‘Waiting for the perfect EHR’ EHR holdouts: Concerns still keeping some DOs away, but with good reason? Anxieties about cost, reliability, patient privacy weigh on some DOs. But one expert says many worries have been addressed in recent years. June 22, 2011Wednesday Daniel McCann Contact dmccann Facebook Twitter LinkedIn Email Topics EHRs If Raymond E. Cole, DO, could hear just one physician give an electronic health record (EHR) an unblemished review, it would go a long way to assuaging his concerns about the technology. “Some physicians in my area have had systems fail, others are struggling with them, and three offices with the same systems had to scrap them because the manufacturer went out of business,” says the Saline, Mich., family physician. “The other physicians are only somewhat happy with their EHRs.” In addition to his colleagues’ experiences, Dr. Cole’s concerns about the cost of an EHR and the possible loss of privacy with Internet-shared data have stiffened his resistance. “I’m aware that eventually we’re going to have to install an EHR,” Dr. Cole says. “Like everyone else, I’d have to take out a loan to pay for it. But I’m hesitant because I don’t want to lose my investment in a system that fails or doesn’t work well. I keep waiting for the perfect EHR.” Dr. Cole isn’t alone in his hesitancy. In 2010, approximately half the physicians in the country continued to use paper records and charts, according to estimates from the National Center for Health Statistics. As with Dr. Cole, common concerns center on the cost of EHRs—$30,000 to $50,000 per physician—coupled with uncertainty about their reliability, interoperability and privacy. “I’m not a big fan of using technology that’s only been around for a year or so,” says James Huang, DO, a family physician in Brea, Calif. “I usually like to adopt second-generation or later technology. Signing with a company to use its system usually involves a three-to-five-year commitment. If you encounter problems, you can’t just stop and change systems within a year. That would be too costly and disruptive to the practice and to patients.” But many of the physicians’ worries about unreliable EHRs have been addressed in recent years, according to Thomas G. Zimmerman, DO, a trustee of the American Osteopathic Association of Medical Informatics. “The technology is still not perfect, but I do know that what’s available today is much more compatible with other systems than what we had a few years ago,” Dr. Zimmerman says. He explains that physicians can avoid unreliable systems by choosing from Medicare’s list of certified EHRs, which meet the standards and implementation criteria adopted by the federal government. “Those systems have proved compatible with hospitals and labs, and the companies have to guarantee that the EHRs will interface with future technologies,” Dr. Zimmerman says. Nevertheless, physicians need to do their homework or work with a consultant to ensure they choose the EHR best suited to their needs, Dr. Zimmerman continues. “It can be very messy, expensive and time-consuming to divorce yourself from an EHR that has taken six to 12 months to install and implement.” Privacy a priority As for physicians’ concerns about patients’ privacy, Dr. Zimmerman points out that many EHRs allow physicians to restrict access to certain people. “For example, you can block all clinical documents from nonclinical personnel,” he says. “They may be able to see the dates of the patients’ visits but not the documentation. Also, most systems have a clinical note section that won’t print with the rest of the patient’s chart. So there are ways to ensure that the electronic post is private yet accessible to you.” While the initial financial outlay for an EHR system has caused some physicians to resist incorporating the technology, Dr. Zimmerman urges them to take advantage of Medicare’s incentive program to help cover the cost. From now through 2016, physicians who annually demonstrate “meaningful use” of their EHRs can receive up to $44,000 during the five-year period. To get the maximum payment, physicians must begin participation by next year, after which the annual incentives taper. In 2015, Medicare providers who do not successfully demonstrate meaningful use will see their payments cut by 1%. Reductions increase each year that a physician does not comply with meaningful use, up to a maximum of 5%. “From what I hear, the main obstacle to EHR adoption has been cost,” says Dr. Zimmerman, “especially in solo or small group practices where the profit margins are not that high. A lot of doctors balk and say, ‘Why am I going to pay $30,000 per physician when more and more research shows that I may not be any more productive with an EHR?’ “Well, right now the EHR incentives will take care of the bulk of the investment. The money is not going to last forever, and down the line Medicare will make EHRs mandatory. You have to strike while the iron is hot.” Previous articleIn Memoriam: June 17, 2011 Next articleSchools keying on writing, verbal skills to deepen students’ clinical acumen
The problem with using an electronic health record is the underlying technology. Writing software put me through college and medical school. I learned quickly that great software and its supporting hardware requires zero incentive. For example, the glass cockpit for pilots, etc. Google’s recent abandonment of the personal patient record saying, [It]“didn’t scale as we had hoped…. we’ve observed that Google Health is not having the broad impact that we hoped it would.” No kidding. Jul. 1, 2011, at 11:37 am Reply
