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How to make health care better

Jim Cameron
Vail CO, Colorado

Early in his first term President Bush publicly promoted the adoption of electronic medical record systems to both improve the quality of care and reduce societal health care costs. Nearly all of the 2008 presidential candidates in both parties have endorsed electronic medical records.

So, exactly what is an electronic medical record, what does it mean to you and what benefits will it bring to us?

Electronic medical records became commercially available almost two decades ago. Hospitals were the first to adopt the systems because they could readily justify the relatively expensive capital investment and staff training requirements by off-setting cost savings ” not only in staffing and physical space savings, but by shortening the accounts receivable schedule through faster chart completion and billing.

The paper-based medical record, with entries either handwritten or dictated/transcribed, is still the physician office standard. It is inexpensive, convenient for office staff and quite efficient in terms of entering information. However, paper chart content and therefore its value is limited to the office it resides in and then only during office hours.

The lack of instantaneous data access leads to duplicated services, untimely services and sometimes contraindicated services. Quality of care suffers and waste is estimated in the many billions of dollars annually within our nation’s $2.1 trillion health-care bill.

In the world of the paper chart, each encounter we have with different providers/locations produces a unique chart. So, we don’t have a single medical record, but multiple medical records and the older we get the more records we have ” each more or less unknown to the others. A fully developed national electronic medical record system will bring together all of the information across the full spectrum of providers ” physicians, hospitals, laboratories, imaging centers, pharmacies, etc., and combine all of the different medical records (or charts) that each of us have generated. Health-care providers requiring patient information could obtain it almost instantly and be able to evaluate patient circumstances with complete medical history. The technical, system challenges of a national electronic medical record system are substantial but not overwhelming. Major companies such as Microsoft, IBM and GE among others have already invested heavily in various segments of this undertaking.

Data security and privacy are main concerns. As we know, brilliant minds design fail-safe systems and other brilliant (misdirected) minds find ways to hack into them. We should not delude ourselves into thinking that a fail-safe system can be reality. Rather, we should focus on the legal sequences to persons or organizations who would illegally gain medical information and/or use such information to our detriment, and make punishments so severe that insurers, employers, government and individual persons dare not attempt to illegally gain or use our medical information.

The primary barrier to a national, comprehensive system is the physician office practice. While electronic medical records hold great benefits to society, the economics don’t work well in the physician office. Only about 25 percent of physicians have deployed an electronic system and most of those are within large group practices where economies of scale are more reachable.

Initial capital costs including hardware, software and installation can easily run $40,000 per physician. Ongoing annual costs include maintenance, depreciation and software licensing fees, which can also approach $40,000 per physician.

Then there is the ongoing training issue. Staff turnover in physician practices is high so existing staff members must train new hires. The office is then out two staff members ” the one training and the one being trained. That’s the lesser of two major problems. There is nothing faster than scribbling chart notes in medical shorthand in a well-organized paper chart or doing same for a couple of prescriptions. It takes a lot longer to do these same functions in an electronic environment.

However, the power of electronic systems to do searches, sorts, data mining and various analytics provides the physician with diagnostic and treatment tools that are not available in a paper chart.

From personal experience, the productivity loss in a physician office using electronic medical records is initially about 20 percent, a percentage supported in various studies. The productivity drop results from the input side of the electronic record, which still requires keyboarding of entries.

Really powerful voice recognition programs will someday solve this productivity problem for physicians but we aren’t there yet.

So, who benefits from electronic medical records?

The major beneficiaries are private and public-health insurers, medical malpractice insurers and, of course, we the patients. In order to reap the enormous benefits of a national medical record system, we must provide incentives for physicians in terms of initial and ongoing expenses. It is reported that physicians receive only about 11 percent of the savings from electronic medical records.

We need them to be winners in this equation and lot losers. If they lose, then they don’t adopt the technology and we all lose.

Jim Cameron is a retired health care executive who resides in Eagle-Vail. E-mail comments about this column to editor@vaildaily.com.


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