Medical Information Technology
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EHR Or Not EHR: That’s Still A Question?
By Bernd Wollschlaeger,MD,FAAFP,FASAM
Many doctors are still debating passionately the merits of an Electronic Health Record (EHR). Some claim that the government has no right to mandate its use, others are suspicious that such systems provide government with the tool to peek into their practice and that “big brother” should stay out of their office.
The majority of doctors I have spoken with are mostly concerned about the costs of the switch from paper to electronic record system. With the average traditional EHR systems running about $50,000 per physician, not including monthly maintenance costs, many docs are hesitant to sign-off on such an expense, especially in those challenging economic times.
Furthermore, doctors have been fed horror stories of EHR implementation failures and the fact that thirty percent of medical practices that adopt a full-fledged EHR system deinstall it later!
It’s also of interest to consider the detrimental short term impact of the stimulus package upon adoption of Electronic Health Records systems. Some have attributed an almost Kafkaesque quality to stimulus package because it will probably serve as a speed bump to EHR adoption until the details of the act have been spelled out. Up until the passage of the stimulus package, adoption of EHR systems has been proceeding slowly but steadily. However, the vaguely defined promise of $17 billion in reimbursements for EHR if unknown criteria are met could result in gridlock among purchasers, i.e. doctors and hospitals, in the short term while they wait for finalization of the provisions of the stimulus package’s Health Information Technology for Economic and Clinical Health Act (HITECH Act). At this point I can state with a high likelihood of certainty that our government will NOT provide financial support to doctors to purchase hard- and software but will incentivize their use. In plain English: you will get paid MORE for demonstrating and proving the “meaningful” use of an EHR system in your practice. This undefined description will likely deter healthcare organizations from rushing to purchase an EHR system.
Another speed bump of the HITECH Act pertains to the reimbursement modality which would only be provided if a certified EHR was implemented. However, the certification standard is to be developed by an office (ONCHIT) that has not been staffed yet, with a coordinator that has not been named yet and by the Secretary of HHS, who has just been appointed.
So what do I advise you to do?
1) Start preparing your practice for the switch toward an EHR. That requires thorough workflow assessment and the careful parsing of essential information out of your existing paper record. This will achieve two goals: a) that your future EHR will model your current workflow, b) that you can transfer the extracted patient information quickly into your new EHR system.
2) Do NOT focus on the big number ($50,000/per physician). This number pertains to the OLD legacy system on which most current EHR software is based. These systems require costly installation, maintenance, updates and can not be adjusted to your practice. Focus instead on the new technologies. The Web 2.0, or second generation of web development and design, aims to facilitate communication, secure information sharing, interoperability and collaboration on the Internet. Web 2.0 websites allow users to do more than just retrieve information. They can build on the interactive facilities of “Web 1.0” to provide the Internet as computing platform, allowing users to run software-applications entirely through a browser. Users can own the data on a Web 2.0 site and exercise control over that data. These sites may have an architecture of participation that encourages users to add value to the application as they use it. This will dramatically cut costs to ~ $6000/year/physician.
3) The new Web 2.0 technologies offer interactive web-based software application with modular design components. For example, you can use an appointment scheduler, a patient registry and lab module to manage your information flow and allow patient to choose their doctors appointment whenever and whereever they want to do it. I am successfully applying such a module for > 2 years and my patients are loving it.
Jumping on the EHR bandwagon NOW gives you a competitive edge and allows use to benefit from the multitude of additional reimbursement opportunities including e-prescribing, quality of care reporting and chronic disease management.
Don’t way and be proactive. Change does not offer only financial opportunities but will provide greater job satisfaction.
We will help you along the way!
Disclosure: The author is a practicing family physician, addiction specialist and computer consultant. In addition, he is a founder and managing partner of a medical IT company.
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2 comments:
As physicians perform due diligence about EHRs, they need to also be sure the systems can provide the functionality to comply with the new privacy and security requirements of the HITECH Act. They should know that there are hugely increased civila penalties for violation of the privacy/security provisions: from $100/violation previously to the current range of between $100 and $50,000/violation at the lowest level of culpability! Violation of HIPAA is now potentially a bankruptcy-inducing event.
The functionality that will now be necessary in an EHR is the following:
1) EHRs must be able, at a patient's request, to restrict disclosures of PHI from the EHR to a health plan for payment or healthcare operations purposes regarding any service for which the patient has paid in full, out-of-pocket. This functionality is tough enough if the patient requests restriction of one discrete service. It will be much more difficult if the patient requests restriction of one service delivered along with other services.
2) The EHR must now be able to produce the information necessary for a physician to provide to the patient an "accounting for disclosures" if the patient requests it. Under the HITECH Act, the acoounting must now include all disclosures from the EHR for treatment, payment and healthcare operations purposes. The content of the accounting is currently unknown, and won't be known till DHHS promulgates regulations (due by June 30, 2010), but any EHR purchased between now and Jan. 1, 2011 must be able to produce the accounting, starting on Jan. 1, 2011.
The double-whammy of newly created HITECH Act patient rights with regard to PHI and the greatly increased civil penalties means that physicians should ask lots of questions of their EHR vendors.
I agree with this discussion. The new HITECH Act puts "teeth" into HIPAA, which cannot be ignored. These teeth bite Business Associates in addition to health care providers and other covered entities!
Part of the reason many physicians may get "burned" if the EHR systems they purchase do not perform as expected, or meet HIPAA requirements is that they believe what the vendors tell them and do not retain an experienced HIT (health information technology) attorney to negotiate a good contract for them before they expend their money!! Sales promises, even when in writing, mean nothing once a contract is signed (unless the sales document is specifically incorporated). Hardware Purchase Agreements,Software Licenses and ongoing Maintenance and Support Agreements are VERY Vendor favorable. When you consider not only the expense of the products, but the expense to the physician of the time and effort he or she and staff must expend to implement EHR, and the potential HIPAA/HITECH exposure, hiring good legal representation is the least costly part of the transaction!! Practicing preventive contracting is as important as preventive medicine!
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