Report explains doctors’ reluctance to adopt EMRs

Writing for the Center for Public Integrity’s iWatch News, Susan Jaffe spent time in the trenches to better understand how government incentives toward the adoption of electronic medical records are (or aren’t) working. She spent time with Cleveland-area small practices and government agencies to understand the real obstacles faced by physicians on the ground. It offers a picture of the reality of EMR today. Some of my favorite tidbits:

  • “570 different electronic health systems certified by private organizations for non-hospital settings may be used to qualify for the bonus.”
  • “The systems are priced in a way that does not make comparison shopping ‘easy or necessarily valid,’ said Dottie Howe, a spokeswoman for the Ohio regional extension center. There is no basic price because each company offers different components, features, options, and level of technical support.”
  • EMR systems can include more than a thousand sometimes-customizeable details, and that’s not including the myriad warnings and cross-checks.
  • Compatibility with the systems in the area’s large hospitals is tough to guarantee, yet factors as a major concern for many small practices.
  • How early adopters in the field were burned and are wary of getting fooled again.
  • When practices adopt EMRs, they typically have to go through a “learning curve,” a period of weeks or months during which they can only see about half as many patients.
  • Many major HIT companies don’t guarantee that physicians who adopt their systems will meet the standards for a government HIT bonus.
  • The VA’s proven HIT system is available for free, but can’t handle billing and insurance.
  • To get the maximum bonus payment, practices must adopt EMRs this year or next.
  • Only certified systems can earn bonus payments, yet the second and third stages of certification haven’t even been finalized yet.

An accompanying piece by Emma Schwartz looks at one physician’s concerns.

1 thought on “Report explains doctors’ reluctance to adopt EMRs

  1. Joseph Conn

    Susan did a fine job maintaining a skeptical approach. EHRs will be a challenge, particularly for the 500,000+ office-based physicians, a majority of whom still don’t use one. Just a couple of points, however. I’ve been writing about health IT going on 11 years in August and I’ve not only heard about their potential, I’ve seen what they can do in practice, and it’s impressive. There is no way we’ll be able to get soaring healthcare costs under control or maximize the safety and efficacy of our healthcare system without them. The VA’s VistA electronic health record system was designed for use in the VA, with work on it beginning in 1977. The VA has its own insurance component, so it really didn’t need to bill anyone. Recently, however, there have been billing systems created for or interfaced with VistA as entrepreneurs and some not-for-profits have developed VistA versions and helped VistA migrate into the private sector. See Oroville (Calif.) Hospital and Midland (Texas) Memorial Hospital for examples. But while most of the VistA software is available free of charge from the VA under FOIA and from not-for-profit WorldVistA (I have a copy on a CD Rom on my desk..) it still costs money to install, configure and maintain it. So it isn’t free.
    Also, the physician in the video above is right, there are going to be all kinds of messes, including, unfortunately, errors induced by or linked to, EHRs. They’ve been document since at least 2005. Still, researchers are only just now developing the vocabulary to categorize and count EHR-related errors. (This happens with any new technology, however. As an aside, NPR this morning had a program about errors with GPS systems in automobiles, one of which was linked to the death of a young boy in Death Valley.) But IMHO, there is a preponderance of research available that EHRs, if configured and used properly, will reduce preventable medical errors and even help constrain rising healthcare costs. The VA is a national leader in this field, but it is by no means alone. Nice work, Susan.

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