is because of the ubiquity of Windows operating system. This allows our computers to understand each other easily. With several hundred EHRs on the market, transferring records from one practitioner to another will become a nightmare once widespread adoption does occur. More effort needs to be put into coming up with an EHR system standard that everyone will be able to use.
We couldn’t agree more with the assertion that EHR propriety solutions are either too expensive or just plain difficult to implement in most practices and health care institutions. That is why Medsphere created OpenVista based on VistA, the military’s proven technology. The use of open source mitigates both of these main drawbacks and allows all groups involved to talk to one another. Rather than a prohibitive up-front cost, Medsphere uses a subscription-based pricing model that allows for much easier entry into the market and covers quality certification, support and all upgrades.
Making life easier for doctors doesn’t have to be the only endpoint. If it substantially cuts down on medical errors, then it may make sense to implement an EMR.
EMRs still have to get to the point where they don’t malfunction and are almost bullet proof, are easy to use, and integrate everything we do, before the benefit of increased patient safety is overcome by the problems of cost, usability, and system crashes.
In quick follow-up to my previous comment where I misspoke. OpenVista is based on VistA, the Veterans Administrations proven technology that should be seriously considered by the entire military.
Kevin,
Ever notice how all your “solutions” for what ails medicine always involve you getting more money or free stuff?
Your attitude is the result of what’s wrong with medicine today. Because physicians willingly choose not to be part of the free market, they don’t look at innovations from a dollars and cents standpoint. Your business senses, if you ever had them, have atrophied beyond belief from lack of use. All you know is that you make a pretty good living doing what you’re doing, and the only way you will change is when the entity, either govt or insurer, paying you forces you with their own cost cutting innovations.
Incidentally, the “main problem” you describe is not that much of a problem if one simply uses a tablet computer. Which is essentially a problem of ludditic doctors.
Kevin,
You ever notice that there are people who comment on this blog who don’t understand that if the government mandates something like EMR, Uncle Sam should pay for it? Why should docs lose money implementing a system that hasn’t proven itself to work?
And these same writers think we willingly don’t want to be part of the free market. Geez, if only Medicare would allow me to take care of elderly patients outside “the system”….
Who told you to sign up for Medicare? You sign their contract to take their money. You know what it entails or if you don’t you should read the contracts you sign closer.
Anon 6:22, what you don’t understand is the fact that when I take care of patients with Medicare in the hospital, I HAVE TO PARTICIPATE!!!!! Get it? I otherwise would be providing care for free. While I could go non-par with Medicare, I would only be allowed to receive 80% of the 95% Medicare allows – and the check goes to the patient!!!!! So – I HAVE NO CHOICE,and as a physician who practices critical care medicine, that specialty is not exactly an outpatient one…
So again, it comes back to YOUR choices. You have choices. You’ve always had choices. You had a choice in medical school to pick your specialty, one you apparently didn’t investigate very well.
You have a choice to spend more of your time lobbying your representatives for a better way of paying you, something you’re either not doing enough, or not doing very effectively.
And you’ve got a choice to do something different with your life. Unless you were practicing medicine in the 60s you knew, or should have known, the deal when you signed up to get paid by the government. Your predecessors made this deal with the devil, and you chose to follow in their footsteps. And now all you do is bitch about the deal you cut.
Man up and do something besides bitch or get out of it. Begging for more free stuff from the government like Kevin is doing won’t get you far.
I think the govt can help reduce overall healthcare costs by getting behind a universal eMR system. It would provide better continuity of care and reduce redundant work ups, especially for the pts with no stable PCP and float between EDs. If someone would crunch the numbers, it might come out in the govts best interest to help organize a universal eMR.
10:42, you are beyond clueless and tiresome. Insurance acceptance is certainly optional, in the same way eating is optional. Some patients will pay cash for the care they want, but not many. So you could go after those, and just starve, that is a choice.
