Stanley Feld M.D.,FACP,MACE
There is no shortage of opinions about the value of EMRs. There are a lot of intelligent people writing about the advantages and disadvantages of the Electronic Medical Record.
No one has figured out how to break the physician resistance barrier. If someone would develop an EMR that would add value to the advantage of the physician and the patient, utilizing an easy learning curve, I think the universal EMR would spread like wildfire.
First, we need an enlightened and respected leader who could force the healthcare system to face its problems, namely the inefficient costs of administration, price opacity, lack of systems of care for chronic disease, and the lack patient control of their healthcare dollar.
The inefficiencies of administration of the healthcare system by facilitator stakeholders waste $150 billion dollars a year. I can understand why a facilitator stakeholder such as an insurance company or hospital resists eliminating this waste. There is a large profit margin in waste. In order to protect this income generating inefficiency, multiple excuses and barriers to fixing the waste are constructed. These stakeholders always seem to blame the physicians and the patients for the waste.
The following two comments from nationally prominent physicians sum up the problem and perceptions about EMR of most physicians.
The first comment is from a nationally prominent specialist who at one time was the head of a 300 physician multi-specialty IPA (Independent Practice Association). He subsequently headed a large single specialty group of physicians. He had start up experience with EMRs in both practice groups. His view is cynical but in my opinion accurate.
“Stan,
The EMR is expensive awkward technology. EPIC possibly the most widely developed (in part owned by Kaiser I believe) is not user friendly, requires much administrative support and has so many bells and whistles that users empirically incorporate their own mini user protocols, essentially defeating the purpose. I disagree that physicians are particularly computer literate and believe that cost and the fact the technology is still awkward and non-standardized is a barrier. Someone is going to need to underwrite or give physicians the technology, and it better not be the VA EMR which Medicare was at one time proposing to roll out. Of course, if the technology is provided, the giver will want to be able to puts its nose under the tent and gain information, consistent with HIPPA's provisions.
Will EMR improve patient care and safety? No question it will but I suspect it will take 25 years. Will it generate information that may or may not result in physician disincentives, possibly? Very difficult for me to believe EMR will ultimately result in benefit as defined by current vendors. New generations of physician users, however, may believe there is benefit and be unaware of the coexistence of physician disincentives.”
Those developing EMRs should pay attention. No one has developed an easy to use and inexpensive EMR. No one has explained the multiple values of the EMR measurement. Only negative and costly experiences linger. The key questions not asked are who the real customers, and what do the customers really need. In the mind of most EMR vendors the hospital, government, insurance industry are the real customer. These are the stakeholders that have the money. Physicians and patients do not have the money to invest in an EMR.
I was told this 12 years ago by the head of the medical informatics division of a large corporation. I told him his focus in my opinion was dead wrong. I predicted and his EMR would fail. It has not succeeded although they have generated some very painful experiences for all the stakeholders.
The healthcare system needs the development of an EMR that will satisfy the needs of the physician and the patient. It must be user friendly and augment rather than hinder the physicians daily work flow. The EMR can not be punishing nor have a steep learning curve.
An ideal EMR would be one we did not buy. The needs of the physician and patient would be clearly defined. The EMR would be paid for by the click, just as you pay a credit card company for adjudicating a purchase. There is no reason the patients insurance claim could not be adjudicated immediately with a credit card. The physicians would not have to pay for endless upgrades and improved interfaces. The EMR vendors would pay for their mistakes, not us. There would be continuous quality improvement in the software system at no up front cost to the user. The system would be a heavily encrypted web based system for privacy. The patient would own their own data. It would be totally portable. The more the physician uses the EMR and its financial packages the more the physician pays for its use. The patients' electronic medical record would have to be connected to the patients' financial history in order to evaluate medical outcomes appropriately. EMR’s will not succeed until some creative vendor realizes this and can get over his own bureaucratic hierarchy. There should be no penalty to abandon an EMR that does not work well for the patient or the physician.
The second note is from another prominent leader in medicine. He is describing the core of the problem in the healthcare system. Until we abandon our legacy systems designed to protect facilitators stakeholders’ vested interests, we are not going to get anywhere in repairing the healthcare system. We will continue to generate million dollar plus salaries for insurance company CEOs and hospital administrators who add no value to the medical care system.
“Stan
My own opinion is that, until our government guarantees adequate health care access and cost/coverage to all Americans and requires transportability of medical records for all without casting the cost for this onto the physicians, we will continue to have the same mess we now have.”
I do not think Nancy Pelosi has a clue about what needs to be done. Remember, the government is not going to solve our problems. The primary stakeholders (the patients and physicians) must solve our problems.
The government’s job is to create the conditions for patients to be responsible purchasers of healthcare with their own money in a totally price transparent environment. Then, and only then will price and quality competition take place among physicians and hospitals as well. At that time, adoption of an EMR to increase efficiency, decrease expenses and increase quality will make sense to physicians and hospitals. The EMR will be driven by the patient demanding a lower cost vendor in a price transparent environment with improved quality of care. The ideal MSA would encourage the use of the ideal EMR.
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