Electronic Medical Records – Incentives and Pressures for Use Mount, Obstacles and Costs Shrink

The mind of man is more cheered and refreshed by profiting in small things than by standing at a stay at the great.

Francis Bacon (1561-1626), Of Empire


It’s been three years since Congress approved a nearly $30 billion plan to digitize health care records, yet much of the health care industry is still drowning in paper.

Shefali Kulkenn, “Bipartisan Report Highlights Gaps, Recommendations for Health IT, Capsules in KHN Blog, January 27, 2012

January 30, 2012 – When future historians write the story of electronic medical records, they will ask: What took so long? After all, they will say, EMRs reduce costs, duplications, and errors, improve quality, and are more efficient because they cut across specialty lines and allow physicians to review the complete patient record at one setting in one format.

Many physicians of today would respond: Well, maybe, but not yet, but that’s another story.

The answer to the historians, according to the Bipartisan Policy Center in a 43 page report, is delay in getting various EMR systems to talk to one another. As of now, the myriad of systems tends to create a Tower of Babel.

The report says other obstacles to routine use include lack of enthusiasm among consumers, privacy and security concerns, paucity of hard-pressed physicians’ and hospitals’ financial incentives to convert from paper to digital records, prohibitive costs, and the necessity to completely change practice dynamics.

Still, recently, in the last year, there has been an upsurge of EMR installations, with perhaps as many as 50% of physicians using EMRs in one form or another, usually as incomplete systems. There are a number of reasons, tangible and intangible, why this is so.

• Government carrot and stick financial incentives – 1% to 2% bonuses or punishments to install and use EMRs and to prescribe electronically.

• A sense of the inevitability of digitization, partly propelled by software advances, mobile devices, and the flowering of the social media.

• Subsidies of EMR systems by some health plans.

• Ease of adoption and use by new EMR business models, in which ads rather than physicians pay for adoption and in which software and hardware resides in “The Cloud” rather than onsite.

• Improvements in usefulness, e.g. speech recognition allowing voice entry of narrative summaries by physicians accustomed to dictating.

• Administrative pressures on acquired and salaried physicians in hospitals and physicians groups to use EMRs – or to practice elsewhere.

• Difficulties in recruiting young physicians, weaned on computers, and refusing to join practices without EMRs.

• Increasing awareness by some consumers that EMRs are a hallmark of practice excellence.

• Realizations by physicians that future practice survival and thrival will depend of digitization.

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