Electronic medical records were fervently promoted as a panacea to medical inefficiencies, medical errors, and cost.
The reality has been to date, anything but. The New York Times article, “In Second Look, Few Savings from Digital Health Records,” outlines some of the disappointments that the technology has delivered to date.
Clearly systems relying upon handwritten and typed notes and reports, repositories of paper, and lack of portability are not worthy of the future. Quality systems should be secure, interoperable on any platform via a common set of data standards, and should not permit meaningless content and boilerplate or inflation of fees and improper billing.
Given our ability to put a variety of data on the web, one must wonder why the move towards electronic medical records has been so disappointing to date and has failed to deliver as promised.
There is no turning back but we are still in version 1.0 it would appear. Perhaps Apple or Google should take it on? Could it be that because it is “medical” it has been made needlessly complicated?
MCNTalk thanks Richard Bensinger, MD for referring this article to us.
it is partly that it is complicated yes needlessly so because it is medical and because the voluminous requirements to comply with HIPPA laws, and it is enormously expensive. just the software costs over $15.000.00 initial investment (which will pay for a lot of paper, copying, filing and transcription before it begins to pay for itself) then there is annual updates to ensue you STAY HIPPA compliant and it cn be accessed via the new operating systems, and be able to handle the new coding requirements. It is just overwhelming to small offices.
Lynda is to be complimented for her comments; the price of computerization is indeed high for the small office. From a patient’s standpoint regarding large systems, here in San Diego County all major healthcare providers have separate systems and DO NOT SHARE INFORMATION. e.g. to transfer pt chart info from a SCRIPPS doctor to one in the UCSD systems means to handcarry the “paper”. Are we really in 2013?
The problem with the Electronic Health Record (EHR), beside the fact that Microsoft Word always wants to correct it to HER, is not the fear of the computer, but the quagmire of requirements under “Meaningful Use.” I have used an electronic record for 20 years with the assistance of a word processing software program. Microsoft Word has all the bells and whistles necessary to create a useful, legible, and transferable electronic record for the small office. It is as secure as your system (local network, Internet, etc.).
With the Medicare incentive and “Meaningful Use,” the vendors are seeking ways to achieve the Meaningful Use criteria, and thinking about the needs or wants of the provider as an after-thought.
The standards touted as good examples were Kaiser and the Veterans Administration electronic record systems. Either may be good and effective within their respective vunue, but for those not within the system, trying to make use of a printed or electronic copy of records from either source is a nightmare. Buried within pages of fluff may be one or two lines of clinical information.
There may be an entry, but it may take 5 minutes of searching to determine it is a phone message to the “advice nurse” and not an actual patient encounter. Such a record does not improve patient care, but may stymie the sharing of information.
Additionally, electronic records can easily allow fraudulent use to increase provider income and may actually subsequently raise healthcare costs. The concern of misuse of EHRs was identified by the US Department of Health and Human Services (HHS) and the Office of the National Coordinator for Health Information Technology (ONCHIT) as noted in a comprehensive report from 2007. Some comments (courtesy of Daniel Mangum, D.O.) from that report include:
“Moving to an electronic environment without proactive fraud management capabilities built in has the potential to greatly increase fraud.”
“Provide a new opportunity for fraudulent behavior, and on ever-increasing scales…”
“EHRs [Electronic Health Records] provide a variety of tools that enable a provider to be more efficient when documenting an encounter . . . These tools include the use of defaults, templates, copying, and others.
The report then continues with the warning:
“[These tools] can be extremely helpful if used correctly; however, the tools can also open the EHR [system] up to fraud or abuse.”
There is a need for clear, concise, and legible records from healthcare providers. However, to set a standard based on data collection (meaningful use) that has little applicability to the practitioner is counter-productive at best, and could actually increase cost and fraud at the other side of the spectrum.
All previous comments were outstanding and to the point. My experience lies in having coordinated, authored and teaching insurance billing to the acupuncture community for the past 10 years. I also moved to electronic records with a palm pilot, integrating with ms word and other simple software. For the small office, inexpensive opportunities exist. Nonetheless, it can be challenging for even small offices. And the learning curve of software is never fast enough when patient care remains front and center. I still like ehr but a simple format is still preferred. All that being said, I end with that the ehr software options being sold are way to expensive only because folks think doctors can afford it.