Monday, June 30, 2008

The Economics of Electronic Medical Records

As a big believer in the efficiencies gained by technology appropriately implemented, I always find it shocking that medicine seems so far behind the curve in terms of electronic medical records (EMR). Most doctors agree that EMRs are beneficial, yet a recent report found that only 1 in 5 doctors have them in their practices:
The report, published online on Wednesday in The New England Journal of Medicine, found that doctors who use electronic health records say overwhelmingly that such records have helped improve the quality and timeliness of care. Yet fewer than one in five of the nation’s doctors has started using such records.

Bringing patient records into the computer age, experts say, is crucial to improving care, reducing errors and containing costs in the American health care system. The slow adoption of the technology is mainly economic. Most doctors in private practice, especially those in small practices, lack the financial incentive to invest in computerized records.

At first, I was disappointed and wanted to blame the doctors for not biting the bullet and paying for EMRs looking at it as an investment. But, the more I considered it, I can't blame them. If it were my practice, and the implementation costs of EMR were in the tens of thousands of dollars, I might hold off as well. I know I am over-simplifying this, but an EMR is really just a fancy, specialized database. Databases are ubiquitous in business. Clearly, the costs of implementing one cannot really be that high across the system.

The problem, as in many other situations in U.S. healthcare, is the lack of centralized, standardized solutions. Honestly, this can be either through the U.S. government or through free markets. Either the government should provide incentives, perhaps tax credits, for physicians to implement EMRs (heck, even low or zero interest loans, whatever). Or, the free market should step in and provide a low-cost solution that becomes the de facto standard for EMRs. To some degree, Google and Microsoft are already doing this, but their approach is more patient-centric isntead of practice-centric. What medicine needs is a "patient OS", much like how Microsoft Windows became the standard platform for PCs. With a patient OS, there would some default format for EMRs making it easy for offices even with different implementations to communicate with each other. If the basic patient data is defined in this open standard .emr format, then it would be easy for groups to implement modules for particular specialties (like, the results of p-thal tests in cardiology or something). Patients benefit, doctors benefit:

Dr. Masucci was already using Athenahealth’s outsourced financial service, and less than two years ago adopted the online medical record.

Today, Dr. Masucci is an enthusiast, talking about the wealth of patient information, drug interaction warnings and guidelines for care, all in the Web-based records.

“Do I see more patients because of this technology? Probably no,” Dr. Masucci said. “But I am doing a better job with the patients I am seeing. It almost forces you to be a better doctor.”

At the end of the day, this just shows the lack of leadership within medicine as a whole, which is why doctors end up getting squeezed by service providers as well as by insurance companies. Sad, really. Today's reality is doctors lose and patients lose.

I'm not really this pessimistic. Read the next, hopefully happier post! Subscribe to Scrub Notes by email or in a reader!


  1. The most important benefit of obtaining medical records in particular is that this can allow you to receive more appropriate screening if it becomes necessary. There are many different types of screening that we may need as we grow older, and it is essential to know when and if we have ever experienced that screening before. If it is a type of screening that requires regularly scheduled updates, having your medical records on hand can prove to be especially helpful.

  2. Agreed. A truly portable EMR will also eliminate the need for redundant testing any time an individual goes to a different institution since one could simply look up the old results. I don't know how many times I've seen patients who come from "outside hospital" have a whole battery of test redone for no particular good reason.



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