Sorry, Obama: EHRs won’t save money

Sorry, Obama: EHRs won’t save money

Pediatricians have been among the more conservative medical specialists when it comes to electronic health record (EHR) systems: Results of a 2005 Medical Economics survey showed that only 16% of pediatricians use an EHR in the office, compared with 20% of family practitioners and 22% of internists.

However, the American Recovery and Reinvestment Act of 2009 provides $17 billion in incentives for health providers to switch to EHRs. The package also includes $2 billion for the development of EHR standards and best-practice guidelines.

Given that some if not all of the cost of migrating to an EHR system will be assumed by Uncle Sam, we can expect many pediatricians to at least consider EHR. Others will continue to wait until the finer details of the stimulus plan subsidies are released.

As a longtime user (and reviewer) of EHR systems, I believe that the government’s assumption that EHRs will help save billions in health care costs–through improving efficiency and reducing the number unnecessary medical tests ordered by physicians–is incorrect. The EHR is nothing but a new and evolving tool for documenting medical care. Like any new technology it is in the process of evolving, and when it comes to EHRs, we have a long way to go.

From a user’s perspective, EHRs help us write more legible notes, but at the cost of decreased efficiency. While reducing some medical errors due to legibility issues, they also introduce the opportunity to create a variety of new unique medical mistakes, such as documenting in the wrong record, or prescribing the wrong dose of medication. The majority of enterprise EHRs I’ve used actually decrease the staff and physician’s efficiency. In my pre-EHR days, I could easily see 30-plus patients in day. Now, while using an HER, I am lucky to see 25.

Perhaps the most frightening thing about government involvement in the EHR market is that we might all be made to use one EHR system across all specialties, with records available to medical oversight by a government “agency.” This will undoubtedly have the effect of increasing costs, since we’ll strive to further improve documentation (resulting in fewer patients being seen), and increasing the number of medical tests ordered to justify our diagnoses.

What’s your take on EHRs? Weigh in below.

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How to successfully plan and implement an EHR | EHR Plans

How to successfully plan and implement an EHR

Hiring outside help, purchasing quality hardware, and getting staff buy-in all important in this phase of adding technology

Buying quality hardware, hiring outside help, and getting buy-in from the practice staff members were three of six key ingredients that helped ease challenges associated with an electronic health record (EHR) system implementation, according to primary care physicians participating in the Medical Economics EHR Best Practices study.

In a recent Medical Economics survey, 30 of the physicians participating in the study were asked to identify key factors that helped them prepare for this implementation. Although the responses varied, the study participants offered this advice:

  • Hire a scribe to help with data-gathering and the creation of templates.
  • Identify one main resource person at your vendor to help guide you through the implementation process.
  • Research and buy quality hardware that supports the EHR. “Cutting corners on hardware is penny wise and pound foolish. The stress, service calls, and cost of upgrades more than offsets the extra cost of buying good hardware,” says Dana Simpson, MD, of Life Center Family Medicine in Summerville, South Carolina.
  • Get buy-in from your staff before implementing.
  • Establish a timeline to complete online training each week before implementation.
  • Set up weekly telephone conference calls with the vendor’s implementation manager to discuss progress, troubleshoot problems, and answer questions.

During the implementation phase, a majority of the study participants contracted with professionals outside of the practice to help during the implementation.According to the survey, 44% of the participants contracted with an information technology (IT) professional or an IT firm, 12% hired other outside assistance, and 8% paid for assistance from a regional extension center.

More than 60% of the survey respondents report that the implementation negatively affected patient flow. And although the unanticipated costs now average $3,094 among study participants, 85% of the respondents say no out-of-pocket charges were billed by vendors.Training was cited by many of the study participants as being a crucial to implementation success, but survey respondents were split about whether their staffs were adequately trained for the EHR implementation. In contrast, nearly 63% of respondents said the doctor was adequately trained.

Only 54% of the respondents identified the practice as having a “super-user.” About 46% of the study’s respondents report that the system’s training modules did meet their expectations. (The other 54% of respondents said they did not.)

Study participants where asked whether they have been able to integrate some of the interfacing features of their systems. The results include:

Images (scanned documents)
Yes: 52%                 No: 48%

Laboratory findings
Yes: 35%                 No: 65%

Billing
Yes: 40%                 No: 60%

Scheduling
Yes: 68%                 No: 32%

Hospital interface
Yes: 0%                 No: 32%

E-prescribing
Yes: 73%                 No: 27%

Health information exchange
Yes: 8%                 No: 92%

Compliance with the Health Insurance
Portability and Accountability Act
Yes: 68%                 No: 32%

Medical equipment
Yes: 8%                 No: 92%

When asked whether software vendors met their expectations, 42% of respondents said yes, but 39% remained undecided. Another 19% said vendors did not meet expectations.

Despite some of the negative views about implementation, the majority of the survey participants report making progress in the EHR implementation, according to the Medical Economics survey.

In the most recent survey, 82% were e-prescribing and 74% were able to maintain an active medication list. Just 19% were able to implement one clinical decision support rule, and 7% were able to exchange key clinical information among providers of care and patient-authorized entities electronically (see table).

Participating vendors

ABEL Medical Software….. www.abelmedicalsoftware.com
Amazing Charts….. www.amazingcharts.com
Aprima…. www.aprima.com
athenahealth….. www.athenahealth.com
CureMD….. www.curemd.com
McKesson Physician Practice Group…. www.mckesson.com
MedNet Medical Solutions….. www.mednetmedical.com
Practice Fusion…. www.practicefusion.com
Vitera…. www.viterahealthcare.com