Few out-patient physicians have access to full-function EHR systems
June 23rd, 2008According to a summary report on a comprehensive national survey, more than eight out of 10 physicians practicing in an ambulatory setting have no access to any form of electronic health record (EHR), and only four in 100 have access to a full-function EHR system, despite four years of federal ballyhoo of health information technology (Modern Healthcare 6/18/08).
The report was funded by the Office of the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services, and the Robert Wood Johnson Foundation. Three authors receive support from GE Corporate Healthcare, and author and spokesman David Blumenthal, M.D., M.P.P, is an advisor to the presidential campaign of Barack Obama.
Given the low current availability of EHRs, “the U.S. healthcare system faces major challenges in taking full advantage of EHRs to realize its health goals” (ibid.).
The majority of physicians reported being satisfied with their EHRs (93% of the 117 with fully functional systems and 88% of the 2,160 with basic systems). The four possible responses, “very satisfied,” “somewhat satisfied,” “somewhat dissatisfied,” and “very dissatisfied” were combined into two categories, “satisfied” and “dissatisfied.” The possibility of a bias in the respondents, especially greater receptivity toward and facility with EHRs could not be excluded; the response rate was 62%.
Most of those with fully functional systems reported averting a known drug allergic reaction (80%) or a potentially dangerous drug interaction (71%), being alerted to a critical laboratory value (90%), ordering a critical laboratory test (68%), or providing preventive care (69%)—at least once.
Cost was the biggest barrier to adoption, the researchers concluded. “The cost of achieving widespread adoption of electronic health records in the United States could be high, probably in the tens or hundreds of billions of dollars” (DesRoches CM, et al. N Engl J Med 2008;359:50-60).
In its recent survey on Health Information Technology (HIT), AAPS included many of the items on the survey used by DesRoches et al. The AAPS survey asked about additional potential barriers, which proved to be just as important. Disruptions to practice were cited by 75%, third-party or government interference with decision-making by 77%, and potential linkage with pay for performance by 66%.
Concerns about how electronic technology could affect clinical reasoning are explored in a general way by Nicholas Carr in the July/August issue of Atlantic, “Is Google Making Us Stupid?”
The boon to thinking and research brought by the internet comes at a price. “As the media theorist Marshall McLuhan pointed out in the 1960s, media are not just passive channels of information. They supply the stuff of thought, but they also shape the process of thought.” Our ability to interpret text and make rich mental connections could suffer, as the brain reprograms itself in response to the new media, Carr suggests.
Additional information:
- “EMR—a Nonconsented Experiment,” AAPS News, July 2008.
- “Electronic Panacea,” AAPS News, April 2008.
- “Record for Data Loss Set in 2007,” AAPS News of the Day 1/15/08.
Tags: ehr, hit, information technology
June 23rd, 2008 at 7:58 pm
One of the best things I ever did was start to invest in a EMR 21 years ago. I started with billing and then added the scheduler and medical record about 15 years ago. It was a big investment then but, it is worth 5x more now-one of the few things that has appreciated in medicine. I could never afford it now but now that I have it, I would quit rather than ever go back to paper records. I am 10x more efficient and need less people to do my billing, coding, and pulling charts. Also, there is no big file room to pay for. I can email records without printing them out. I can email results to patients on a secure email and avoid the $1000 of postage our multiperson group used to pay for mailing results. My notes are much more organized, readable, and valuable…Get connected,,,its better for you and costs less in the long run.
June 23rd, 2008 at 8:02 pm
The advent of ASP’s (online application service providers) obviates the need to purchase expensive legacy systems — clinic based servers, IT support/departments, software updates, hardware.
ASPs charge a monthly subscription fee. The software resides on the server of the ASP which is responsible for maintanance, software upgrades,etc.
Since there is no upfront investment, the risk to providers is minimized.
June 24th, 2008 at 5:34 am
I have been studying this issue for many years, basically waiting for a system based on open standard, commercially mainstream product that is affordable and intrudes the least on the doctor-patient encounter. I continue to use pre-printed hand-written templates, at times assisted by a scribe in the exam room, with the templates generated in Excel, which is not open standard, but is well-supported commercially. I would love to see Palm develop a menu-driven template-oriented note that follows the doctor’s typical work-flow, or see a Google Health product that would have many of the desired features, including the ability to beam my note to the patient after the encounter, as Palm could conceivably offer. Either could let the patient generate text that outlined the medical history.
Current hand-helds could easily hold years of text notes, and would not divert the doctor’s eye-contact like laptops or monitors do. Also the possible decentraliztion of the medical records into the hands of the patients as is done in the military where active duty service men and women bring their records to their new doctors after re-assignment would avoid some of the problems of centralized bureaucratic control.
The federal government’s record of handling medical and other records securely is not good, and yet it will soon force us to face an unfunded mandate to secure our workplace from identity theft with posible large fines for poor demonstration of compliance efforts, which many doctors don’t even seem to know about…
June 24th, 2008 at 6:28 am
If they want electronic medical records, give the patient a $10 stick drive with 2 gb of storage to keep and every doctor with a simple computer and operating system can load on his notes, labs, x rays, etc. and the patient can take it with them where ever they go. Full privacy is in the hands of the patinet. It can be translated into any langauge, given to whom ever the patient decides to trust and no doctor has to invest in expensive programs and their upkeep. If you follow the ones pushing for mandatory EMR’s and follow the money, you will quickly realize tis is a government mandated jobs program
June 24th, 2008 at 8:54 am
A Note for Dr Orient,
Hello, Jane, I know you’ve read a few of my essays in the past and I thought you might appreciate a few recent thoughts from a column in the Idaho Medical Assn IMAges newsletter:
http://www.idmed.org/public/components/societytools/admin/viewNewnews.asp?newsjob=ArticleID&ArticleID=9109&ArticleName=%3Cb%3EQuack+Tracks%3A+The+Database+Blues%3Cb%3E
June 25th, 2008 at 4:11 pm
THERE ARE NO “GOALS” OF THE “US HEALTHCARE SYSTEM”. THE GOALS ARE THE GOALS OF CENTRAL PLANNERS, WHO DO NOT DO OUR WORK.
CONVENIENCE AND EFFICIENCY ARE ONE THING, AND CENTRAL DATABASES ARE ANOTHER.
RESTORE CONSTITUTIONAL GOVERNMENT. nOTHING IN THE CONSTITUTION GIVES THE GOVERNMENT AUTHORITY OVER MEDICAL CARE.