Why We Will Not See Widespread Electronic Medical Records Soon

There are many reasons why use of electronic medical records remains rare in small physician practices. Many are buggy and do not meaningfully correspond to how physicians work. Another problem is communication between programs. It defeats the purpose if I purchase a system for medical records which does not interface well with my billing program, the equipment in my lab, or with systems in use by others.  The biggest problem is the cost. I saw a hopeful headline at The Wall Street Journal on Sam’s Club planning to offer a “low cost” system for small physician groups. My interest dropped as I read the article:

The system, expected to be available at the clubs in the spring, will cost $25,000 for the first installed system, and $10,000 for each additional system, plus $4,000 to $5,000 a year in maintenance costs.

The more complex systems cost about $40,000 for the first installation in a small physician group, said Kent Gale, founder of Klas Enterprises LLC, a research company for health-care technology.

They also note the difficulties in establishing such systems:

Adaptation of these systems hasn’t been widespread because of their cost and complexity, said Mr. Gale. “The easiest part is picking the hardware, loading the software, and walking the staff through training,” Mr. Gale added. “The hard part is connecting electronically to labs, pharmacies and image centers. It so complex, it is hard to imagine.”

This is the inexpensive alternative to what we have now?!!  The hardest part will be getting doctors to spend this much money when reimbursements are already dropping. Some components are actually in place at present, but each is separate from the others. I can obtain lab results electronically from the two labs I use the most for lab not run in my office. I can view x-rays on line from the hospital where the majority of the x-rays I order are performed. I can send in prescriptions on line. The problem is that each of these systems is totally independent and does not communicate with the other systems. I also have a totally separate system for billing, and another system set up in WordPerfect to handle  office notes and consults.

On top of all of this, there’s yet another computer system which is used to track information for incentive payments from insurance companies. This has limited communication with some of the other systems (but nothing in my office) and winds up generating tons of inaccurate information. At present I’m holding off on adding information into the system as, besides other flaws in the system, the staff time involved in correcting all the bad data and entering new data will cost me far more than any incentive payments for reporting the information. This doesn’t include data for Medicare incentive payments which I submitted through yet another system.

Hopefully readers are totally confused and bewildered by all of this. If so, you will have a feeling for where we now stand with regards to medical information systems.

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4 Comments

  1. 1
    S SIlverstein says:

    See my site at http://www.tinyurl/com/hit-misadventure for why I agree we will not have widespread EHR by 2014, but more likely a UK-style HIT debacle on a grand scale.

  2. 3
    Medical Billing Software says:

    This is a very interesting post onIT and health care joining together for maximum efficiency t. I still believe that our private info should not be transferred digitally, only stored digitally and not connected to the web in anyway.
    Check this out , pretty disturbing already
    http://www.nextgov.com/nextgov/ng_20090227_9147.php
     
    But as with anything in life there are pros and cons, the trick is finding the best solutions
     

  3. 4
    Ron Chusid says:

    That article does raise a legitimate concern. It can also be taken as a reason for more spending to improve healthcare computing system.

    Limewire is clearly not the best way to do this. I suspect people resorted to it due to the lack of good and affordable alternatives. More secure systems developed for health care information might reduce this risk.

    Some sort of connection to the web is important–but not over peer to peer systems like Limewire. I frequently connect to the hospital’s computer system over the web to get reports and enter orders on patients from my office, home, and ocassionally while traveling. In this case I have to sign on to a secure system–the data isn’t floating around in unsecured areas or transmitted over Limewire. Similarly I connect to other computer systems to get results from a reference lab and to write prescriptions (or check on previous prescriptions) remotely.

    One concern I do have about the system is that medical office employees with little real medical training can have access to a tremendous amount of information. There are confidentiality policies but I remain concerned about the wide number of people with access.

    Connection to the web certainly does increase the potential risk, but it is this connection which often makes electronic records of value.  This is also what allows ER and MedCenter doctors to obtain information, hopefully both improving care and lowering costs. I imagine this benefit might be achieved if people carried around a smart card with their information, but invariably people will show up in ER’s without them. In addition, having the patient carry something around also creates its own privacy risks if lost.

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