As human existence makes its inexorable migration into cyberspace, patient medical records are following suit. Intended to replace the paper records that have long been a hallmark of the medical profession, proponents of electronic health records ascribe to them the ability to improve patient care – even save lives – as well as tens of billions of dollars annually in healthcare costs.
In fact, the Obama Administration in 2009 allocated nearly $20 billion in stimulus dollars to encourage doctors to make the switch to electronic health records, a process that had been stalled for years by their high cost of implementation and maintenance. But the administration perceives the reaping of those benefits to be such a sure bet that it will begin penalizing doctors and hospitals that have not adopted and properly deployed EHR software systems by 2015.
President Obama justified spending stimulus money to aid the switch to electronic medical records by asserting that their deployment will save the domestic healthcare industry $80 billion annually. In a country that spent $2.24 trillion on healthcare in 2007 (the last year for which figures are available) and where healthcare costs are increasing by six percent every year, that seems like justification enough. But some prominent doctors have been questioning Obama’s claim, arguing that the savings that electronic health records generate is actually much lower.
Drs. Jerome Groopman and Pamela Hartzband, both professors at Harvard Medical School and physicians at Beth Israel Deaconess Medical Center, a Harvard teaching hospital in Boston, told the Wall Street Journal that Obama based his $80 billion claim on a theoretical study the RAND Corporation published five years ago, and that its analysts admitted “there was no compelling evidence at the time to support their theoretical claims.” Groopman and Hartzband also point out that “considerable data” has been collected since that study was conducted indicating that EHRs will not save the healthcare industry anywhere near $80 billion.
According to the two physicians, the most effective use of EHRs – spotting dangerous drug combinations before doctors prescribe them to patients – only saves the industry “a few billion dollars yearly,” a fact RAND’s analysts affirmed themselves in their study. Avoiding medical malpractice lawsuits can save a significant amount of money but no evidence exists that electronic health records prevent the types of events that can lead to such suits, Groopman and Hartzband write. It is not uncommon for medical practitioners to be faced with accusations of malpractice, through electronic health records or otherwise. Through having, or applying for malpractice insurance with a trusted company, can ensure that you have the relevant protection should this situation ever arise, as it can cover the costs of any legal bills you may need to pay. When working in this industry, you must take a great level of care of how you do things, as you could find yourself faced with a lawsuit. If a victim does consider taking legal action against a medical professional, there are things they need to complete first. Creating a lawsuit is difficult, which is why most patients will require the help of a personal injury attorney jacksonville fl or wherever you might live. With a personal injury lawyer, the victim can try and claim some compensation if the medical malpractice has caused them to miss work.
Of the few billion in savings that EHRs do produce, physicians receive only about 11 percent, according to a study conducted by the Center for Information Technology Leadership, a healthcare research group. Insurers pocket the other 89 percent, the center found, mostly because EHRs reduce the number of duplicate medical tests for which insurers must pay and automate a sizable portion of the records handling process.
“The doctors bear all the costs and others reap most of the benefit,” Dr. David J. Brailer, President Bush’s national health information technology coordinator between 2004 and 2006, told The New York Times in 2009.
With the switch to electronic health records costing a small medical practice upwards of $200,000 in start-up costs, and over $100,000 in maintenance and upgrades – into the millions for hospitals -and with no guarantee they will recoup their investment, doctors have been reticent to swap pen and paper for zeroes and ones. According to the US Department of Health and Human Services, only 20 percent of doctors and 10 percent of hospitals currently use EHRs.
As a result, Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009, which promises to reimburse small practice doctors who implement EHRs with $44,000 in Medicare or $63,750 in Medicaid incentive payments, and hospitals with significantly more, over five years in order to overcome that reticence.
But those payments may not materialize because HITECH requires doctors and hospitals to demonstrate that they have achieved “meaningful use” of their EHR systems in order to be deemed eligible for reimbursement. That means their use of EHRs must meet an increasing number of criteria over the next five years that the Department of Health and Human Services has deemed indicative of improvement in the quality and efficiency of patient care, such as recording gender and blood pressure and ordering prescriptions electronically (for the 2011 to 2012 period, healthcare providers must demonstrate they meet fourteen “core” objectives and five “menu” objectives). Meaningful use also requires doctors to use certain functions in their EMR systems at specified rates. If DHHS, which is overseeing the implementation of a nationwide electronic health records database, judges a physician or hospital to have failed to meet the requirements for meaningful use, they will deny them their incentive payments.
“I know of many physicians who are speculating that they don’t know if they will ever see an incentive payment,” says Betty Otter-Nickerson, president of Sage North America’s Healthcare Division, a Tampa firm that sells EHR software systems to doctors and hospitals. In short, the stimulus dollars have not allayed their fears.
“I think that fear is misplaced,” says Farzad Mostashari, deputy national coordinator for health IT within DHHS’s Office of the National Coordinator for Health Information Technology. “I firmly believe and we commit to having the first group of providers be able to attest to meeting meaningful use and be able to receive incentive payments,” he says.
But according to Otter-Nickerson, even if doctors do receive reimbursements there is no guarantee they will get back all the money they spent. “Depending on the size of the practice, they might get as much back as they invest,” she says, with hospitals and physicians in large, well-heeled practices more likely to break even than those in small ones.
The RAND study based its EHR cost savings projections, and therefore its proclamation of their usefulness, on the condition that they be “adopted widely and used effectively.” But the training and IT support that is integral to such systems being used effectively is lacking, potentially throwing a wrench in a physician’s or hospital’s efforts to achieve meaningful use and collect reimbursements. Many have considered bringing in an IT support company London to help out in these cases with their businesses, and it could be helpful here.
