July 4, 2012

Electronic Health Records, Slow But Steady

The best article I have seen on the subject of Electronic Health Records (EHR) was in Bloomberg BusinessWeek (21 June 2012) called "This machine saves lives so why don't more hospitals use it."

What I liked about this article was how straightforward it explained the marketplace, the benefits, the resistance, and the trends.  

Some basic statistics on the subject of EHR:

The healthcare industry is $2.7 trillion annually or ~18% of GDP.

Yet we continue to be quite inefficient with only about half of hospitals and doctors projected to be using EHR by end of 2012.

Annual spending on EHR is expected to reach $3.8 billion by 2015.

Basically, EHR is the digitization of our medical records and automation of medical services so that we can:
- Schedule medical appointments online

- Check medical records including lab and test results
- Communicate with our doctors by secure messaging/email
- Send prescriptions into the pharmacy electronically
- Automatically keep track of dosage and refills
- Get alerts as to side effects or interactions of medication
- Analyze symptoms and suggest diagnosis
- Receive prompts as to the latest medical treatments
- Recognize trends like flu outbreaks or epidemics
- File and speed claim processing

So why do many doctor's seem to resist moving to EHR?
- Cost of conversion in terms of both money and time

- Concern that it can be used against them in medical malpractice suits
- Potential lose of patient privacy
- Lack of interoperability between existing systems (currently, "there are 551 certified medical information software companies in the U.S. selling 1,137 software programs"--the largest of which are from GE and Epic.)

The government is incentivizing the health care industry to make the conversion:

- Hitech Act (2009) "provides $27 billion in financial incentives" including $44K from Medicare and $63K from Medicaid over 5 years for outpatient physicians that can demonstrate "that they are using the technology to improve care."
- Patient Protection and Affordable Care Act (2010)--a.k.a. Obamacare--calls for "accountable care organizations" to receive extra money from Medicare and Medicaid for keeping patients healthy, rather than by procedure--"they are expected to do so using computers."

The big loophole in EHR right now seems to be:

- The lack of standards for EHR systems from different vendors to be compatible, so they can "talk" to each other.
- Without interoperability, we risk having silos of physicians, hospitals, labs, and so on that cannot share patient and disease information.

So, we need to get standards or regulations in place in order to ensure that EHR is effective on a national, and then even a global level. 

A number of months ago, I went to a specialist for something and saw him a few times; what he didn't tell me when I started seeing him what that he was retiring within only a few months.
Aside from being annoyed at having to find another doctor and change over, I felt that the doctor was not too ethical in not disclosing his near-term intentions to close up shop and giving me the choice of whether I wanted to still see him. 

But what made matters worse is that I got a letter in mail with the notification--not even in person--along with a form to fill out to request a copy of my medical records at a cost per page, so that I could transfer them--hardcopy--elsewhere. 

Of course, this was also the doctor who hand wrote prescriptions still and wasn't able to get test results online. 

To me, seeing someone with a great amount of experience was really important, but the flip side was that in terms of organization, he was still in the "dark ages" when it came to technology. 

I look forward to the day when we can have both--senior medical professionals who also have the latest technology tools at their disposal for serving the patients. 

In the meantime, the medical profession still seems to have some serious catching up to do with the times technologically. 

Let's hope we get there soon so that we not only have the conveniences of modern technology, but also the diagnostic benefits and safeguards. 

(Source Photo: Andy Blumenthal)


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