Another clueless administrator Dr Zimmerman! I just attended an MOA conference on HIT where the Medicare rep said explicitly DO NOT do HIT for the money. Striking while the iron is hot will only burn the doctor. CMS is considering loosening up the eprescribing rules…whats next? In our retirement seminar a question was posed: what happens when you retire, who will deal with the electronic records? A big deal expense. What about selling your practice? A big expense. What if the hospital system you pay to be a member of changes vendors? A big expense. The current hospital based system MONTHLY fee for the priviledge of emrs is $1500 per doctor per month. That equals the cost of the original system, EVERY year. Hmmm, the $44,000 he note seems trivial doesn’t it? I asked our current HIT hospital vendor what would happen to the cost if the hospital was ACO’d out of business and converted to another system? He said I’d just have to pay for a new system. Did you ever stop to realize that if someone breaks into my office and steals records, he is the criminal and goes to jail, but if someone “steals” my EHR data, I am the criminal and have huge fines! Honestly, this is an effort to put the little guys out of business, and take the personal out of personal physician. Ask any patient how much they like it when their doc puts their face in the computer and not on them It isn’t pretty! Good luck to all of you suckers. Jul. 1, 2011, at 9:04 pm Reply
James, you cynical old cuss, you. Your curmudgeonly admonishments only reveal your lack of any in-depth knowledge about EHR systems and the variety of capabilities available. Also, costs for great systems range widely from very little to ridiclously large (such as the ones with which your particular hospital apparently stuck you and yours.) It is always so much easier to bitch and moan than it is to actually “smart-up” and/or try to provide helpful contributions. Honestly, do you really believe there’s some deep conspiracy to “put the little guys out of business” behind the EHR path we’re on? Really?! If so, I bet I can guess what your takes on Roswell and the single bullet theory… Jul. 2, 2011, at 7:24 am Reply
PS – If you’re a D.O. and haven’t taken a look at HealthFusion’s MediTouch EHR, then you really should. I don’t use it currently, but it’s such a great system (no other system comes close for anybody who does anything with manipulative therapy) that I’m thinking of switching. It’s browser-independent, very easy to look at and navigate, and very reasonably priced. They are doing some really great development. Your cynicism is anticipated: no, I don’t work for them and have no financial or personal relationship with them. I just felt it was worth mentioning a great system, especially one that cares about building for D.O.s, to help offset your extreme negativity. Jul. 2, 2011, at 7:35 am Reply
To James: Let me reply to your comments first by stating that I am not a clueless administrator – I am a board-certified physician practicing family medicine full-time in a very busy primary care office. My office had over 20,000 patient visits last year. I am in the front lines – I know what practicing physicians face each and every day. I’m concerned with the numbers and figures that you are citing. The average EMR implementation (emphasizing AVERAGE), including all software, hardware, and training, has been consistently rated at about $30,000 per physician. This means that the Medicare/Medicaid incentives should more than compensate for the initial investment. Many quality EMR systems cost about $500 a month which includes electronic billing AND tech support/maintenance. You should ask your hospital’s CIO (or CMIO if they’re cutting edge) about different EMR’s that may be more affordable and still able to interface with the hospital’s system. I’ve lectured on EMR selection, EMR use, and meaningful use incentives many times at the AOA, ACOFP, and state conferences over the past 4-5 years and I always emphasize (just like the Medicare rep) that no one should ever move to EMR’s just because of the incentives. You need to believe in the ongoing benefits of electronic records, not just in the short-term financial picture. Physicians discounted and ridiculed the stethoscope when it was first invented in the 1800’s; can you imagine practicing medicine today without one? The $44,000 incentive is not designed to sway the minds of cynics; it’s purpose is to help enable physicians who believe in the improved patient care, improved workflow, and ultimately increased revenue that EMR’s can provide. We’ve already seen the e-Rx incentive program turn to penalties this year; by 2016 the penalties will begin for non-EMR users. Considering the current budget debacle in DC, don’t you think that Congress and CMS are just looking for more ways to decrease reimbursements to physicians? That’s why I say, take the money while it’s being offered, before you lose out and then start getting penalized. You mention retirement – if you’re horizon for retirement is within 5 years, you definitely shouldn’t be thinking about EMR. If you’re coming to OMED 2011, I invite you to come to the AOAMI’s presentations. We’ll have physicians who’ve already started to receive the Medicare incentives, and have lots of current and ACCURATE information for physicians to make informed decisions. Jul. 2, 2011, at 9:48 am Reply
DO’s should check out the EMR by Stat Systems called Q.D.Clinical. I have owned it for 17 years, starting with the old DOS version and then the Windows versions. Jul. 5, 2011, at 10:26 am Reply
The most anoying part with most EMR is that the only blog i find are the positive ones. Can some one tell me the negatives about HealthFusion® and MediTouch EHR®. And How much does HealthFusion® and MediTouch EHR®. cost? Jan. 27, 2012, at 1:56 am Reply