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EMRs Might Work for Physicians in PHM

by Scott MacStravic

Despite the continuing pressure on physicians to invest in electronic medical records, only about one-quarter have done so, and usually in large medical groups. There are numerous quality and efficiency of care reasons for making the investment, but these often fail to persuade physicians, who tend to feel that others gain most of the benefits while they suffer all of the costs.

Recently, BlueCross Blue Shield of Massachusetts came out on the physicans’ side on this issue, indicating its belief that the return on investment to physicians would not justify the expense, based on its current bonus program. Its own analysis indicated that physicians gain only 11% of the money saved through EMRs, and that isn’t enough to cover costs what physicians in that state gain under its bonus program. Henceforth, it will not require physicians to have EMRs in order to qualify for bonuses. [PL Dolan “Insurer Finds EMRs Won’t Pay Off for Its Doctors” amednews.com, Mar 10, 2008]

In many, probably most small physician practices, available bonuses and financial/efficiency gains from EMR investments tend to be far greater per patient served than is the case for larger groups. And there simply is no current way to recover the investment costs, even if physicians could afford to spend or borrow the money required. But there may be a way to do so through the growing movement toward “medical homes” and proactive health management (PHM), at least for primary specialty physicians and secondary specialties that are willing to move into PHM for their chronic disease patients.

One of the elements of PHM as practiced by physicians is the need for frequent contact with patients, through individual or group visits, phone consultations, outbound e-mails and other methods used for monitoring and motivating patient adherence to medications and lifestyle change “prescriptions”. Moreover, while EMRs are used mainly as background information in sickness care, they are close to essential for patients and physicians to monitor and make adjustments on an ongoing basis for PHM goals and processes.

EMRs become “personal health records” routinely and easily accessible to both patient and physician, as well as to other practice staff involved in patients’ PHM efforts. They can be the basis for reminding patients when regular measures of their behavior change commitments, when it is time to make a measurement of progress in losing weight, blood pressure/sugar/cholesterol levels, calorie intake, physical activity, etc. They also serve by providing objective data, often including graphic displays, of patients’ overall progress, and can be used by patients involved in employer-based PHM efforts to validate their eligibility for incentive payments.

The MDVIP organization, with over 200 physician practices in 19 states, for example, offers EMRs and patient web pages that are used to track and record patient progress toward whatever personal health goals each is working on. The records, themselves, serve as a reminder of how far each patient has come since initiating each’s health improvement effort, as well as how far each has left to go. They also serve to remind physicians to consider congratulating patients on progress, or adjusting the patient’s support program if progress is slow or non-existent.

MDVIP patients also receive a mini-CD that they can use in their own computers or carry with them when they go to physicians or other providers that are not in the MDVIP system. They have their own web page for their records and MDVIP’s electronic access to health information they might be looking for. In spite of the fact that MDVIP physicians have no more than 600 patients each, this is enough to make having EMRs worthwhile for their PHM-focused practices.

Given the significant value of sharable EMRs in PHM, together with the greater simplicity of the records and applications required therein, before primary physicians make decisions on EMR investments, it might be wise for them to confer with peers who have adopted truly PHM-focused medical home models, such as MDVIP physicians, to get a more complete idea of the advantages vs. costs involved. The investment may not be justified under traditional payment systems, but may be sensible, necessary, and affordable in PHM-focused practice.


4 Comments »

[…] who tend to feel that others gain most of the benefits while they suffer all of the costs.” Article Scott MacStravic, World HeathCare Blog, 26 March […]

  Dr. Robert Mandel wrote @ March 26th, 2008 at 3:45 pm

Scott writes about BCBSMA and its incentive programs to hospitals and physicians, but let me give a clarification on the AMNews coverage of our CPOE announcement:

BCBSMA offers an incentive to PCPs who add electronic medical record (EMR) or medical decision support (MDS) technology to their practices. This is one of the many measures for which PCPs can receive an incentive payment. The other measures are clinical, HEDIS-type measures.

BCBSMA recently announced that having Computerized Patient Order Entry (CPOE) technology by 2012 will be the threshold for Hospitals to participate in our Hospital Incentive Program.

Thanks for the opportunity to clarify

  Scott Smith wrote @ March 28th, 2008 at 2:28 pm

March 29, 2008

I read with great interest your article on electronic personal health records and thought you would find MyMedicalRecords of interest. MMR has contracts with organizations covering more than 30 million lives to provide our services. We have a new way for physicians to set up a system of digitizing records at very low cost.

Contrasting MMR to other popular EMR products, MMR is delivering the most user-friendly, convenient and versatile web-based Personal Health Record available today. Using our proprietary patent pending technologies, complete patient information including actual lab test results, radiology reports and images, progress notes and all of a patient’s charts can be uploaded or faxed with annotated voice notes and comments directly into the user’s password-secured account. Users do not need to install any special software or use any special hardware to use our service.

MMR also has integrated other advanced features, such as multilingual translation, a drug interaction database of more than 20,000 medications, calendaring for prescription refills and doctor appointments, and private voicemail for a doctor’s message and other personal uses.

There also is a special “Emergency Log-In” feature that allows a doctor to access a user’s account to view their most important medical information in the event of a medical emergency. To ensure individual privacy, specific data, such as prescriptions, allergies, blood type and copies of actual medical files or images, are pre-selected by the user for inclusion in the online read-only Emergency Folder.

In addition, MMR also includes an online ESafeDeposit Box feature that enables users to securely store any important document in a virtual “lock box” and access them anytime from anywhere using an Internet-connected computer or PDA. These documents can include Advanced Directives, Wills, insurance policies, birth certificates, photos of Family, Pets and Property, and more. MMR is clearly one of the most complete user-friendly Personal Health Records available today (I can provide details).

Incidentally, MMR has built a two-way data interface to Google Health and our understanding with Google is that MMR will be part of their public launch expected shortly. This will enable users to move information from their Google Health account to their MyMedicalRecords account and vice versa. This will enhance the Google Health user experience by allowing the individual to store documents, images, and other personal information in MMR’s easy-to-use personal health record and will have the benefit of all the additional features MMR has that are not available directly within Google Health.

I would encourage you to visit MMR and set up a complimentary account. Simply go to www.mymedicalrecords.com and sign up using registration code MMRBLOG. I would be interested in your experience and hope that you will include us in any further discussions of Personal Health Records. I could also send you more information by email or snail mail (the latter allows me to send a bit more than I’d want to clog your email with). Recently, we sent out a release about MMR Pro, which will better enable physicians to put patient records into secure, online accounts.

Sincerely,
Scott S. Smith
Director of Public Relations
MyMedicalRecords.com
11000 Santa Monica Blvd. #430
Los Angeles CA 90067
888/808-4667
Ext 123 (Cell: 310/254-4051)
ssmith@mmrmail.com

  JayAndrews wrote @ May 21st, 2009 at 1:22 am

Business world of the 21st century is fast-paced. Even in medical practices, speed equals ability to compete, especially when managing information. That is why an EMR is used by most medical practices. In addition, a fast electronic medical record system requires less time invested in trouble shooting and allows more time invested in caring for patients.

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