Electronic health records: Probably won’t deliver on all promises
The American Reinvestment and Recovery Act of 2009 (ARRA, or as it is commonly known — the economic stimulus plan) included nearly $20 billion in financial incentives to encourage physicians to adopt and utilize certified electronic health records (EHRs) under a section known as the Medicare HITECH Initiative.
These incentives are available to those already using EHRs as well as those who have yet to adopt these systems. This application of information technology is being pushed as a means of making a positive financial impact on your practice as well as producing financial savings in patient care.
In a recent speech to promote his plan, President Obama claimed that adoption of these systems could save $80 billion in health care costs annually as well as improve patient care. However, some experts believe his numbers, based on a 2005 RAND study, overstate the value of some of the EHR benefits.
This move by the government to eventually require widespread use of EHRs is supposed to reduce health care costs, medical errors and malpractice claims, as well as facilitate chronic care and ongoing medical treatments. Officials claim this technology will make data relating to a patient’s medical care, laboratory tests and treatment history available to any physician when needed.
Despite the president’s assertions, there is an overall lack of evidence in the existing literature proving that EHR systems improve patient care and/or save health care dollars in comparison to paper charts. The RAND study that the Obama team used to justify this approach is scientifically weak and funded by companies which could benefit from adopting EHRS and supporting information technology. Reviews of more recent literature fail to substantiate its conclusions.
Costs vs. incentives
Many physicians who have already bought into this evolving technology feel the costs for many medical groups will far exceed the incentives by two to three times. The funding is front-loaded with $30,000 coming in the first 2 years. A total of $44,000 in incentive bonuses for adoption and meaningful use of EHR technology can be received from 2011-2015.
Any of us who have used the currently available systems are aware of the actual monetary costs — which tend to be greater than projected — time-consuming additions to record keeping, and a learning curve for dealing with frustration from incorrect data entry.
To receive funds, the EHR system purchased must be certified by the Department of Health and Human Services. This can lead to a health technology monopoly because requiring certified systems can have the potential to stop or slow down newer systems from entering the marketplace.
Time will tell if this stimulus actually will create national health information technology standards that help doctors choose the most advanced system to increase patient safety, care coordination and reduce paperwork.
The free market would have decided the winners in the record-keeping arena. However, this new legislation may force (incentivize) physicians into purchasing the current old, slow and time-intensive systems and not the newer, faster and more user-friendly systems to come.
It appears the greatest immediate benefits of these systems will be to help monitor the costs and effectiveness of certain treatments and analyze which drugs and devices are being used. It will bring into clearer focus regional differences in the utilization of costs and help establish health care outliers and cost centers.
The data culled from these systems will allow Medicare to have a basis for coverage and reimbursement policies where most of the potential cost savings will come. However, rationing and denial of coverage for certain drugs, devices and procedures could be done without an elaborate EHR system.
Another potential benefit appears to be that patients may have access to their medical records and may be encouraged to become more involved in their individual care. Also, it could prevent conflicting pharmacy prescriptions and/or alerts, allow notification of missed appointments, and provide a more hands-on approach for patients to manage chronic diseases.
Financial reform of our health care system is necessary, but the big reforms can be done with paper records. I do not think electronic records, as they exist today, will result in great savings and benefits inpatient care over paper records. It is great technology and it will become even better. However, I believe that physicians will pay much more then the incentives facilitate and it will take up to 10 years for most of us to recover these additional costs, if ever.
A physician with 5 to 10 years left to practice will experience significant out-of-pocket costs without ensuring improved patient care during their remaining years in practice; all while their personal and small business tax burden increase.
Innovation and technology has been a great part of our health care advances. This new electronic technology will definitely be a part of the future, but it will come with additional costs to physicians. Much of the reasoning to date has not been based on the scientific literature instead it is based on is arm-chair research.
Even though that may eventually exceed my short-term expectations, I feel EHRs will cost many physicians more than they will reclaim.
Douglas W. Jackson, MD
Chief Medical Editor