Doctors Wary of New Health IT

By Frank Pasquale
In Electronic Medical Records
March 17, 2011
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pasquale_frank_lg11The Washington Post recently featured Lena Sun’s reporting on why many physicians are wary of adopting an electronic medical records system.  As noted in the piece,

Many are aware that beginning this year, health-care professionals who effectively use electronic records can each receive up to $44,000 over five years through Medicare or up to $63,750 over six years through Medicaid.  But to qualify, doctors must meet a host of strict criteria, including regularly using computerized records to log diagnoses and visits, ordering prescriptions and monitoring for drug interactions. And starting in 2015, those who aren’t digital risk having their Medicare reimbursements cut.

Deven McGraw, director of the health privacy project at the Center for Democracy & Technology, complains that, despite all these requirements, patient confidentiality concerns are being neglected:

But no federal regulations clearly require that doctors turn the data encryption on or prevent those who don’t do so from getting paid. . . . “This is a point of frustration,” said McGraw, who sits on an advisory group that sought unsuccessfully to prevent those who violate privacy regulations of the federal Health Insurance Portability and Accountability Act, or HIPAA, from getting incentive money.

Some older doctors may find it easier to retire than to get on board with new EMR systems.  We frequently hear complaints about Luddite doctors resisting technology that has long been adopted by other sectors.   But, as one commentator recently insisted, a doctor is not a bank.  To get a sense of how frustrated doctors can become because of the new health IT (and the legal contracts that accompany it), check out this parody website for the faux firm Extormity.  It announces a memorable experience for doctor clients/conscripts:

At the confluence of extortion and conformity lies Extormity, the electronic health records mega-corporation dedicated to offering highly proprietary, difficult to customize and prohibitively expensive healthcare IT solutions. Our flagship product, the Extormity EMR Software Suite, was recently voted “Most Complex” by readers of a leading healthcare industry publication.

I loved this description of a firm committed to maximizing the value of it’s intellectual property:

The Extormity EMR Software Suite is built on a proprietary software model renowned for its complexity. This proprietary platform and all of its components must be procured and implemented as a complete package we call the Extormity BundleTM (which describes both our comprehensive package and its associated cost).

Operating the Extormity Bundle requires a phalanx of servers, which of course need to be replicated for redundancy. Fortunately, Extormity acts as a value-added reseller of these servers, which we pre-load with operating software. This allows us to mark-up the cost of the servers and charge for server configuration. In addition, the server software carries with it steep annual license fees.

Let’s hope the ONC’s ongoing regulatory process can help reduce the risk of Extormity-style raw deals for doctors. Given the recent flap over the FDA’s effective imprimatur for an extreme drug price increase, no DC agency should set in motion a process that could lead to prohibitively expensive fees for an essential aspect of health care.

X-Posted: Health Law Prof Blog.

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