Wednesday, February 27, 2008

Eletronic Medical Records - Short Take on Electronic Medical Records and Patient Health Records

I keep six honest serving men
(They taught me all I knew)
Their names are What and Why and When
And How and Where and Who

Rudyard Kipling, 1865-1936

What - A nationwide system of interactive and interoperative Electronic Medical (Health) Records in Physician Offices and Personal Health Records owned by Patients.

Why – To promote practice business efficiencies, to avoid duplications, to promote safety, e.g., inadvertent drug interactions, and to track quality improvement...

When – Unknown, work in progress. Uptake by physicians in 10-20 percent range and among patients in 5 to 10 range despite five years or so of active promotion and electronic records development.

How - .Obstacles have been cost, practice disruption, loss of revenues for first six months, no tangible return on investment, suspicions EMRs are for health plans benefits rather than for benefit of physicians, time and expense of entering data, lack of infrastructure in small or solo practices, little evidence of improved quality, privacy concerns, and fears that payers will use data for surveillance, punishment, and exclusion purposes (e-Big Brother Syndrome). Implementation will probably require positive financial incentives through low cost loans, payments for signing up patients, carrot and stick approaches with P-4-P rewards and punishments, or payer mandates.

Where - Mostly in larger practices and in integrated health organizations with resources and infrastructure. Also being promoted in states like California, Minnesota, Massachusetts, and others with number of large practice or academic groups. American Academy of Family Practice also is EMR advocate.

Who - Physician leaders, young physicians, Michael Leavitt, had of CMS, who advocates mandated EMRs, leaders and members of organizations like HIMSS (Health Information and Systems Society).

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