Jan 03: EMRs Have a Long Way to Go

Assuming $20 billion would incentivize every independent physician, clinic and hospital to set up such a system, a serious unanswered problem remains. Unless we recognize the need to deal with interoperability, we could end up with a collection of systems that cannot communicate with each other. Right now there’s a plethora of competing systems with over 200 vendors including large-scale systems for hospitals and health systems like Providence Health System. Yet if a patient is seen in the emergency room at a Providence hospital but has a physician in the Legacy Health System network, currently there’s no easy and secure way of communicating that information beyond computer systems.

These competing systems do not interoperate. Just imagine what would happen if we had multiple Internet systems. The only reason the Internet works is because there’s only one.

The only viable solution is for every physician practice, hospital and healthcare organization to use the same EMR system though not necessarily the same modules. Despite its many drawbacks,  the most viable candidate is the Veteran’s Administration’s EMR known as VistA.

Interoperable systems require vendors to agree on and adhere to standards. But this isn’t as easy as it may appear. Adherence to standards has always been problematic in high tech because each vendor seeks to have a competitive advantage by insisting on standards that favor their systems, and they profit from meeting the needs of their individual customers rather than cooperating to meet our social needs.

Achieving a universal EMR system faces other difficulties. The medical system has been slow to apply information technology to healthcare. Most physicians, particularly those in small practices, consider EMR systems a cost, not an investment because it will not improve their incomes. A recent survey found that only 4 percent of physicians had a fully functional EMR and 23 percent reported having a basic system. Typically such systems can range from $10,000 to $100,000 per physician, who have voted with their wallets.

Digitizing medical records and providing online access also raises security and confidentiality issues lacking in paper-based systems. Massive numbers of medical records have been revealed as subject to rapid and unauthorized access. Almost no system is immune from being hacked. In addition, processes for handling digitized records on notebooks and tapes have been revealed as lax.

If we can overcome these problems, a universal EMR system could over many years reduce paperwork and, inevitably, reduce the costs of health care and medical errors. Such a system could also improve quality, continuity of care and help uncover Medicare and Medicaid fraud.

In a more comprehensive sense it would include a patient’s medical history and current health conditions, along with lab results, therapies, medications, allergies and radiology scans. Medical records would be instantly available throughout the country – whether a person is seeking care at an emergency room in Miami or Portland, Oregon. But we have a long way to go before we achieve instant access which has only occurred, to date, in a minority of cases.

The proper incentives can and will lead us in the direction of a universal EMR system. But we need to remember that EMRs alone will not solve the greater healthcare problems facing this nation. We must still tackle these issues:

·         The ability of health insurers to reject people because of pre-existing conditions.

·         The inordinate administrative costs and high salaries of health insurance executives that are an ineluctable faulty of our multi-payer system.

·         The limitation of people to seek healthcare outside their provider networks.

·         Making certain that everyone receives appropriate care based on medical evidence.

·         The need to refocus our system on prevention and life cycle costs.

·         Elimination of the three-fold variation in annual costs for Medicare enrollees throughout the country.

·         Making certain that health insurers provide value to patients rather than just shift costs.