Electronic Medical Records (EMR) for Providers & Patients: Part of the Solution to Runaway Health Costs?


nurse using computer to view electronic medical records

Introduction

Employers providing health benefits should keep informed about trends and developments impacting health care costs, including the adoption and implementation of electronic medical records storage systems.

Many potential efficiencies may be gained from use of electronic medical records, including better coordination of care, standardization of billing, and avoidance of duplicate, conflicting, or erroneous treatments and prescriptions.

The Flawed Status Quo: Medicine Has Been Unusually Resistant to Computerization

A FrumForum post entitled, “Finding the Good in Obamacare,” describes the flawed status quo:

Everyone who deals with healthcare—left, center, and right—agrees that medical record keeping needs serious improvement.

Nearly two decades after every other industry computerized its databases, most medical records still get kept on paper in filing cabinets. Those computer systems that do exist usually can’t exchange data.

As a result, many patients fall through the cracks. Literally millions of unnecessary tests get run each year simply because nobody can find records. Drug prescription errors, likewise, kill thousands.

Entities like the Department of Veterans Affairs’ system, Utah’s Intermountain Health, and Kaiser Permanente that make widespread use of electronic records tend to get better results. Dated anti-trust statutes and recalcitrant medical professionals have delayed widespread electronic medical records standard setting for too long.

“Stimulus Act” and “Obamacare” Push Adoption of Electronic Medical Records

“Stimulus Act”

Stimulus funds have been allocated to assist providers in transitioning to electronic medical records (also referred to as Electronic Health Records or EHRs):

[F]unding is provided under the Health Information Technology Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009 [the “Stimulus Act”]. The HITECH Act created the Medicare and Medicaid EHR incentive programs, which will provide incentive payments to eligible professionals and hospitals that adopt and demonstrate meaningful use of certified EHR technology.

Incentives totaling as much as $27.4 billion over 10 years could be expended under the program, which is administered by the Centers for Medicare & Medicaid Services. In addition, the HITECH Act provided $2 billion through the Office of the National Coordinator for Health Information Technology (ONC) to support technical assistance, training, and demonstration projects to assist in the nation’s transition to EHRs.

Detailed information on this federal electronic medical records program is available at hhs.com.

Like it or not, that’s a huge pot of taxpayer money going into this effort! One wonders why, if the benefits are so clear, providers themselves aren’t footing more of the bill. I’m not aware of other industries in which the adoption of beneficial productivity-enhancing technology has required such massive government support.

Affordable Care Act (“Obamacare”)

The Affordable Care Act, often referred to as “Obamacare,” includes additional provisions promoting electronic medical records:

The new law will institute a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information.

Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care.

Perhaps this explains the huge government investment. It’s not that providers won’t invest in electronic medical records on their own, but that they won’t standardize them as the government envisions. This standardization could streamline Medicare and Medicaid payments and make those programs more efficient. Cynics might say it could also lay the groundwork for a more socialized healthcare system.

Types of Electronic Medical Records

The Medicare.gov website breaks electronic medical records into three types:

1. Electronic Health Records (EHRs): Records doctors, hospitals, and other health care providers maintain on a computer about patients’ health care or treatments, so providers can share up-to-date information about patient conditions, treatments, tests and prescriptions. Providers can join a network to securely share such records with each other. One benefit is helping cut down on medical errors and avoiding duplicate tests.
2. Electronic Prescribing: Prescriptions sent electronically directly to pharmacies. Patients can save time, as prescriptions can be promptly filled and ready for pickup. Providers can check which drugs a patient’s insurance covers and prescribe ones that cost the patient less. Electronic prescriptions are easier for pharmacists to read than handwritten ones, so there’s less chance of an incorrect drug or dose. With access to a patient’s prescription history, providers can be alerted to potential drug interactions, allergies and other warnings.
3. Personal Health Records (PHR): Electronic health records patients can access for their own reference, secured with user IDs and passwords. These are health records curated by an individual user themselves, rather than by medical providers.

An Electronic Medical Records Success Story Comes Out of a Deadly Natural Disaster

Photo of Tornado Illustrating Point on Electronic Medical Records Mitigating Impact of Natural Disaster
The tornado that devastated Joplin, Missouri in May, 2011, was one of the deadliest natural disasters in the U.S. in recent years, and the deadliest tornado in the U.S. since the 1896 St. Louis/E. St. Louis tornado.

In addition to cutting a huge swath through town, the tornado hit a hospital full of staff and patients. Here’s the story, as told by the Department of Health and Human Services to emphasize the value of electronic medical records:

St. John’s Regional Medical Center evacuated its patients, triaged at a community hall, a high school cafeteria and other nearby locations, patched up the most urgent of the injuries from flying glass and debris and then set about to redistribute the patients to hospitals many miles and states away.

Paul Johnson, 78, suffering from pneumonia, was very specific: “Take me to Springfield.”

“They were taking people everywhere: Oklahoma, North Arkansas, Kansas City. I wanted Springfield,” Johnson recalled.

Wearing only a hospital gown and shorts — no shoes—finding his way down a dark stairwell and hallway as “my niece kicked stuff out of the way” and worrying about his injured wife and other family members who had been visiting him when the tornado struck, Johnson had the presence of mind to ask for St. John’s Hospital in Springfield, Mo. His reason: His electronic health records (EHR) would be accessible there.

St. John’s Regional Medical Center had just transitioned from paper to EHRs three weeks before the tornado, joining its sister hospitals … , which had already moved to the electronic age in medical records.

“We wanted to make sure they had our records. If I was asked what my medications were, what tests I had, how could I answer?” Johnson said….

