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Health Care Providers Failing To Adopt e-Records, Says RAND
Nerval's Lobster writes "Back in 2005, RAND Corporation published an analysis suggesting that hospitals and other health-care facilities could save more than $81 billion a year by adopting electronic health records. While e-records have earned a ton of buzz, the reality hasn't quite worked out: seven years later, RAND's new study suggests that health care providers have largely failed to upgrade their respective IT systems in a way that allows them to take full advantage of e-records. Meanwhile, the health care system in the United States continues to waste hundreds of billions of dollars a year, by some estimates. 'The failure of health information technology to quickly deliver on its promise is not caused by its lack of potential, but rather because of the shortcomings in the design of the IT systems that are currently in place,' Dr. Art Kellerman, senior author of the RAND study, wrote in a Jan. 7 statement. Slow pace of adoption, he added, has further delayed the productivity gains from e-records."
It has been my experience that every health care provider that I have dealt with that offers electronic records, also charges you an "administrative fee" to get a copy of said records at over $1 per page (regardless if it is an electronic document emailed to you).
Need an example? Altoona Regional Health System
"When life gives you lemons, don't make lemonade. Make life take the lemons back!" -- Cave Johnson
Because the credit card companies have done such a good job with information protection...
"I say we take off, nuke the site from orbit. It's the only way to be sure."
I support several small medical practices. They don't (or say they don't) have enough money to upgrade their systems. Like any small business, potential savings in the future don't always translate to extra income now. New systems are expensive and often included monthly fees from the software providers. In addition, if their analog, handwritten system has been working for decades, there's not a lot of incentive to switch.
I'm contracting in the industry right now, and... The problem with e-records is draconian HIPAA requirements. Also all our systems have to be able to pass an audit by the FDA, meaning if I add a piece of javascript to check for numerics... re-validation! I'm not saying the government should back down, medical records need to be private, but they've got IT management and senior staff here trembling at the mention of their existence. Supposedly, it's kept the main production system from being update for the last couple of decades or so simply because nobody wants to take on the responsibility of potentially getting the business shut down... then again that's operations, and they can be a bit dirka dir, but it's definitely a problem from both sides of the fence.
My physician's office explicitly tells me why they stick with paper-only records: They don't want to deal with the data security mess. They are a medical office, not an IT shop.
Amazingly after all these years on paper records, I don't get double-billed, I've never had a problem between them and the insurance company, and they manage to handle my billing in a timely manner.
Go figure.
//TODO: Think of witty sig statement
I am involved as a consultant to several practices and frankly the software stinks.
Buggy, incomplete, error prone, and over priced.
If I had a nickel for every time I have been told it will be fixed in the next release I would be a millionaire.
I feel sorry for the medical professionals who have to deal with the garbage software on a day to day basis and the consumers who get sub-par service both medical and billing because of it.
One example is:
If one thing is billed another is automatically added to the bill because they were often used together.
The problem: They are no longer recommended to be used together as a better and cheaper test has replaced one of them.
A year and a half later the problem is still in the software and if someone forgets to manually remove it the insurance rejects payment and the patient gets a bogus bill for several hundred dollars.
It's been my experience that requiring e-records in the office have actually increased the number of items that get billed. The charges are higher than they have before simply because the physicians must record everything now as a bill-able item. No more freebies from your doctor. They have to itemize every medical issue you ask about now. I support a bunch of offices and it's happening in 100% of the offices. Ironically the doctors hate it because they spend all their time looking at a screen entering data rather than paying attention to you. Plus the fact that the software was designed by engineers who haven't spent a lot of time with physicians doing those jobs. Previously 1 lab report on a sick patient now could turn into 15 separate actions that have to be done one at a time. So much for your doctor having time to spend with you.
"RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005."
Is due to the fact there's no standardization for medical records from hospital to hospital. To accomplish it we first need to nationalize and unify every hospital in the United States. I use the VA Hospitals as my model. They have electronic record interchange already.
Then you can use best practice to standardize all procedures from actual medical procedure to operational procedure and everything in between. Then once you've nationalized the hospitals, setup several NATIONAL universities that grant M.D.'s and integrate the training.
Quality of care is also important. I have a relative with a mental illness. Occassionally they need to be confined to a hospital. Everytime they go in, the hospital doesn't have their records. This means the doctors start from scratch each time. They start off with the same treatment that doesn't work. They then rerun the same tests and experiment to find a treatement that works. 3 or 4 days to get records is a long time.
If I call the hospital to speak to my relative my call is forwarded to a nurses station. That station then looks up the patient list on paper and if my relative is not found they forward my call to a different station. After 3 or 4 forwards I get my relative. Some hospitals in the USA are still in the 1980s.
