Thursday, May 23, 2013

Electronic Health Records (EHRs) and Government
More than half of U.S. doctors have switched to electronic health records and are using them to manage patients’ basic medical information, according to federal data.

Louise Radnosky, “ Electronic Health Data Gaining Favor,” Wall Street Journal, May 22, 2013
So saith government.  Overall, addeth the  government, 291,325 doctors and other providers -55% of office-based providers “eligible” for adopting EHRs and using them at a set level -  have received $5.9 billion for doing so.   An additional $8. Billion have been disbursed to hospitals for the same purpose.
All of this is good news, according to Farzad Mostashari, MD, national coordinator of HIT for HHS, and to David Blumenthal, MD,  Mostashari’s predecessor.  Blumenthal believes the including all eligible doctors, roughly 530,000 of them, using EHRs will be completed in 5 more years. Or else, in 2015 the government will start penalizing physicians for not using EHRs and prescribing electronically.
The heavy-handed government use of carrots and sticks is evident here. What is not evident are answers to these questions.
·         Does the use of EHRs make care more efficient and safer? 

·         Do the existing EHRs communicate with one another  at the physician-to-physician,  physician-to-hospital, and hospital-to-hospital levels?

·         Is there any solid evidence that EHRs raise or lower costs?

·         What effect, if any, do EHRs have on malpractice costs?

·         Have the privacy and security concerns of patients, physicians, and hospitals been adequately addressed?

·          Have EHRs increased physician productivity and patient safety?

·         What are  the error rates of EHR data entry?

·         What about those 240,000 other physicians who receive Medicare or Medicaid payments

But who are not “eligible” for federal EHR subsidies or who do not choose to prescribe electronically. 

Fear not, saith Dr. Mostashari, to patients, “Please be patient with your physicians as they transition to EHRs.  The ‘Under construction, pardon our appearance” is the phase we’re in.” 

Indeed,  EHRs are “under construction.” But there is no  assurance unversal EHR use will ever be complete.  In the U.S,, the private sector – physicians and businesses-   have ways of wiggling free or avoiding government mandates – physicians by going into cash only or concierge practices, businesses by waivers or self-funding or reducing workers to 29 hour weeks. 
The U.S. is not the same as Europe, where EHR use is more universal and where socialized medical systems  are  more prevalent.  In Europe, the government sector is much larger than the private sector – by a factor of 2-to-3, compared to 1-to-4 in the U.S.,  which means government is roughly 2.7  times more powerful in Europe. In the U.S., private doctors are more likely to fight EHRs rather than switch.

Tweet:  Federal data indicates that 271,325 doctors out of roughly 500,000 “eligible” for government subsidies have switched to EHRs.




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