From the mid- to late-2000s, lots of pundits got into the business of shoving electronic medical records (EMRs) down doctors’ throats. There were a few incentives from the feds to help with the upfront costs, but it was a pittance of what it really costed hospitals and physician practices. And there was no consideration made for the ongoing costs of EMRs, except for cuts in already skimpy Medicare and Medicaid payments if doctors and hospitals didn’t jump on the silicon bandwagon.
A recent estimate from the Medical Group Management Association is that health IT, including hardware, software, IT support personnel, and licensing fees, costs $32,500 per physician, which is 40 percent higher than 2009.
No payer has increased its fees to cover these costs. There are about 800,000 practicing physicians in the U.S. So (rough estimate) assuming this IT push has been going on about 10 years, and adding in the upfront costs, this means that the U.S. has spent about $250 billion on EMRs; $25 billion per year in ongoing costs.
And what have we gotten as a country from this top-down mandated expense? A meta-analysis of computerized decision support EMR tools found no difference in mortality or total cost of care, and some decrease in chronic disease morbidity, though “selective outcome reporting or bias could not be excluded.” A qualitative study of the role of EMRs in primary care found that EMRs can improve or worsen patient safety, especially when they “override the opportunities for face-to-face communication.”
I am not a Luddite. I do not have a blanket distrust of electronics. I own a recent model smartphone. But ask yourself this: If EMRs were so great and we live in such a technophilic country, then why didn’t EMR use naturally spread like smartphones or iPods? Why did outsiders feel the need to force us to use these klunky tools?
It’s simple. They cost a fortune, merely create extra mostly useless work for frontline caregivers to do, and improve little to nothing in our ambulatory care. I wish we could put the genie back in the bottle and start all over. Hey, a guy can dream.
Richard Young is a family physician who blogs at American Health Scare.
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