I am a physician and operate a small practice. The issue for my practice is simply the cost. To make the switch I will have to invest thousands in IT upgrades, and pay thousands of dollars every year for the privilege of continuing to use the software. Further, if this slows me down to the point that I see one fewer patient per day, it will cost me an additional $10,000+ per year in lost revenue. I'm sure an EMR would streamline things for insurance companies, but my practice will see none of the benefits. I feel I provide high quality care with my current system and I don't believe a different record system will improve that. At the end of the day, switching to an EMR means a huge paycut with no improvement in patient care. I just don't see how that makes sense.
Hah don't have to pay anything at all. Clearly you've never seen a medical bill. Get real, it's more accurate to say, you don't get to choose whether or not you pay due to insurance, so why is the health establishment going to bother? They make an absolute killing already, they have no interest in risking any of their huge profits on projects that don't have guaranteed measurable yields such as all IT projects; predictability is near none. So they stick with the predictably enormously rising prices they keep charging for health care. 81 billion dollars a year? HAH. Drop in the bucket. To that industry billions are as good as pennies.
When my data is on paper in a doctor's office, I know who can see it... the doctor and anyone I ask him to send to. Why do you think there is such a manic PUSH for all the digitized records? The cynic in me says it's a Data Mining Goldmine for insurers, advertisers, those stupid background checkers, anything at all.... There is so much money to be made from 3rd party access to our records, it's just disgusting. It's like jackals circling in for a piece of the carcass. And don't tell me any BS about "congress ensures only people who need to see the info will see it". Not only is all computer security laughable, just wait. Maybe not this congress or the next, or the next, but eventually, some congress will say "we are now allowing access to this information for the good of the children". Then collect all the fees for the use of our private info. Just wait.
If they are build right... absolutely...The two dominant systems (Epic and Cerner) and only as good as the people who installed it for the facility.
My wife is an MD and (relatively speaking) is computer literate. She can touch type and navigate typical desktop machines.
Her clinic converted to EHRs several years ago and she still hasn't reached the level of efficiency she had with paper charts. At this point she's gone back to dictating parts of her chart (via speech recognition) to try to regain some of her lost productivity.
A lot of the problem is that the data is VERY free form. The mundane measurements (height, weight, temp, BP, etc) are easy to insert and digitize, and you can pass it off to another health worker to enter it. The really important information, however, doesn't fit into an established structure.
MDs learn how to collect and document patient status during med school and residency. The details vary from one program to the next. The efficiency of an office visit and its subsequent documentation all depend on how well the EMR flow (and even the number of clicks) fits how the MD does an office visit and/or documents a medical procedure.
The disconnect between habits and automation will continue to affect MDs until we have a generation of experience.
While we are finding that medications, drugs, and various substances in fact are reduced in error rates due to adoption of electronic forms, due to table lookups and the lack of data corruption on transcription, it is not always a panacea.
For data capture of patient histories, especially in medical research, due to the complexity and fallibility of the humans involved - our source data, if you will - we find that paper records sometimes are better at allowing us to capture a more correct record of what is happening.
Hence some of the resistance.
Some of the electronic forms take longer to record data with, and slow down patient/doctor communication and observation. Some of the electronic forms incorrectly presume that the patient has all their limbs, or that data is correct as first given. We have a lot of problems with veterans in terms of such data.
But that's my personal observation.
Just because you can capture things electronically, doesn't mean it's always the best method.
-- Tigger warning: This post may contain tiggers! --
There are a ridiculous number of emr systems out there, several with available 3rd party support to manage your IT setup, and some that will offer a VPN or secure citrix environment to work in.
I worked as an intern in IT for a large medical group a couple of years ago, and the consulting firm i work with now does a lot of support for just clinics/doctor offices and the IT aspect alone is expensive. In particular we help them upgrade IT infrastructure in a clinic so they can go live with their central EMR system.
there are workflow assessments to be done, and IT assessments to be done. We charge $95/hour per person, i can spend 3 - 8 hours doing an assessment and documentation for an office. They have staff to do the workflow assessments. We have assessed and rolled out 40+ offices in the last 12 months.
There are PCs to buy (Figure ~1 grand each, though they use thin clients now and again....just not often) and even a small clinic may need 6, a large one may need 30 or even more. Dont forget printers, patients are required to receive after visit summaries from their providers. and a couple of scanners for each clinic.
There is cabling to run...a lot of older buildings have zero cat5/6 wiring so that can be expensive.
there is networking equipment to buy (switches and wireless APs)
there is bandwidth to pay for (most clinics for this group have metro to get them to the main IT office)
there are laptops to buy (often with rolling carts for mobility/convenience)
sometimes we install mounts for the desktops in patient rooms.
there is labor required to image and prep the PCs and laptops, and labor required to roll them out and train the users on the very basic IT concepts they need.
There is training needed to prep users for the EMR system and massive training to get into details and customize the EMR system for a practice or provider.