“I’ve noticed that the IT training for the staff and doctors before implementing the system is often very basic or irrelevant to how and what you will be using the system for,” says Andonis Terezides, a resident surgeon in the Division of Oral-Maxillofacial Surgery at Jackson Memorial Hospital in Miami. “The training never seems to cover the important factors and variables that are faced in each department and specialty. We tend to have to learn how to deal with these situations on the job in front of a waiting patient.”
Otter-Nickerson refused to disclose how much training Sage offers to doctors and hospitals.
A shortage of health IT workers meant to assist physicians with their EHR systems also threatens to derail their efforts to achieve the meaningful use quotient. “Everybody is recruiting and there is a shortage of health IT workers and of servicing that need,” Otter-Nickerson said.
DHHS is trying to alleviate that shortage by training health IT workers to staff 62 Regional Extension Centers throughout the country to help physicians establish their EHR systems and use them effectively. DHHS has begun offering three and six-month non-degree programs at community colleges in Autumn 2010 as part of its Health IT Workforce Development Program to serve the country’s impending EHR needs. Two-thousand students have enrolled so far and the agency plans to train 70 million students total for the job.
“Health IT is a growth area,” says Mostashari. “There is a lot of demand – from hospitals, vendors, doctors’ offices and regional extension centers.”
Even so, Mostashari acknowledged there might be a health IT worker shortage. “Anecdotally, we are hearing that in some areas it has been hard to find the workforce and in other areas it has not been hard,” he said. “Where there are jobs, people find a way to get their skills up.”
Navigating the EHR Maze
Learning how to navigate an EHR system is not the only obstacle healthcare providers face in collecting their incentive payments. Hospitals that DHHS deems to have failed in to implement HITECH’s privacy and security measures, meant to protect a patient’s electronic medical records from being hacked into, and the details in those records stolen and even made public, will lose their incentive payments under meaningful use requirements.
That may seem like something that wouldn’t happen, but recent statistics prove otherwise. According to a study conducted by the Poneman Institute, a privacy and information management firm, many healthcare facilities have failed to properly deploy HITECH’s security safeguards. What’s more, Poneman found that healthcare providers still do not know how to secure their EHR systems to prevent data theft, with the lack of IT support and training the likely culprit. This is a prime example of why finding IT support that suits the dynamic and system of a company like this is highly important and must be researched thoroughly before any commitment is made.
Otter-Nickerson disagrees. “Quite honestly, paper is less secure,” she says.
But according to Poneman, data breaches are costing hospitals $6 billion annually, and because many breaches go undetected, that figure could be much higher. Some experts predict those hospitals that fail to meet the standards for meaningful use, including the ability to effectively and consistently secure patient data, will be targeted for mergers or go out of business entirely.
EHRs “standardize [doctors’] work well and makes it easy to manage their business,” says Otter-Nickerson. In turn, proponents argue, doctors can save money.
Jackson Memorial’s Terezides doesn’t see it that way.
“At the present time, I do not believe the [electronic] system is more efficient,” says Terezides. “Creating a universal system that permits the passage and sharing of information between doctors and specialties has been quite challenging. It’s further complicated by government and insurance regulations and requirements, thereby creating more work,” he says, not less.
“I don’t think any of us are satisfied with the current system, as it is cumbersome,” Terezides continues. “We often refer to it as the electronic monster.'”
But that inefficiency is not a characteristic inherent in EHRs, says Terezides. Rather, the twin lack of universality of software systems and the financial strain of switching to those systems is to blame.
“The problem we face is that there are so many companies creating their own products and each institution is bidding on and implementing the system that appears best for them financially. The systems are not universal,” Terezides says.
“There are excellent systems available,” he continued. “I can think of a few that are available to private practitioners in my specialty that are absolutely amazing. They do everything necessary to run a successful paperless office, right down to the doctor being able to access information from home on his or her mobile phone.”
“But remember, the system has huge limitations,” he said. “You can’t pull up records from groups or hospitals outside of your own system. So you are limited essentially to the records within your own institution.”
That creates unnecessary work and costs unnecessary time and money for a doctor like Terezides, who uses three to four different systems depending on which hospital he is rotating through.
“Sometimes there is crossover with the patients and locations and obtaining previous records from the other location or system is difficult or impossible,” he says.
Terezides recalled the EHR system used by the Veterans Affairs Hospitals, which allows physicians to access medical records from any VA hospital in the country. Although not as slick or user-friendly as some other systems he has seen, he says it is the most effective system in use today because it is universal.
Conflicting Claims on Patient Care
Last, and unfortunately least in the debate on the efficacy of electronic health records, EHR software companies make the claim that EHRs “enhance” the quality of patient care. They fulfill this function, says Otter-Nickerson, by “giving [doctors] analytical information to improve upon their best practices and improve care.”
But Groopman and Hartzband point to several studies disputing Betty’s claim.
A 2008 study assessing the influence of EHRs on the quality of care of more than 15,000 patients with heart failure published in the cardiology journal Circulation found that the “current use of electronic health records results in little improvement in the quality of heart failure care compared with paper-based systems.”
Researchers at Brigham and Women’s Hospital in Boston in conjunction with Harvard Medical School and Stanford University published an analysis of 1.8 billion ambulatory care visits in 2007 and concluded that “electronic health records were not associated with better quality ambulatory care.” And in their study of seven countries employing EHRs, Canadian researchers found no evidence of benefits or drawbacks to using them.
The lack of knowledge surrounding the effects of electronic medical records on patient care, the Canadian researchers concluded, “should be of concern to adopters, players, and jurisdictions.”