Tuesday, December 4, 2007

Electronic Medical Records, Limits of Technology -EMRs and PHRs Don't Impress Doctors and Patients

Something’s going on out there in the electronic medical world, and the “experts,” government and commercial cyber pushers, don’t know what to make of it or what do about it.

Doctors and patients aren’t flocking to EMRs (electronic medical records) and PHRs (patient health records) as the be-all, do-all, and end-all to eliminate medical errors, coordinate care, and streamline care.

It’s not for lack of trying. There are as least 300 EMR vendors are there, and more than PHR systems are available. And yet only 10% of solo physicians, and 20% of all doctors have installed EMRs, and only 5% of doctors and patients are using PHRs. This is even in face of the fact that the Veterans Administration has a system-wide EMR, and Kaiser has both an EMR, available to its 12,000 doctors, and a PHR, My Health Record, available to 8.7 million Kaiser members.

What’s the hang up? Personally, I don’t hanker to go to a doctor to have my problems documented. There are certain personal things I want to keep personal. I want the doctor to pay attention to me, not to the computer. To me documenting isn’t the same as doctoring. As David Pallestrant, MD, founder of Sermo, commented to me, “Having a computer in the room changes the chemistry of the doctor-patient relationship.” And as one VA patient said to me, “ I hate to go the VA. The doctor is always sitting behind that damn computer.” To have a personal record of the encounter is not sufficient incentive to me. Even Gary Baldwin, the technological advisor of Healthleadersmedia and an ardent EHR supporter, admits that his doctor having an EMR is not a sufficient reason to switch doctors.

So what are the experts to do? Michael Leavitt, secretary of HHS, is resorting to veiled threats. In a recent statement, he said he was inclined to proceed with the 10.1% Medicare payment cut unless doctors installed EMRs. This “or else” comment has the sound of childish playground threat and certainly doesn’t speak to the maturity of Mr. Leavitt.

Doesn’t Mr. Leavitt know,

Only 1/10 to 1/5 of doctors have installed EMRs despite 5 years of government and health plan pressure.

EMRs costs $20,000 to $40,000 per doctor to install, and primary care physicians are already trying to make ends meet.

Current evidence indicate EMR users are not less error prone, quality-enhanced, or productive than non-EMR users.

Most doctors see no tangible return on investment form EMR-use.

Meanwhile on the PHR front, vendors are reaching out to health plans and employers to make PHRs more attractive. They’re expanding the data base to make PHRs more useful to doctors.

But privacy, security, and personal obstacles remain. PHRs have advantages for patients with active conditions requiring transfer from one doctor to another, but they have yet to catch on among doctors because of their costs, negative impact on work flow, and expense to maintain, and among patient, who remain concerned about privacy issues. Going to a doctor is not the same as a routine retail transaction, either for the doctor or the patient.

1. Kevin Freking,"Leavitt: Doctors Need Electronic Records, Associated Press, December 3, 2007.

2. Pamela Lewis Dolan, "Pretty Half-Hearted Reception, " American Medical News, December 3, 2007


Lisa said...

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This is the ONLY system where a personal health record
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This is just a few central details about the
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S. Erik Skoug

Unknown said...

In a recent online survey of 2,153 U.S. adults ages 18 and over conducted by Harris Interactive® between November 12 and 14, 2007 for The Wall Street Journal Online’s Health Industry Edition they report that more adults (60%) feel that the benefits outweigh the privacy risks than those who do not (40%).

Majorities agree that electronic medical records could reduce healthcare costs (55%), decrease medical errors (63%), and reduce redundant tests (67%) – similar to 2006 results. Even more (74%) believe that patients could receive better care if doctors and researchers were able to share information more easily.

But, as when banking or shopping first went online in nineties, there have been issues of privacy concerns regarding healthcare data as well today. As things become more common though, these concerns tend to wane, as evidenced by a 10-point drop this year (from 61% in 2006 to 51%) in those who say electronic records make it difficult to ensure privacy.

As electronic records of health information become more common,there will be increased adoption of these services in future.


RoseAG said...

Well, I'm gonna raise my hand and say that I'm impressed with my plan's EMR.

Having my physician pull my test results or notes from a prior visit, sometimes from a different Doc, impresses me. I can't help but believe that it's more accurate than my recounting prior visits and recommendations from other Docs.

Having him/her print out the summary of my visit with my stats and instructions is nice.

When I can skip the pre-op EKG (and the $20 co-pay) because they know that I already had one recently then savings are happening.

Going online and printing off my kids immunization records when I need them for day camp beats the self-addressed envelope and a prayer that I'll receive it back before camp starts.

If I get sick on a weekend and go to an after hours clinic then whoever sees me has got my whole history, as does the advice nurse I talk to when making the appointment.

Heaven only knows how many patients a doctor sees in a day. I don't expect to be remembered, being recorded is fine with me.

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