Refuting RAND: Why I am optimistic about EHRs

I recently read an article on the RAND Corporation’s analysis of electronic health records (EHRs). As a practicing pediatrician currently using EHRs, and given the reality that EHRs are still a relatively new addition to the U.S. medical profession and have created a fundamental shift to the care delivery process, I am compelled to respond to assertions made in this article.

The first RAND study, sponsored by a group of large corporations, was looking to find out whether there would be potential savings for health care if EHRs were implemented. The study predicted there would be large health care savings; in turn, some of these same corporations went about developing software to fill this niche and then, went on to market them. Apparently these cost savings have not yet been realized.

I am not sure why this is a surprise. It has only been about 7 years since the study was done and EHR adoption has been slow up until very recently when physicians were offered government incentives to jump on-board. If health care was one big corporation, the expectation would be a considerable time gap between capital expenditure and return on investment. In light of this, I find it interesting that the authors of the study were surprised that they have not found the “productivity and quality benefits” they were looking to find. We probably need to wait another 5 to 7 years to reap the benefits of this transcendent change.

Another issue discussed in the article relates to corporate responsibilities. Two of the companies mentioned face lawsuits for failing to meet goals and abandonment of their provider clients. In many cases, companies have held physician practices ‘hostage’ by making changes to their EHR system and then charging customers exorbitant prices to receive the upgrades. Both physicians from small practices and large hospitals are on the hook as these EHRs develop and morph into – what we hope – will be improved products.

As a physician, I started looking at EHRs in the mid 2000’s. I found companies making very intricate and very costly software that need to be purchased with large cash outlay for servers, software, hardware, training, and hiring of IT support staff. It was overwhelming. After an exhaustive search, I chose a (at the time) young and not too well known cloud-based company; it required only an Internet connection and a laptop.

This worked well for me. It didn’t cost my practice a king’s ransom and we worked and still do work, hand-in-hand with the company. In fact, they only make money if our practice makes money. It’s a symbiotic relationship that allows me to focus on patient care, be more efficient, and maintain more control over my practice’s operations.

The authors of the RAND study focused on the potential downsides of EHRs in general, and not on the differences among them. Had they conducted the same search I did several years ago, they might have discovered the greatness of next-generation EHRs.

For one, even though I am physically a part of a seven-physician practice, I effectively work with thousands of other pediatricians from all over the U.S., using a cloud-based EHR. I can mine my own data by creating a report right from within my laptop or I can work with another group of pediatricians from Texas or California. We can run the same report and find out that a certain medication is working better than another to treat a particular illness. The “cloud” as its called gives me access to non-identifiable data from almost 40,000 other physicians.  My EHR can see trends on flu outbreaks or pertussis with the push of a button: that’s value. These types of EHRs have vast power for using data to monitor health care and trends. This will certainly result in health care savings and efficiencies, but it will take time to reach its full potential.

The author also takes on the issue of Health Information Exchanges. Basically this is the ability for one system to talk to another electronically via a cloud-based communications. There are huge security and confidentiality dilemmas that will need to be resolved to get these right, but when they do, the mass of health records will be able to be sent in seconds from one provider to another with fewer errors and with less cost. I believe when this occurs, those savings the RAND study predicted will become a reality, physicians will become more productive and patients will get better and more efficient health care.

I encourage other physicians who may have read the RAND study and felt disheartened to continue to evaluate their options, tell vendors what they really want from their EHRs.  Know that we are turning an important corner in creating a new model of care that is going to reduce costs, keep physicians in business and eliminate inefficiencies in the current system.

Sally Ginsburg is a pediatrician and is a regular contributor to the athenahealth blog.

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