Stanley Feld M.D.,FACP,MACE
In 2005 the RAND corporation published a study stating the HIT through EMR can save the Healthcare System $81 billion dollars a year in a short period of time.
In 2009 the administration’s stimulus package put aside $19 billion dollars in the first two years and an extra $50 billion dollars over the next five years to stimulate and subsidize the adoption of Electronic Medical Records (EMR) to further development of Health Information Technology (HIT).
The RAND corporation’s 2005 study predicted a healthcare cost savings of $81 billion dollars a year.
The RAND corporation’s study was wrong. In the interim healthcare costs have risen $800 billion dollars
“In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT.”
Many EMR software development companies have reaped handsome benefits from the administration’s largess. These software companies have a strategic defect in common.
These companies are trying to transform the processes used in the practice of medicine into a process that permits the government to commoditize the quality of medical care.
If successful the government believes it could then “judge quality of care” and “pay for performance” accordingly.
The RAND corporation’s new suggestions are repeating the same mistakes that have failed.
“We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data.
Providers must do their part by reengineering care processes to take full advantage of efficiencies offered by health IT, in the context of redesigned payment models that favor value over volume.”
In the meantime annual health care expenditures in the United States have grown by $800 billion.
The new RAND study blamed the underperformance on several factors,
“Including: sluggish adoption of HIT systems, along with balky systems that are hard to use and aren't interoperable; and a failure by providers and hospitals to adjust care processes to better benefit from HIT. “
The RAND corporation is looking at the EMR problem from 30,000 feet. On the ground many private practices and hospital systems had previously installed information systems that cost them dearly and eroded those providers’ net revenue.
Money is the main impediment especially when reimbursement for physicians and hospital systems is decreasing. Presently, physician groups and hospital systems are struggling to remain solvent. This is partly from decreased reimbursement and partly from the cost of ineffective non-functional information systems.
A new capital expenditure of $65,000 dollars per physicians and $200 to $500 million dollars for hospital systems is unrealistic even with the government’s partial subsidy. The cost increases when maintenance fees are added.
Many hospitals simply do not have the capital to buy systems that can cost $20 million to $200 million, especially when so many are struggling to remain solvent. Hospitals also worry about high maintenance costs, an uncertain payoff on their investment, a lack of staff with adequate technical expertise and resistance from doctors.
In 2009 only 1.5 percent of 3000 hospitals had a comprehensive and fully functional electronic medical records system “ comply with meaningful use criteria.”
The meaning of meaningful use is all major clinical units in a hospital must perform 24 functions deemed important by a panel of experts.
The EMR should incorporate data points. It should include physicians’ and nurses’ notes in data point format.
The EMR must have the ability to order laboratory and radiological tests.
It must include clinical guidelines defining criteria for treating various conditions. It should contain alerts to avoid dangerous drug interactions and 20 other functions.
It is cookbook medicine all over again. The goal is to eliminate physician judgment.
On January 1,2013 only 11 percent of the hospitals had even a basic EMR system in at least one major clinical unit that performed 8 of the 24 functions.
Physicians have been slow to cooperate. Intuitively they know that a functional EMR might collect data that will be used against them,
The question is will the data improve medical outcomes, result in less medical complications and less morbidity and mortality? Will it increase or decrease physicians work hours or increase or decrease physicians’ net revenue?
“Pamela McNutt, senior vice president/CIO at Dallas-based Methodist
Health System, says HIT advocates were a little naïve early in the
"There was a bit of over-simplistic thought that if we just purchased and installed some software that suddenly everyone would start connecting and talking and it is premature," McNutt says. "Even people who have met high levels and are ready to meet Meaningful Use Stage 2 still have to work to get efficiencies."
McNutt says the whole idea of "efficiencies" in HIT is undefined.
have to talk about what are the efficiencies we are looking for," she
Accumulating data to judge performance should not be the goal. Judging performance does not necessarily increase efficiency.
The EMR should improve the physician-patient relationship. It should be for the patients’ benefit. It should not be for data collection to commoditize medical care..
The ideal EMR should be constructed through the eyes of practicing physicians and not through the eyes of bureaucrats and computer software companies.
It should be an EMR that is interoperable and compatible with physicians and patients needs not the administration’s needs.
The EMR should be cloud based.
It should be secure and protect patients’ privacy.
It should not result in a capital expenditure by physicians or hospital systems.
Provider would pay by the transaction.
It should not provide a financial burden to physicians and hospital systems.
It could be updated and maintained at no cost to providers.
It would turn an expense into a profit center for the government.
Why can’t the administration’s healthcare policy makers figure this out?
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.