Stanley Feld M.D., FACP, MACE Menu


Most Doctors Aren’t Using Electronic Medical Records: Part 2


Stanley Feld M.D.,FACP,MACE


The common impression is that physicians are resistant to the use of Electronic Medical Records. I believe there are important reasons adoption by physicians is slow.


Dr. Paul Feldan, one of three doctors in a New Jersey practice, said switching to electronic records did not make economic sense for his practice.

Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see fewer patients during the conversion from paper to computer, we don’t get paid.”

Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a nonprofit medical group that includes Massachusetts General Hospital in Boston hit the nail on the head.

“We have a broken market for electronic health record adoption because the people who gain financially are not the people who pay.”

“To fix the market, Dr. Middleton recommends that the government play a role in providing incentives or subsidies to speed the use of computerized patient records in the United States.”

Wouldn’t it be simple if the government and healthcare insurance industry along with input from practicing physicians created the ideal electronic medical record? I believe adoption of an EMR would be rapid under certain circumstances.

I emphasize including practicing physicians of all specialties in creating an ideal EMR. If policy makers happen to ask for physician input it is usually from high profile academic physicians with little private practice experience. Academic physicians do not understand the practice problems of the private practice physicians.

The ideal EMR must contained strong patient privacy rules. Patients should have ownership of their EMR. Patients must have the exclusive decision making voice in how the information is distributed and used. This concept is totally opposite from the newly introduced HR6357 that is rapidly moving through the House of Representatives.

Private practices should be able download the EMR software for free. Customization of the generic EMR could be fitted to the physicians practice style. All measurable entries would be formatted as a relational database. Physicians would pay a minimal transaction fee for each click making the EMR affordable to physicians in all sized practices. All maintenance and upgrades would be web based and downloadable at no cost. (nomadic software as described in the Unfinished Revolution)

The saving to the government, the healthcare industry and the healthcare system would more than offset the cost of providing a uniform and upgradable electronic medical record to all the physicians in the U.S. The system must be easy to download and its use must be intuitive.

It is estimated that the healthcare system would save 5 billion dollars over five years alone if every physician used an e-prescription system. If would avoid many prescription errors due to handwriting misinterpretation.

For some reason government policy makers can not think about physicians needs. Someone must think innovatively. An EMR must be created that provides incentives to physicians to want to convert to an EMR. An EMR would not be used against physicians punitively but rather by physicians educationally.

Instead the government has just initiated a $150 million dollar long term pilot study that will fail because of its design.

“The government took a step in that direction last week, announcing a $150 million Medicare project that will offer doctors incentives ($58,000 over 5 years) to move from paper to electronic patient records. The program is intended to help up to 1,200 small practices in 12 cities and states make the conversion.’

I believe the government is making another costly complicated mistake. Winston Churchill was correct. “Americans eventually get it right after they try everything else.” The intent of the study is to test the impact of incentives on the adoption of electronic health records. Wouldn’t it be easier if someone used some common sense and asked private physicians and patients what they need rather than create a study that is destined to failure? The physician incentive is too small and the dangers to the patients and physicians too great.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

  • Scott Hodson

    Many American health systems are significantly underinvested in quality management Infrastructure, Process, and Organization. To achieve breakthrough improvements in quality, patient safety, and resource utilization hospitals and physicians must work together to develop a “world class” quality management foundation that includes:
    Strategy: including a clear linkage of quality and patient safety to the organizational strategy and a Board-driven imperative to achieve quality goals.
    Infrastructure: incorporating effective quality management technology, EMR and physician order entry, evidence based care development tools and methodologies, and quality performance metrics and monitoring technology that enables “real time” information.
    Process: including concurrent intervention, the ability to identify key quality performance “gaps,” and performance improvement tools and methodologies to effectively eliminate quality issues.
    Organization: providing sufficient number and quality of human resources to deliver quality planning and management leadership, adequate informatics management, effective evidence based care and physician order set development, performance improvement activity, and accredition planning to stay “survey ready every day.”
    Culture: where a passion for quality and patient safety is embedded throughout the delivery system and leaders are incented to achieve aggressive quality improvement goals.
    My firm has assisted a number of progressive health systems to achieve such a foundation, and to develop truly World Class Quality.

  • John medical records

    A Medical Records technician has the sometimes complicated job of decoding and organizing the different information that come in for each patient.

  • John medical records

    It is better to use medical patient record which has good efforts but at the same time they have disadvantages that effects lot to patients as well as doctors.

  • Adam

    By obtaining a copy of immunization records, you can easily benefit in that you know exactly what diseases and conditions you have less of a chance of developing. It is important to also keep up with the updates in order to ensure proper defenses from various types of medical conditions, as well as infectious diseases. And nowadays EMR are becoming very popular among people.

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