Stanley Feld M.D. FACP,MACE
The promise of the Electronic Medical Record (EMR) is fading for physicians and patients. The EMR was supposed to reduce the cost of medical care, improve quality of care, improve physician communications, reduce duplicate testing and improve efficiency of care.
I believe EMRs can accomplish all of the above goals but not with their present rollout format.
In 2009 President Obama declared that EMRs,
President Obama's estimate is a little higher than that of the Rand Corp. study on the same issue.
EMR’s have not accomplished its goals. EMRs have been a money-loser for most physicians.
EMRs bought by physicians and hospital systems in the past are not fully functional. Less than 20% of hospital systems and physicians practices that have fully functional EMRs
Physicians and hospital systems that already have EMRs will have to purchase new fully functional EMRs.
Physicians historically know that all data collected, whether accurate or not, has been used against them in the past.
They are hesitant to provide more data at their own expense that compromise the privacy of their patients and potentially harm their own reputation.
Physicians would be happy to participate in EMR implementation if the EMR improved their ability to serve their patients without a potential penalty.
It is clear the government and healthcare insurance industry want to control the healthcare system. The stakeholder who controls the data controls the healthcare system.
A recent survey from forty-nine community practices in a large EMR pilot study by the Massachusetts eHealth Collaborative studied the projected five-year financial returns on investment to physicians’ practices. It was published in Health Affairs.
"We found that the average physician would lose $43,743 over five years; just 27 percent of practices would have achieved a positive return on investment; and only an additional 14 percent of practices would have come out ahead had they received the $44,000 federal meaningful-use incentive."
Only a few practices would have had EMR’s that qualified for the Obama administrations meaningful –use incentives. The Obama administration’s criteria for meaningful-use are too strict and complex for EMR software that physicians can afford.
More amazing is that the only way for a practice to have a positive cash return on investment for their EMR is to game the healthcare system using their EMR. The resulting cost of medical care would rise.
“The largest difference between practices with a positive return on investment and those with a negative return was the extent to which they used their EHRs to increase revenue, primarily by seeing more patients per day or by improved billing that resulted in fewer rejected claims and more accurate coding.”
This does not constitute an improvement in medical care. It also contradicts the idealistic advantages of the Electronic Medical Record.
The survey concludes that current meaningful-use incentives alone may not ensure a positive return on investment from EMR adoption.
The survey’s authors suggest,
“Policies that provide additional support, such as expanding the regional extension center program, could help ensure that practices make the changes required to realize a positive return on investment from EHRs.”
The government and healthcare insurance industry’s goal is to reduce physicians’ reimbursement to those physicians that do not meet Obamacare’s imposed criteria for quality medical care. The controversial Independent Physician Advisory Board (IPAB) will set these criteria.
Many physicians in practice object to converting medical care into a commodity. Medical care is a very personal and complex interaction not taken into account by the rigid criteria.
I have said previously that about 50% of the therapeutic index (therapeutic effect) of a physician’s treatment is determined by the patient physician relationship.
"We need to move to EHR for a number of reasons, but if I am a small practice I am going to really think about a few things," she says. "One is how to decrease the cost of adoption and the cost of the system itself.
“ To the extent you can reduce the upfront cost that is going to help bring down the amount you have to figure out how to make up elsewhere.
Increasingly there are new models taking this into account for small practices to decrease the big upfront costs."
There are two basic issues, the cost of a fully functional EMR and the real purpose of EMRs. I believe both can be remedied.
The costs of an EMR to a medical practice can be paid for by the click. The data would be fully secured. The data would be available only to patients and their physicians.
Physicians would pay for the EMR by the click. The EMRs would be maintained and updated for free in the cloud.
The EMRs could not be used for penalizing physicians. It would be used for educating patients and physicians thereby improving the quality of care.
If there is a bad physician in the community, a way needs to be found to deal with that physician within his community. All medicine is local.
This is where a consumer driven healthcare system with public critique of physicians would be an effective deterrent to bad physicians.
The current healthcare system is defective. It has to be changed. Obamacare is making the business plan worse.
America cannot afford it becoming worse.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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