Monday, June 23, 2008

Electronic Medical Records: They Only Work If You Use Them

The positive effect of implementing electronic medical records (EMRs) is well documented through a number of studies and sources. It is a fundamental axiom of the move to reconfigure health care in the U.S. so that the system actually works.

Steve Lohr at The New York Times has done some digging around on the subject investigating why EMRs have not made more of an impact as of yet. His findings turn out to be pretty intuitive: they don't work if they are not being used.

Via The New York Times:

The national survey [by the New England Journal of Medicine] found that electronic records were used in less than 9 percent of small offices with one to three doctors, where nearly half of the country’s doctors practice medicine.
Suddenly certain aspects of our situation snap into sharper focus. If half the country's medical providers are not using EMRs, that would certainly be a large factor. Once Mr. Lohr starts digging, he finds that the bugaboo to implementation is one we have expounded upon frequently in this blog: cost. To pull another quote from The New York Times:
Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care system. The slow adoption of the technology is mainly economic. Most doctors in private practice, especially those in small practices, lack the financial incentive to invest in computerized records.
One doctor from a small, three physician practice in NJ is quoted as saying that he has explored making the jump to a digital system and found the expense prohibitive. According to his statements, converting their practice would take $15-20 thousand dollars per physician to implement, a level of cost that places it firmly out of reach for both him and his partners.

So this is the part of the post where the subject of market forces comes up, as it always does when speaking of national level subjects and financial expenditure. This is the part of the article that begins to get really interesting.

"We have a broken market for electronic health record adoption because the people who gain financially are not the people who pay," said Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a nonprofit medical group that includes Massachusetts General Hospital in Boston.

To fix the market, Dr. Middleton, like others, recommends that the government play a role in providing incentives or subsidies to speed the use of computerized patient records in the United States, whose adoption rate trails most developed nations.

The government took a step in that direction last week, announcing a $150 million Medicare project that will offer doctors incentives to move from paper to electronic patient records. The program is intended to help up to 1,200 small practices in 12 cities and states make the conversion.

This looks like a one-two punch straight out of George C. Halvorson's book! Two points that he stresses in Health Care Reform Now! are the need for EMRs and the perverse nature of the financial incentives utilized by our health care industry. If we can reconfigure incentives in this fashion and use them to fix the system rather than continually erode it, we will have taken a giant step towards bringing health care to all of our citizens!

SOURCE: "Most Doctors Aren’t Using Electronic Health Records" 06/19/08
photo courtesy of john norris, used under its Creative Commons license

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