Volume 10  Number 3  October 4, 2013
Second Opinions

THE ELECTRONIC MEDICAL RECORD: Promises and Perils I

An error in the premise will appear in the conclusion.

Baxter's Law (Anon.)

Nothing is so dangerous as being too modern; one is apt to grow old-fashioned quite suddenly.

Oscar Wilde

The science fiction writer, Neal Stephenson describes how political systems have always been subject to "power disorders," sudden deviations or disequilibria in which "certain groups or persons" suddenly concentrate a lot of power and abuse it. Today, perhaps, one could broaden Stephenson's groups and political systems to include the Internet itself in some of its endless applications, as a "techno-political" power disorder profoundly affecting the practice of medicine. Or it this merely one of many pathologies afflicting our present system of health care, including, but not limited to conversion to electronic medical (or Health) records ("EMR", "EHR")?

A Brief History

In 2005 the influential RAND Corporation issued an exceedingly optimistic report, widely praised within the technology industry, predicting that widespread use of electronic medical records could save the United States health care system at least $81 billion a year, a figure RAND now admits to being overstated (though hardly impressive in today's healthcare economy). The report, paid for by a group of companies, including General Electric and Cerner Corporation, helped propel an explosive growth in the electronic medical records industry. After years of behind-the-scenes lobbying by Allscripts, Cerner and other companies, the efforts finally paid off. In February, 2009 the Obama administration and Congress authorized billions of dollars in federal stimulus money to help hospitals and doctors pay for the installation of electronic records systems.

Today, as doctors and hospitals struggle to make new records systems work, Allscripts, annual sales have more than doubled since 2009 to an estimated $1.44 billion last year while Cernerís revenue has nearly tripled in eight years to a projected $3 billion this year (Google yields 13.8 million results using the search term "EMR").

According to Kalorama, a New York City-based research firm and probably the top healthcare database, six companies earn over half the $17.9 billion revenue in the EMR/EMH market.

Who's Going Paperless and What's the Cost?

By 2015 the federal mandate to switch to electronic health records (EHR) will effect almost 30% of American physicians still using mostly handwritten charts. Presumably, 70% of physicians and hospitals are already being enmeshed in the digital record-keeping world. If you want to be blown away by the complexities of the law, try decoding the regulations. These mandates, many still unfinished, define how health care providers qualify for Medicare and Medicaid EMR "meaningful use" payments under The Health Information Technology for Economic and Clinical Health (HITECH) Act.

The change to electronic medical records systems is heralded as bringing "compelling" benefits in the form of more efficient care, easier billing, and establishing the ability to access and share patient records from any location. All of these advertised advantages presumably will bring better patient outcomes and, (and, of course, save lives.) This is a good spot to recall that old adage, "Just follow the money."

As to who's going paperless, it's not just the 70% of doctors and most hospitals who think they're already in the game, let alone the others who haven't tip-toed-or jumped in yet. For starters think upfront costs of software licenses, additional computers, and the process of converting paper records to computer databases and how far to go back to begin data entry (certainly years for some chronic patients.) Conversion is estimated to take 6 months to a year, but this may well be an underestimate. The $15,000 to $70,000 investment on the line for an average practitioner, may include other hidden costs. In the end choosing an EMR system could be a gamble, considering the checkered history of some systems and the fact there are so many vendors out there. Then there are hospitals spending hundreds of thousands to millions of dollars initially, plus the expense of staff training, hiring additional IT technicians, and paying for inevitable upgrades.

While proponents brag that computerized record-keeping technologies will ultimately reduce costs and improve care, profits and sales are soaring now across the entire EMR records industry. Dr David Ludwig, Chief Operating Officer of a primary care network in Alberta, Canada observes, "Most often the benefits of adopting electronic medical records don't accrue to the physicians themselves... the benefits accrue to patients and insurance companies." "Patients?"-yes and no. Think privacy and other problems.

Stay tuned.

Martin F. Sturman, MD, FACP

Copyright 2013, Mathemedics, Inc.

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