Electronic Medical Records: How to Prevent the Creation of a Costly High-Tech Tower of Babel
Manuskript von Aelfric dem Grammatiker, Szene: Der Turmbau zu Babel
Steve Lohr of The New York Times has written an article, “How to Make Electronic Medical Records a Reality” (a follow-up to “Health Care That Puts a Computer on the Team” 12/26/08) that it is well worth taking the few minutes requisite to read it.
Professors Sharona Hoffman & Andy Podgurski have published an article in the Harvard Journal of Law & Technology that should be on Obama’s nightstand. “Finding a Cure: The Case for Regulation and Oversight of Electronic Health Records” will take more than a few minutes to read, but for those charged with the responsibility of making the prospect of Electronic Medical Records a reality, it should be required reading–because, as the authors point out, we simply cannot afford to get this wrong:
The benefits of EHR systems will outweigh their risks only if these systems are developed and maintained with rigorous adherence to the best software engineering and medical informatics practices and if the various EHR systems can easily share information with each other. Regulatory intervention is needed to ensure that these goals are achieved. Once EHR systems are fully implemented, they become essential to proper patient care, and their failure is likely to endanger patient welfare.
The Journal article is essentially a map, designed to point out hazardous terrain and harness the resources at hand to effectuate a comprehensive Electronic Health Record system– and, through interoperability and regulated standards, to prevent the creation of a costly high-tech Tower of Babel. As the authors remind us, in this territory, malfunction and miscommunication can be deadly–and the concerns of the market are not necessarily coextensive with the common weal.
For those of us who have an interest in the subject, and are convinced that it is essential to have a comprehensive guide (if not a blueprint) for “how to get this right” — take heart–it’s here, and I highly recommend you take the time to read it–and then pass it on and up until it reaches that nightstand, if it’s not already there.
How to Make Electronic Medical Records a Reality
The NY Times article depicts the paucity of EMR use at present (17%) in terms of  ”market failure,” and points out that U.S. Government guidance and investment in growing (”jump-starting”) industry and technology is not novel. Lohr writes:
…computer technology and the industry really flowered in the United States. That happened in no small part because the federal government nurtured the market with heavy investment, mainly by the Defense Department, and by choosing standards, like the Cobol programming language.
Today, Washington is about to embark on another ambitious government-guided effort to jump-start a market — in electronic health records. The program provides a textbook look at the economic and engineering challenges of technology adoption.
Lohr correctly points to the chasm which exists in EMR usage between large practices and small, and the failure of the market to incentivize further usage by doctors in these smaller practices. Lohr states:
These larger groups have the scale to invest in information technology, and they are often insurers as well as providers, so they benefit directly from the cost savings. Yet these large groups are the exceptions in American health care. Three-fourths of the nation’s doctors practice in small offices, with 10 doctors or fewer. For most of them, an investment in digital health records looks like a cost for which they are not reimbursed.
It is that “market failure,” says Lohr that the Obama plan seeks to address. To that end, the legislation which has devoted $19 Billion towards this “jumpstart,” “calls for incentive payments of more than $40,000 spread over a few years for a physician who buys and uses electronic health records.”
The legislation also requires that this payment to doctors be in exchange for “meaningful use,” but thus far the term has been left undefined.
We addressed both of these concerns on this blog in mid-January in response to a post on Health Affairs by Dr. David Brailer, Chairman of Health Evolution Partners, a health care investment fund. Dr. Brailer suggested payment linked to use. We stated:
Brailer is right to make the distinction between “purchase” and “use.” No one wants to subsidize a high tech, dust gathering coat rack. He makes the point that “We should not incent physicians and hospitals simply to purchase electronic records. We get no benefit when a physician or hospital buys an electronic record. What we should do is reward the use of these tools as part of a patient’s care.”
What he fails to address, however, in this incremental ROI “pay for use” approach is what he characterizes as the “foremost barrier” to those “Rural hospitals, nursing homes and small physician practices” on the other side of e-med record chasm: initial capital outlay.
Considering the financial difficulties of many hospitals-and the chilled credit markets– it is somewhat difficult to envision how the gradual return on investment through “pay for use” will offer great affect for those medical service providers who, at present, have a “lack of capital to purchase and implement information tools.” It is not, however, hard to envision how such a continuous “pay for use” incentive would benefit those larger providers who have already implemented electronic medical record systems.
Additional payments each time they used what they have already invested in would, no doubt, provide an additional dividend which these typically larger providers would greatly appreciate. It is not at all clear, however, that such a program, requiring significant investments of capital–which may well not be available at this time–will lessen the “chasm” by any great measure.
As such, as we go forward to define “meaningful use,” let us remember that initial implementation itself is, at present, a barrier. “Incentives” to those who have already done what we want to be done are not incentives, they are rewards.
Initial capital outlay must be addressed– as must “use,” and, very importantly, technical support. In the words of Dr. Farzad Mostashari, an assistant commissioner in New York City’s health department and head of the much heralded Primary Care Information Project (which is functioning as a sort of I.T. Department for many of the City’s doctors using EMR), “There’s no way small practices can effectively implement electronic health records on their own. This is not the iPhone.” The stimulus legislation calls for the creation of “regional health I.T. extension centers.” As Lohr points out, the administration would do well to look to NYC.
Have EMR’s ever, ever?, been shown to increase quality or care or decrease costs? You’d be hard pressed to find any *scientific* data to support either. Turns out, the medical record is only a small part of overall medical management/care. Looking for a Magic Bullet? Keep Looking.
Keeping your patients personal information safe is a very important task, we must protect the client’s privacy and prevent anyone from ever viewing these records without the expressed permission of the client.
When choosing a doctor to take care of your medical needs you need to make sure that the doctor that you trust your most personal information to is keeping that information safe and secure. I am not too sure about the news that Walmart will be selling Medical Billing Software, makes me a little nervous knowing that anyone with a few dollars can go into walmart and get the software. What if this software gets into the wrong hands, many people’s lives can be at stake.
This is a very interesting post onIT and health care joining together for maximum efficiency t. I still believe that our private info should not be transferred digitally, only stored digitally and not connected to the web in anyway.
Check this out , pretty disturbing already
http://www.nextgov.com/nextgov/ng_20090227_9147.php