I don’t see where there is an argument for free stuff, only the argument that if payers want doctors to buy expensive stuff, then they should be willing to pay for that stuff, or else be content with the stuff they are paying for now. And when the trend is to pay less, and certainly not more, don’t expect doctors to willingly embrace expensive technologies that don’t offer any benefit to those bearing the costs. Why that is so hard to fathom is difficult to understand; people scream bloody murder when their taxes go up without receiving improved services so why should this be any different? If patients really believe safety is improved by having EMRs, then vote with your wallets and pay for them.
Anon 10:42,
Try to understand something. Medicare patients will receive NO HOSPITAL CARE when docs drop out of the system. If that’s what you’d like, then fine. But when you are the Medicare patient in shock and on a vent, and there’s no one to take care of you, I wish you luck. And, by law, you’ll have to be on Medicare.
Sure they will. There will always be people willing to do that kind of work, just like there are always lawyers willing to work for low pay at NGOs or the public defender’s office. Will it be the absolute best care money can buy? Of course not, but that’s the case now. If you’re going to argue otherwise to me then you’re just propagating the myth that we are all getting (and should get) the exact same care.
” Insurance acceptance is certainly optional, in the same way eating is optional.”
People pay lawyers, engineers, accountants, etc. all without insurance footing the bill. None of those are cheap. The problem is you’ve been stuck in the system so long you don’t know any other way.
Let me explain how Medicare participation works, because you are clueless about it. This has nothing to do with commercial insurances – another issue entirely. I have 3 choices when it comes to Medicare. I can participate and accept what they allow – they pay 80%, and the patient pays the rest (or their secondary). I can go non-par and accept or not accept assignment – my choice – but I get paid less, and the check goes to the patient, who I then have to bill – not a great choice when you’re caring for hospitalized patients, because you can’t bill prior to services rendered in the hospital. Or I can drop out entirely. Any Medicare patient I care for has to have a prearranged contract signed, and not under emergency circumstances, so it can’t be done for hospitalized patients. I can’t refer the patient to a lab or to a doc who is in the system – that’s the law. And to have hospital privileges, I have to take Medicare. So what you suggest by docs not taking Medicare leaves all Medicare patients without doctors, especially in the hospital. Sure, it’s our choice, but I can’t wait to hear you screaming about lack of access when we all do drop out. Do you get it now? Uncle Sam has us by the balls. This is socialized medicine at it’s best.
7:58/ 10:42;
No they won’t. This is already happening in hospitals with specialists who have gotten tired of being stiffed nearly every time they are called to consult in the hospital or by the ER. That is what is driving these doctors to affiliate with surgery centers and specialty hospitals that don’t run emergency rooms.
You are whistling in the dark with your ideas that “there will always be people who will be willing to do that kind of work.” You indulge yourself in your own illusion that because things have worked so far that they will always work out (well even). There are minimum standards that doctors and caregivers have to meet, and expecting availability at sweatshop prices isn’t going to work.
Doctors don’t appear to fill every void as if by magic, even from India and Nigeria.
Accepting insurance is optional, but few patients with insurance will choose to go out of plan, even if they express a preference for an out-of-plan doctor. If there were such a thing as accountancy insurance, I am sure the same would apply there. Most patients with insurance see coverage not merely as indemnity but as an entitlement to not have any concern about costs or payment. Insurance companies sell their plans that way: go anywhere you want, no worries.
As for Medicare, the other poster is right. To have hospital privileges (and even a state license in some states) you have to participate with Medicare.
No, i don’t have to take assignment, but for hospital physicians, that isn’t always an option that allows a viable practice. Sure, you can try. You will go bankrupt.
With Medicare, I am not allowed to offer some of my services at the allowable rate but not others, even if those are market-competitive rates. I have to “opt-out” by written contract with that patient and by law, if I do so, I am also required to opt out with every patient who has Medicare for two years following. That is if I provide even one service to one patient. I am not allowed to price to my market. Worse, when I “opt out”, my patient gets no payment of any kind from Medicare, not even the amount they would have paid them had I not opted out. So the U.S. government, which taxed this beneficiary for support of Medicare is robbing the patient of his benefit, and is severely penalizing his freedom of choice.
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