Stanley Feld M.D. FACP,MACE
promise of the Electronic Medical Record (EMR) is fading for physicians and
patients. The EMR was supposed to reduce the cost of medical care, improve
quality of care, improve physician communications, reduce duplicate testing and
improve efficiency of care.
believe EMRs can accomplish all of the above goals but not with their present
2009 President Obama declared that EMRs,
President Obama's estimate is a little higher than that of the Rand Corp. study on the same issue.
not accomplished its goals. EMRs have been a money-loser for most physicians.
bought by physicians and hospital systems in the past are not fully functional.
Less than 20% of hospital systems and
physicians practices that have fully functional EMRs
and hospital systems that already have EMRs will have to purchase new fully
historically know that all data collected, whether accurate or not, has been
used against them in the past.
are hesitant to provide more data at their own expense that compromise the
privacy of their patients and potentially harm their own reputation.
would be happy to participate in EMR implementation if the EMR improved their
ability to serve their patients without a potential penalty.
is clear the government and healthcare insurance industry want to control the
healthcare system. The stakeholder who controls the data controls the
recent survey from
forty-nine community practices in a large EMR pilot study by the Massachusetts
eHealth Collaborative studied the projected five-year financial returns on
investment to physicians’ practices. It was published in Health Affairs.
"We found that the average
physician would lose $43,743 over five years; just 27 percent of practices
would have achieved a positive return on investment; and only an additional
14 percent of practices would have come out ahead had they received the
$44,000 federal meaningful-use incentive."
Only a few practices would
have had EMR’s that qualified for the Obama administrations meaningful –use
incentives. The Obama administration’s criteria for meaningful-use are too strict
and complex for EMR software that physicians can afford.
More amazing is that the
only way for a practice to have a positive cash return on investment for their
EMR is to game the healthcare system using their EMR. The resulting cost of
medical care would rise.
largest difference between practices with a positive return on investment and
those with a negative return was the extent to which they used their EHRs to
increase revenue, primarily by seeing more patients per day or by improved
billing that resulted in fewer rejected claims and more accurate coding.”
This does not constitute an improvement in medical care. It also
contradicts the idealistic advantages of the Electronic Medical Record.
The survey concludes that current meaningful-use incentives
alone may not ensure a positive return on investment from EMR adoption.
The survey’s authors suggest,
that provide additional support, such as expanding the regional extension
center program, could help ensure that practices make the changes required to
realize a positive return on investment from EHRs.”
The government and
healthcare insurance industry’s goal is to reduce physicians’ reimbursement to
those physicians that do not meet Obamacare’s imposed criteria for quality
medical care. The controversial Independent Physician Advisory Board (IPAB)
will set these criteria.
Many physicians in practice object to converting medical care
into a commodity. Medical care is a very personal and complex interaction not
taken into account by the rigid criteria.
I have said previously that about 50% of the therapeutic index
(therapeutic effect) of a physician’s treatment is determined by the patient
"We need to move to EHR for a number of
reasons, but if I am a small practice I am going to really think about a few
things," she says. "One is how to decrease the cost of adoption and
the cost of the system itself.
“ To the extent you can reduce the upfront
cost that is going to help bring down the amount you have to figure out how to
make up elsewhere.
Increasingly there are new models taking this
into account for small practices to decrease the big upfront costs."
There are two basic issues, the cost of a fully functional EMR and
the real purpose of EMRs. I believe both can be remedied.
The costs of an EMR to a medical practice can be paid for by the
click. The data would be fully secured. The data would be available only to
patients and their physicians.
Physicians would pay for the EMR by the click. The EMRs would be
maintained and updated for free in the cloud.
The EMRs could not be used for penalizing physicians. It would
be used for educating patients and physicians thereby improving the quality of
If there is a bad physician in the community, a way needs to be
found to deal with that physician within his community. All medicine is local.
This is where a consumer driven healthcare system with public
critique of physicians would be an effective deterrent to bad physicians.
The current healthcare system is defective. It has to be
changed. Obamacare is making the business plan worse.
America cannot afford it becoming worse.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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