Monday, January 14, 2013

Cost Savings from EMRs: A Path to Salvation

The Electronic Medical Record (EMR)'s promised contribution to health care cost savings got a second look recently, and the results were poor at best.  But what I found interesting was the "second look" was from the same organization that did the first look: the corporately-funded, non-profit think-tank called the RAND Corporation.  From their second and more recent report:
"A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually. Seven years later the empirical data on the technology’s impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion."
Who would have thought that such a prestigious organization like the RAND Corportation could have made such a teeny, tiny multi-billion dollar mistake? After all, their 2005 study was funded entirely by several of the major EMR manufacturers who have reaped billions in revenue on EMR sales since.  Is there any wonder that now the same RAND Corporation felt that the EMRs the lack of cost savings is really the end-users' fault?

"In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT."

What a shallow assessment.  There is no mention of the cost of these systems, their maintenance, lack of interoperability, poor user-interfaces, and in many cases, lack of graphics support.  Even more ironic, there was no consideration that someone might actually figure out a way to efficienctly skirt the government's arcaine documenttion requirements for reimbursement that would permit MORE health care spending.  No, those assessments would have been too obvious.  Instead, the Rand Corporation tells us that there were no cost savings with the EMRs is because doctor- and hosptial-customers didn't re-engineered their care processes or "adopt" substandard first-generation systems.

Give me a break.  At least the Congressional Budget Office saw through the Rand Corporation's ruse in their scathing report (pdf) from 2008.

Even so, at this point it doesn't matter.  Doctors and patients alike understand that there was too much corporate money involved and too many politicians' campaigns happily funded as the Stimulus Bill that implemented the EMR nationwide was crafted.  As a consequence, little will be done about either of the Rand Corporation's erroneous and over-zealous EMR cost-saving predictions now.  Whether we love it or hate it, the Electronic Medical Record is here to stay.   Government incentives have made it so and are still slated to grow.  More to the point, our lack-of-cost-savings epiphany came so late that most of our newly-graduated doctors have never used a paper chart and likely never will.

So now that the whole EMR implementation and cost charade has been exposed (and a blind eye permanently cast), what should doctors do now?

First, doctors must demand value for the money wasted spent on the multitude of EMR systems out there.   No where would that value be more evident than if interoperability standards were required within two years, especially when different health care systems use the same EMR system.  This is especially so with EPIC Systems, the largest EMR nationwide that is thought to contain patient records, at last estimate, some 40% of the nation's hospitalized patients.  Right now, this minute, most of the major medical centers in Chicago use EPIC.  There is simply no excuse any longer that doctors from one major medical institution shouldn't be able to view clinical records at another institution, especially when they use the same software.  Silo-ed patient data is not a value-driven proposition for the patient but rather a profit-driven proposition for hospitals.  As such, transferability of patient data between hospitals and health care systems should become one of the highest "quality standards" for hospitals to achieve and (perhaps) stiff payment penalties applied if this goal is not met. Patients (and the doctors trying to care for them) deserve nothing less.

Second, open avenues of communicating concerns about EMR functionality and safety should be mandated  and not restricted to conversations moderated behind secured web-based firewalls hosted by twenty-something computer nerds with no clinical experience.  Social media involvement by companies, be it by way of blogs, Twitter, LinkedIn, or Facebook, should be the norm.  Such open discussions encourages constructive, transparent and understandable transmission of tips, tricks, and (most importantly) needed improvements as EMRs mature.  After all, there's nothing better than a screenshot or picture(s) (devoid of patient information, of course) published for all to see to make a point and affect change. A grass-roots critique of EMR systems by doctors is long overdue.

Third, EMRs should not try to be all-encompassing.  They should stick with what they know.  Do not try to be a graphical user interface when you write in MUMPS, for instance. It's embarrassing.  If you can't do graphics, pictures or difficult multi-layercalendars, then dove-tail with someone who can.   To do otherwise creates unfamiliar non-standardized interfaces that invite treatment errors and inefficiencies rather then correcting them.

Today the sad reality is this: EMR interactions consume more of the physician's time than direct patient care.   EMR companies should realize that as long as doctors are challenged by data entry and the ever-increasing documentation and verification requirements to maintain their livelihood, they will speak out on the new challenges posed by the the EMR publically.  Companies that embrace and respond effectively to constructive criticism openly and honestly are much more likely to be viewed favorably by the health care marketplace and (who knows?) might even help to save a buck some day.



Anonymous said...

Very few people seem to care about
privacy or discretion anymore: social media, facebook, tweeting, bathetic
talk shows, apology/confession tours
on Oprah or wherever, recording every nanosecond of our lives from conception till expiration etc..
I have given up on that one. Security of records is a moot point.I choose to handwring over the quality of the patient/doctor relationship and the rationing of care quite obviously for economic reasons. I expect we will soon follow Britain as they move to incorporate " telemedicine" in which the doctor views and diagnoses his patient via patient's home computer screen. I wonder how secure THOSE images will be.

Anonymous said...

Docs would do well to realize that EMRs are all about data collection and monitoring (and eventually controlling) our behavior. Our experience using them is absolutely meaningless to those calling the shots. Deal with it and move on.