When the tornado destroyed St. John’s, its old-school medical records literally flew with the winds: “paper charts and x-rays were reported found strewn in peoples’ yards 75 miles away.” But St. John’s electronic medical records were available immediately at its sister hospital in Springfield, “allowing for as seamless a transition as possible for patients under such emergency conditions.” The electronic records also eased the recovery of hospital operations in Joplin:

Seven days after the tornado, St. John’s became a mobile field hospital, a tent-like structure at which doctors could access patients’ EHRs. But the EHRs were available within 48 hours of the tornado at Memorial Hall, the Joplin community venue that was used first for triage and then as a temporary clinic site for nearly 35 physicians whose offices had been destroyed in the storm. The EHRs could have been accessed earlier, but Mercy Technology Services had to purchase the necessary satellite equipment….

This story demonstrates a huge advantage of properly backed-up electronic medical records. Can you imagine needing medical treatment following a disaster and having key medical history questions arise, only to be told “the answer, my friend, is blowing in the wind, the answer is blowing in the wind“?

Critiques of Electronic Medical Records

A page on the website of the Association of American Physicians and Surgeons, a group opposed to the Affordable Care Act, raises several points in opposition to the government-supported transition to standardized, coordinated electronic medical records:

  • The government may be unable to guarantee privacy of your personal medical information. If Wikileaks was able to get top-secret documents, couldn’t hackers similarly obtain and disclose medical records?
  • The government may abuse its access to personal medical information. “[G]overnments can use such information to blackmail and smear those considered troublemakers or enemies of the state.”

Yet the author of this article, a physician, admits she is “a great proponent” of electronic medical records, as long as “they are confined to my office or a hospital” because they “help me organize the information I need to better care for my patients.” She concludes:

I took the Oath of Hippocrates, which states I will keep the conversations between myself and my patient private. Accordingly, my electronic medical records will never go online. They are confined to a server right in my office and the privacy of my patients is fully protected.

Do not depend on the government to protect your medical records. Under ObamaCare, the government seeks the right to mine your most private information just as it wants to peer under your clothing in the airport. This is another important reason why ObamaCare must be repealed.

The relevant Hippocratic Oath language is: “I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.” Is this promise of privacy violated by making medical records available to other physicians electronically over the Internet, so they may also help treat your patient, and to the government for purposes of reimbursement and statistics collection? Of course, we may not like the intrusion of airport security upon our privacy, but most of us recognize the benefit outweighs the cost. Is this similar?

Survey of Physicians on Use of Electronic Medical Records

The physician quoted above is not alone in her privacy concerns. An article on the pros and cons of electronic medical records says a 2009 study of more than 1,000 family practice and specialist doctors in Massachusetts found that 86% believed electronic exchange of medical records would improve patient quality of care, 70% thought it would reduce costs and 76% said it would save time.

However, 16 percent said they were “very concerned” about possible privacy breaches, while a further 55 percent were “somewhat concerned.” The study also found that none of the doctors wanted to pay the suggested $150 monthly fee … and about half said they weren’t willing to pay any fee..

That cost sensitivity boggles my mind. If it improves quality of care, reduces costs, and saves time, how could it not be worth a mere $150 a month (or anything)?

The same article says:

A second study, which included 56 psychiatrists, psychologists, nurses and therapists at an academic medical center, found that most believed electronic health records were clearer and more complete than paper records, but not necessarily more factual.

However, 63 percent said they were less willing to record highly confidential information in a patient’s electronic health record than on a paper record. And 83 percent said if they were a patient, they wouldn’t want their mental health records to be routinely accessed by other health-care providers.

“Designers of future systems will need to enhance electronic file security and simultaneously maintain legitimate accessibility in order to preserve confidence in psychiatric and other [electronic health record] systems,” the researchers concluded.

Both studies were published in the Journal of the American Medical Informatics Association.

Electronic Medical Records: In the Cloud or Stored Locally?

Health care providers adopting or expanding use of electronic medical records face a major choice between systems that operate and store data locally and those that are browser and “cloud” based, with most of the functionality and data located outside the provider’s IT system. This does raise further questions about privacy, as well as other considerations.

The KevinMD.com website looks at “Pros and cons of cloud based or web based EMR systems,” coming up with the following list of “pros”:

  • Less up-front costs for licensing
  • No server hardware or software to purchase/house/maintain
  • Possibly easier to transition to a different system
  • More cost effective for solo/small group practices
  • Better support
  • Easy to set up hot-site in case of disaster
  • Host companies typically have more sophisticated security measures/data protection
  • Vendor more likely to meet HIPAA regulations than the practice can
  • Good for physicians who are not office-based or travel a lot

The article also lists cons:

  • Customizability limited
  • Latency or lag time accessing information across web/ slower response time
  • Patient information may be compromised if co-mingled with other clients
  • At the mercy of the vendor regarding backups, security
  • More expensive over the long haul
  • Captive client – host controls your data
  • Practice is dead in the water with internet outage
  • May not be viable for rural practices with limited internet options
  • Practice can lose data if vendor goes out of business
  • May be impractical for uploading larger imaging files
  • Bandwidth limited by practice’s internet connection

Conclusion

As in all other businesses, IT is bringing great changes to the area of medical record keeping. With a big push from government, reluctant medical providers are finally transitioning to electronic medical records, thus joining all the other industries that are ahead of them in IT implementation.

The market is large and lucrative, not least because of the commitment of government funding. In addition to businesses that focus specifically on providing IT services and hardware to the medical industry, some of the largest, most established IT players are now getting in on the game.

For example, according to the Dell PACS website, Dell has developed a picture archiving and communication system (PACS) to help healthcare providers reduce their cost by digitizing medical records and removing the need to mail and fax documents between physicians.

Photo credit: wonderlane via flickr

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