Comments on: Electronic Medical Records: Salvation or Sinkhole?

By: Electronic Medical Records

Electronic Medical Records — Sat, 04 Oct 2008 09:50:57 +0000

yes I agree but you can get great information on many things on electronic medical records though it has disconnect between costs and benefits

By: BJ MD

BJ MD — Thu, 31 Jul 2008 18:39:24 +0000

>Why hasn’t anyone asked patients how much they would really pay extra for an electronic medical record? Aren’t they really the beneficiaries?

This, in fact, is the key question.

Let us suppose that I make and sell cars, and that the technology exists to equip the car with, say, a navigation system. I would be happy to make and sell cars if the amount extra customers are willing to pay for the navigation system is greater than the additional cost of including a navigation system. If customers are willing to pay $0, I will make 0 cars with navigation systems.

So we need to put the consumer in the game and find out what an EMR is worth to the customer. Pay $X to go to Doc Smith, who doesn’t use an EMR or pay $1.25(X) to see Doc Jones, who does use an EMR.

I strongly suspect that when push comes to shove patients aren’t really willing to pay much for an EMR. This is like if consumers were willing to pay $5 for a navigation system, there would be very few car makers foolish enough to include them.

And I see little reason for docs to use capital to purchase equipment like an EMR that does not add to revenue when the same capital could be used to add diagnostic equipment that will add to revenue.

Further, I see little reason for docs to agree to spend uncompensated resources to enter data into some database. Where is the ROI?

Just about anything is available for a price. The problem with healthcare IT is that lots of people want docs to do a bunch of extra stuff, but nobody wants to pay them to do it. That flies in the face of economic reality and is thus a fool’s errand.

By: electronic medical records

electronic medical records — Thu, 26 Jun 2008 09:09:23 +0000

Thanks for the great stuff.Yes, i agree with that there is some disconnect between costs and benefits.The answer is that there is a disconnect between those who have to pay for Electronic Medical Records and those who benefit from them.

By: Michael D. Miller MD

Michael D. Miller MD — Thu, 19 Jun 2008 17:48:39 +0000

Alan & Ben - Thanks for the great real-world comments. I talked with an old friend recently whose mid-sized group practice is part of a demonstration project for implementing EMRs. He noted that while they got the hardware and software for free (state grant), their cost has been huge in terms of time and lost productivity - and they haven’t seen gains in quality or better billing revenue. He also told me that the local efforts to link medical records into a information database/warehouse type of operation was off to a very poor start - it turns out that the warehoused data is all being captured from billing information from the EMR, rather than actual clinical data - so if anyone looks at it for real clinical purposes they likely will get a skewed understanding a the patients actual medical problems, etc.

While everyone agrees that EMRs (and other HIT applications) have great potential - but they still have very, very large barriers in the form of financial investment and implementation/training time. I think the hope is that as the technology improves, the costs and ease of use will make it more attractive, and that the ability to use the systems for wider clinical care and quality improvement will also improve. Only time will tell.

By: Ben Coopersmith

Ben Coopersmith — Thu, 19 Jun 2008 14:25:27 +0000

As a medical administrator for a small practice, I find the challenges of an EMR daunting. From a cost perspective, they make little sense for single site facilities with fewer 1-3 doctors. Why would we spend $10-20,000 for licensing with recurring fees of $2000-5000 per year (plus thousands in conversion fees) when we can make capital investments in equipment which will reap definitive financial rewards and will also increase pt. quality? Capital infusion is scarce and most of the proponents of EMR systems do not realize how much capital this uses up without demonstrating real returns. When a doctor offers new services or enhances existing services with newer and better equipment, doesn’t this too add to pt. quality? The biggest hurdle for these systems is that they are simply too expensive for small practices to bear and the benefits are still too small. Until the cost is picked up by the true beneficiaries (large insurers, Medicare, patients?), the technology is made simpler and is truly standardized, and the benefits are demonstrated convincingly (or the practice is at a competitive disadvantage), there will be little penetration in smaller practices.
Why hasn’t anyone asked patients how much they would really pay extra for an electronic medical record? Aren’t they really the beneficiaries? Why isn’t there a surcharge on insurance premiums to fund these “necessary” services? In theory, we all support this initiative because it makes sense from a macro-economic perspective; however, on a micro-economic level it often fails miserably. If someone can bridge the gap, I am all ears!

By: Alan Curtis

Alan Curtis — Wed, 18 Jun 2008 21:10:47 +0000

I have been in the records management business for 25 years and have participated in automating records systems for every major industry. In the financial field records systems are ubiquitous. In manufacturing they are necessary for competitive advantage. It is amazing to me that the US medical profession is so far behind. The President’s advisory board and the medical associations are trying to make this a very complicated and expensive proposition. Even a small practice can justify the expense of an EMR system. The argument that different EMR’s can’t share information is antiquated. In other industries we integrate these types of systems all the time. If the federal government would define what constitutes the information to be collected in an EMR, then sharing that information would become a simple matter. A standard EMR would allow technology companies to package software and hardware which would be affordable and convenient to install and use. The biggest cost will be the conversion of old paper files to electronic. The easiest and least expensive approach is a “day forward” EMR system for new patients establishing a practice of scanning old files each time they are removed and used. In this way the practitioner will have a complete system in a short period of time. The software and hardware can be provided on a lease to purchase basis for 3 -5 years. Just the elimination of paper file space and coping costs will pay for the system many time over.

By: Michael D. Miller MD

Michael D. Miller MD — Sat, 31 May 2008 15:16:14 +0000

Great thoughts Gary. Here in the US, the term people are using is “Health Information Exchanges” or HIEs, rather than NMD. Local HIEs are being set up as part of the Massachusetts pilot projects. Other states and localities have HIE initiatives - some have been successful, but others have folded. The major challenges for HIEs are 1) the ability of the HIE to accept, integrate, and distribute patient information when the individual clinicians and hospitals have different electronic records systems; 2) Clinicians being willing to participate in these systems, and 3) Patients authorizing their information to be included in the HIE system. In close-knit communities (like Northwestern Massachusetts) these challenges are being met, but in other areas of the country it is harder to make this happen. Some have proposed the single system requirement where there would only be one EMR platform (as they have in the UK and with the VA), but I don’t think that is realistic here in the US - nor do I think it is a good thing.

By: Gary R. Gibson, MD

Gary R. Gibson, MD — Sat, 31 May 2008 02:00:47 +0000

A national medical database (NMD) will revolutionize medical care in the United States. There is no excuse for delay. In the UK, there is a general practitioner medical database that contains records on over 13 million patients, and it is a tremendous resource for clinical information. It has been in use for 14 years. Other nations are building NMDs.

Doctors need to be able to submit records to an NMD and retrieve records relevant to the patient they are treating. This will be most valuable to doctors who serve patients in primary care and various medical specialists (nephrology, rheumatology, oncology), emergeny medicine, hospitalists and least helpful to certain procedure-oriented specialties such as gastroenterology, cardiology, dermatology, plastic surgery, opthalmology and orthopedics. The net effect on an NMD will be to synthesize a patient’s records over a lifetime into one coherent whole, from which doctors will access and contribute to information. Better health care at lower cost will result.

We will have a hard time explaining to the children of the next generation how it was that computer technology was pioneered in the US in the 1980s, that credit scores and automobile vehicle repair histories were available with several keystrokes in the 1990s and it was not until decades later until a national medical database revolutionized health care and accelerated the evolution of useful clinical knowledge regarding the effectiveness of tests and therapies. Medical care prior to a NMD will look like the dark ages of medicine by comparison.