by Scott MacStravic
April 30, 2007 at 9:40 pm
· Filed under Health IT
A recent Accenture survey found that two-thirds of consumers responding indicated that having an EMR system or not played a role in their selection of a physician. Moreover, a little over half of these consumers said that they would be willing to pay a reasonable extra amount to cover the costs of such a system. Despite this consumer preference, only about 10% of practices and 25% of doctors have EMR systems in place. The cost of implementing and maintaining the system is the overwhelming barrier, with 86% of physicians reporting that as a concern. [“Survey Finds Patients Favor Doctors Using EMRs” E-Health Trend Watch Apr 27, 2007 (www.hcpro.com)]
This consumer attitude adds to the many quality and efficiency reasons for physicians to adopt EMR systems. Fortunately, governments, employer coalitions, and hospitals are indicating a willingness to support physicians’ efforts to digitalize their records systems, and laws against hospitals helping are being relaxed. But another reason emerged in a breakout presentation at the World Healthcare Congress this week.
During the presentation of Regence BlueCross BlueShield and the software firm, Kryptiq Corporation, both in the Northwest, the preference of at least that employer for physician practices with EMR systems was made clear. This makes good business sense for Kryptiq, since it is in the software business, but also because of the advantages the EMRs offer in employee health management.
Almost all the current pressure on physicians to adopt EMR systems focuses on their importance in sickness care. They enable physicians to more quickly access information needed to diagnose and treat patients who are ill, to avoid duplication of tests in making diagnoses, and avoid contraindicated medications in treatment, for example. They also facilitate coding and billing, so help practices in managing cash flow.\
Growing importance is being given to the prospect of sharing EMR information across practices, to improve continuity of care when multiple practices are involved in an episode of care, for example. Regional Health Information Organizations are emerging as ways to enable sharing of data by practices when patients seek care away from their usual sources, perhaps in emergencies such as hurricane Katrina.
But EMRs are also excellent foundations for health management, for preventing and catching early risks and diseases that can be managed in ways that reduce direct sickness care costs, but also worker absences, impaired performance while at work (“presenteeism”), disability wage replacement costs and other labor costs to employers. And employers can influence the physician selection of hundreds, even thousands of employees.
Kryptiq considers the presence of EMRs in deciding which physician practices to include in its provider network, for example, and selected GreenField Health System in Portland, OR as a partner in its effort to manage the health of its employees, not simply deliver sickness care. The founder of GreenField Health serves on the Kryptiq board, while GreenField is also a customer for Kryptiq’s secure online communications system for communicating with patients. Such communications improve the efficiency of practices by eliminating unnecessary office visits, while providing the foundation for ongoing health improvement and maintenance efforts.
In addition to using EMRs as one factor in choosing practices for provider networks, employers can use EMR-enabled performance data on how well practices are doing in managing employee health to inform individual employee choices of personal physicians. When employee performance makes a difference to their compensation and career prospects, and health has a significant impact on their performance, this adds another reason for patients to prefer physicians with EMRs.
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It is obvious that World Health Care Blog represents healthcare stakeholders other than doctors with small private practices, like mine. I am a dentist. Dentistry continues to be overlooked in the struggle for interoperable Electronic Medical Records. We are years behind physicians who also own small practices. If 10% of them have EMRs, I would guess that less than 0.5% of dentists have them, and there is no interoperability with anyone, unless you count the insurers.
If the incredible danger of privacy breaches is not mentioned, and it was not, it is understandable that at least half of all consumers want doctors to go ahead and change their paper records to electronic medical records. Why not? It is obvious that if a survey is worded just right, statistics can be strategically applied to the data to show that some consumers “…would be willing to pay a reasonable extra amount to cover the costs of such a system.” One could also show that between 8 and 12% of a given group of people would say that they like the way that athlete’s foot makes socks smell.
Yea. Patients say that they will pay a “reasonable” amount now, but what if doctors and dentists like me take the bait and things just do not work out as planned? Is that possible in this country?
Let us say that I risk the expense and significant danger to my patients to convert my thousands of paper records to electronic form. Let us assume that after I borrow 50 thousand dollars to “invest” in an EMR system, my finicky patients, who were all for the goodie stuff you mention, reveal that when they actually volunteered to pay me more for my services, they (wrongly) assumed that their insurance would pick up the additional cost. This happens, you know. And what happens when my patients hear about another 10,000 EMRs fumbled — patient records in a computer, stolen from a doctor’s office?
With the added expense to my overhead to pay off the note, and even fewer patients to treat, how will my increased fees compete with the dentist down the street who wisely did not take the electronic risk you are pushing?
Can he be somehow taxed heavily and, like HIPAA covered entities, be threatened with jail-time? That would level the playing field and the tax revenue could even be used to pay for the EMR promotion that is desperately needed to overcome common business sense.
Doctors with small practices are not adopting EMR systems because even with cheer-leading from government, IT industry, insurers, big business, and many other business entities who stand to gain from the new and expensive cottage industries, EMRs simply do not yet make sense for small practices. Physicians are indeed moving towards adoption all the time, although very, very slowly. For dentists, information technology is stalled and beginning to roll backwards.
Face it, your selling points are very weak: Employers refer employees only to physicians and dentists who have bought into the EMRs. From what I understand, this could be called employer-managed care. Employees will pick their doctors from an employer-approved list of doctors and dentists. How good is that? Whoever thought up this idea has never shaken hands with either and employee or a consumer. Employees will hate this arrangement even before they are told about EMR “health management.” Its description is vague, but I think the system allows bosses to keep tabs on employees’ weight and exercising habits.
And what is this about employers using EMRs to help their employees choose doctors? Let me get this straight: On top of risking my 50 to 60 thousand dollars, I am expected to allow insurers, who profit by paying me less, to not only grade my quality of care, but to offer their opinion to employers in my neighborhood? Nasty class actions suits begin here. I hope the AMA and the ADA are not supporting this unfair business practice. Those organizations could be named as co-defendants along with the insurers.
As “just one more reason” for doctors to invest in… fantasy, the author mentions the portability of electronic health records in the event of emergencies like hurricane Katrina. My practice, like the majority of practices in the US, is located hundreds of miles inland. A hurricane is less of a risk than a nuclear blast. How well do Electronic Medical Records endure incredibly strong electromagnetic pulses that have no effect on paper records? Maybe practices close to the shore should keep both computers and filing cabinets.
Darrell Pruitt DDS
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