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The Electronic Medical Record Stimulus Fiasco: Part 1

Posted Apr 29 2009 10:47pm

Stanley Feld M.D.,FACP,MACE.

All of President Obama’s goals are commendable. The United States needs to fix the education system, decrease its dependency on fossil fuel, increase production of renewable energy, and repair the healthcare system.

These are all big ideas. They must be implemented for the United States to prosper in the future. I have expertise in (healthcare). President Obama’s route to achieving healthcare reform is wrong. He is not attacking the basic problems in the healthcare system.

A PriceWaterhouse Cooper study showed $1.2 trillion dollars is wasted on defensive medicine and administrative costs. Where is malpractice reform on President Obama’s list of big ideas to eliminate the practice of defensive medicine?  If the $1.2 trillion dollars of waste were eliminated we would have an affordable healthcare system.

The administration’s stimulus package for instituting an electronic medical record (EHR,EMR) is going to create more waste and a larger mess than the fiasco that already exists.

“A recent Robert Wood Johnson survey of more than 3,000 U.S. hospitals found that only 9% were using electronic health records (EHR). “The numbers are disappointing and certainly lower than we thought when we went into this study,” says Ashish Jha, the lead author of the study and an associate professor of health policy and management at Harvard University. “

The survey is a well done. Survey responses were received from 63.1% of all acute care hospitals that are members of the American Hospital Association. This is a high percentage response rate for a survey. The survey looked for the presence of specific electronic-record functionalities. More discouraging than the 9% figure is only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units and fully functional).

Only 7.6% of acute care hospitals have a basic system (i.e.present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, urban area hospitals, and teaching hospitals were more likely to have electronic-records systems than small hospitals in smaller cities. Most of the hospitals spent over $100 million dollars for it EMR. The money spent did not enable the hospital systems to implement a fully functioning EMR.

Hospitals and hospital systems are experiencing financially hard times during this recession. They cannot afford the capital requirements and high maintenance costs to implement the installation of an EMR when the end result is not having a fully functioning electronic medical record. Hospital systems board of directors are not interested in going deeper in debt when the government is going to reduce reimbursement for non compliance.

PriceWaterhouse Coopers’ analysis of the stimulus package for EMR points out government subsidies are through the traditional EMR acquisition channels. Their analysis highlights the government’s punishing actions of non compliant providers. It is going to reduce reimbursement as punishment. Isn’t that silly? The government should be worrying about the financial health of these institutions and physicians’ practices

“The stimulus funding for health IT is a small carrot compared to the amount of resources it will take to deploy this technology over the next 5 years. Also, providers will feel a big stick of financial penalties if they fail to use government-certified electronic health record (EHR) in a government-certified manner beginning in 2015.”

It should be obvious that every physician’s office and hospital system should have a functional electronic medical record. One must wonder how physicians feel when they cannot afford an EHR that will probably not have full functionality.

Who will be the winner? Patients should be the winner. Patients will not win under President Obama’s stimulus package.

“With billions in new funding and government regulations, the health IT market will balloon far beyond the provider segment, providing new opportunities for health plans, pharma companies and other vendors.”

Powerful secondary stakeholder with financial vested interests will win.

The net result is will not be a universal and functional EMR. There will be little connectivity.

The government should invest in the purchase of a web based fully functional EMR with all the attributes necessary to build an effective electronic medical record system. The system would provide complete interconnectivity to physicians, hospitals, pharmacies, and insurance companies. Upgrades and maintenance of the software would be automatic and free.

The government would charge each provider entity by the click for the use of the universal Electronic Health Record. The government would recover its investment over a very short time and instantly create a system of price transparency. The system would be affordable to the healthcare providers. The present stimulus plan for EMR is going to waste the $36 billion dollars. It will try to force hospital systems and physician offices to buy an electronic medical record system that they cannot afford, do not want and might not work.

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

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