I don't want to know what the average cost is to take a clinic live with EMR for this group. I know we billed out $300k in IT and cabling services last year, so thats several grand per clinic, minimum, in IT support. nevermind the emr staff and all of the equipment needed. Then the follow up IT support for misc PC issues, misc EMR issues, misc printing issues.
Some clinics already had a 3rd party supported EMR system that got replaced, but they have to keep it available for years. some of them were on their second system before we took them live on the new one...i have no idea how the very first one is supposed to get supported as legally required, but they were told to keep vendor support for anything they can as long as legally required because the medical group cant support anything but their own system.
for some clinics its a nice, welcome change. for some they equate to some level of hell. for everyone clinic there is a pretty serious cost to consider, and a lot of clinics had a very old or limited IT infrastructure to support what they already had.
By and large, language is a tool for concealing the truth. -- George Carlin
Greed. Pure and simple. That is what has killed electronic medical records.
It's anywhere from $60,000 - $100,000 for an EMR system. And if your EMR of choice doesn't do practice management, you have to spend another $10,000 - $20,000 for that.
The big promise of EMR is data portability. And here's the big secret that no one seems to be talking about: the data *is not portable*.
If I have ABC Company's EMR and you have DEF Company's EMR, I cannot export a patient chart, send it to you and then you import it. You cannot connect to my EMR and get charts for patients I refer to your clinic. So there is no universal patient chart that follows you where ever you go.
Plus, if you *do* have some other electronic system that has to interact with your EMR (say a pathology system or a perscriptions system) you have to pay *both* companies typically $10,000 *each* to do an HL7 link between to two systems. And even then, the link between the systems is spotty at best and half the time doesn't work.
A company that has very little in the way of technology wants to transition to EMR. So they have to spend $30,000 - $40,000 just for the computer hardware (workstations, servers, printers, scanners, routers, switches, etc.) and then another $60,000 - $100,000 for their EMR and practice management needs. THEN, the users have to be trained. I do IT and primarily work with medical offices and sugrical centers. I can tell you that doctors *do not want* to learn how to use computers and software. The office employees fight it, everyone fights it. Eventually they give up and don't use it and let $100,000 worth of hardware and software go to waste because they become too frustrated to use it, it slows them down exponentially and it hasn't made anything easier or more portable. I have seen so many offices basically throw money down the toilet on these EMRs. They get them, and within a month they can't stand them and just go back to paper charts. Not to mention how much they get in the way of patient care. My wife recently went to see the doctor. The doctor was hunched over her computer the whole time and seemed more concerned with making a typo than with paying attention to my wife. Paitent care is suffering greatly.
THEN, the EMR companies want to hold back common sense features and charge you tens of thousands of dollars to implement them. One office I worked with had a web-based EMR and the doctor wanted to be able to recieve faxes right into the EMR. They said sure, you can do that. She asked if they could download and print out the faxes if they needed to. The company told them that yes, they could, but that was an extra feature that would cost $10,000.
Vendor Lock-in is not just something that they strive for, it is the very *core* of the EMR landscape right now.
EMR is a complete and total failure and you can lay that failure squarely at the feet of the greedy bastards who sell it.
I own a software house that makes EMR software.
We distribute to 18 countries, but our primary business is in Australia. We do not sell into the US (and don't want to).
In Australia, the government standard for cloud based EMR is 'Patient Controlled'. They call it PCEHR (Patient Controlled Electronic Health Record). We've nicknamed it 'pecker'. In one sense, it is a good idea, as the patient owns their own data and cannot be held to ransom by their health care provider. Arguably, the authorities could never have made the decision for the data to be owned in any other way.
However, it also means that the electronic patient record contains only the data that the patient wishes to include. Any practitioner would be crazy to accept that record as 'complete' - and for the sake of their PI insurance (and the patient's wellbeing), they basically have to disregard the online electronic record and start from scratch every time.
Furthermore, most health care providers value their business based on the IP in their electronic records (more traditionally known as 'Good Will'). They will not willingly give up that information - at least, not quickly.
Sadly, I can't see an easy solution. It will take time and a bucketload of stakeholder engagement by the government - something that most governments are not very good at.
Come back in 10 years.
The doctors I've met and worked for felt that they were getting jacked around by EMR vendors. One of the biggest promised features for 2012 that won't be added until the 2013 version, requiring double the cost that was originally quoted. And since the feds have kept pushing back the dates for some EMR requirements, many practices are taking a wait-and-see approach. Also, billing is often done through aggregators who will accept older versions of billing software submissions; this means practices don't have to implement the latest and greatest, sometimes saving tens of thousands of dollars and all the hassle that comes from having a workforce who doesn't know how to operate the new version of the EMR.
Remember kids, if you're not paying for the service, YOU ARE THE PRODUCT THAT IS BEING SOLD.