Health Care Providers Failing To Adopt e-Records, Says RAND

Nerval's Lobster writes "Back in 2005, RAND Corporation published an analysis suggesting that hospitals and other health-care facilities could save more than $81 billion a year by adopting electronic health records. While e-records have earned a ton of buzz, the reality hasn't quite worked out: seven years later, RAND's new study suggests that health care providers have largely failed to upgrade their respective IT systems in a way that allows them to take full advantage of e-records. Meanwhile, the health care system in the United States continues to waste hundreds of billions of dollars a year, by some estimates. 'The failure of health information technology to quickly deliver on its promise is not caused by its lack of potential, but rather because of the shortcomings in the design of the IT systems that are currently in place,' Dr. Art Kellerman, senior author of the RAND study, wrote in a Jan. 7 statement. Slow pace of adoption, he added, has further delayed the productivity gains from e-records."

Upgrades aren't cheap

[jdastrup]

I support several small medical practices. They don't (or say they don't) have enough money to upgrade their systems. Like any small business, potential savings in the future don't always translate to extra income now. New systems are expensive and often included monthly fees from the software providers. In addition, if their analog, handwritten system has been working for decades, there's not a lot of incentive to switch.

Are you kidding me?

[Synerg1y]

I'm contracting in the industry right now, and... The problem with e-records is draconian HIPAA [aafp.org] requirements. Also all our systems have to be able to pass an audit by the FDA, meaning if I add a piece of javascript to check for numerics... re-validation! I'm not saying the government should back down, medical records need to be private, but they've got IT management and senior staff here trembling at the mention of their existence. Supposedly, it's kept the main production system from being update for the last couple of decades or so simply because nobody wants to take on the responsibility of potentially getting the business shut down... then again that's operations, and they can be a bit dirka dir, but it's definitely a problem from both sides of the fence.

Re:Upgrades aren't cheap

[Scutter]

It's not just that. It's that there are so many different systems out there, and even with standards for treatment and diagnosis codes getting systems to talk to each other can be a major challenge. Frequently, even between different departments in the same hospital, you'll find different systems. You'll see care givers re-entering the same information into each one.

Re:Upgrades aren't cheap

[tepples]

Then why not just adopt the VistA system developed by the US Department of Veterans Affairs for use by veterans' hospitals? Like all other works of the United States Government, it's public domain.

Re:Upgrades aren't cheap

[realmolo]

That would be a good idea. But you know why it doesn't happen?

Because the various competing "e-record" systems providers don't WANT an open standard. There is FAR more money to be made in proprietary systems, and expensive "translation layers" to talk to OTHER proprietary systems.

Basically, we don't have e-records because the healthcare system in this country is riddled with greed. Efficiency and quality are NOT a priority, and in fact, are generally DISCOURAGED.

I think part of it

[kilodelta]

Is due to the fact there's no standardization for medical records from hospital to hospital. To accomplish it we first need to nationalize and unify every hospital in the United States. I use the VA Hospitals as my model. They have electronic record interchange already.

Then you can use best practice to standardize all procedures from actual medical procedure to operational procedure and everything in between. Then once you've nationalized the hospitals, setup several NATIONAL universities that grant M.D.'s and integrate the training.

There really is no benefit

[Anonymous Coward]

I am a physician and operate a small practice. The issue for my practice is simply the cost. To make the switch I will have to invest thousands in IT upgrades, and pay thousands of dollars every year for the privilege of continuing to use the software. Further, if this slows me down to the point that I see one fewer patient per day, it will cost me an additional $10,000+ per year in lost revenue. I'm sure an EMR would streamline things for insurance companies, but my practice will see none of the benefits. I feel I provide high quality care with my current system and I don't believe a different record system will improve that. At the end of the day, switching to an EMR means a huge paycut with no improvement in patient care. I just don't see how that makes sense.

Re:Not so fast

[Malenx]

HIPPA states providers can charge up to x dollars per page for records requests.

Problem is with EMR providers: greed and lock-in

[arbulus]

Greed. Pure and simple. That is what has killed electronic medical records.

It's anywhere from $60,000 - $100,000 for an EMR system. And if your EMR of choice doesn't do practice management, you have to spend another $10,000 - $20,000 for that.

The big promise of EMR is data portability. And here's the big secret that no one seems to be talking about: the data *is not portable*.

If I have ABC Company's EMR and you have DEF Company's EMR, I cannot export a patient chart, send it to you and then you import it. You cannot connect to my EMR and get charts for patients I refer to your clinic. So there is no universal patient chart that follows you where ever you go.

Plus, if you *do* have some other electronic system that has to interact with your EMR (say a pathology system or a perscriptions system) you have to pay *both* companies typically $10,000 *each* to do an HL7 link between to two systems. And even then, the link between the systems is spotty at best and half the time doesn't work.

A company that has very little in the way of technology wants to transition to EMR. So they have to spend $30,000 - $40,000 just for the computer hardware (workstations, servers, printers, scanners, routers, switches, etc.) and then another $60,000 - $100,000 for their EMR and practice management needs. THEN, the users have to be trained. I do IT and primarily work with medical offices and sugrical centers. I can tell you that doctors *do not want* to learn how to use computers and software. The office employees fight it, everyone fights it. Eventually they give up and don't use it and let $100,000 worth of hardware and software go to waste because they become too frustrated to use it, it slows them down exponentially and it hasn't made anything easier or more portable. I have seen so many offices basically throw money down the toilet on these EMRs. They get them, and within a month they can't stand them and just go back to paper charts. Not to mention how much they get in the way of patient care. My wife recently went to see the doctor. The doctor was hunched over her computer the whole time and seemed more concerned with making a typo than with paying attention to my wife. Paitent care is suffering greatly.

THEN, the EMR companies want to hold back common sense features and charge you tens of thousands of dollars to implement them. One office I worked with had a web-based EMR and the doctor wanted to be able to recieve faxes right into the EMR. They said sure, you can do that. She asked if they could download and print out the faxes if they needed to. The company told them that yes, they could, but that was an extra feature that would cost $10,000.

Vendor Lock-in is not just something that they strive for, it is the very *core* of the EMR landscape right now.

EMR is a complete and total failure and you can lay that failure squarely at the feet of the greedy bastards who sell it.

Re:Upgrades aren't cheap

[jimbrooking]

Just so. If there was a standard for medical records storage, as there is for electronic billing for medical services, it would provide a much greater incentive to join the pool. As it is, installing a medical records system from the Mrs. Grace L. Ferguson Medical Records and Storm Door Company (credit: Bob Newhart [youtube.com]) might get your medical practice an electronic records system, but interchange with the hospital you admit your patients to? So sorry, just fax us the hard copy and we'll re-enter the data here.

I once asked the CIO of a major medical facility (top 10 in the nation in many treatment areas) why credit cards from ANY issuer will work in EVERY little swiper in the world (some but not egregious exaggeration) but medical records from his facility had to be printed and transferred via sneaker-net whenever a patient moved across town to a different hospital. His answer: The Fed insisted on standards for credit cards, and healthcare doesn't have a Fed. Realmolo has it right - but the benefits to patient care of a standard system are not adding to anyone's profit, so are ignored. And the patchwork we have today offers scant prospects for improvement to a small, or medium practice. Hence old systems abound, and paper systems still flourish, as they're "good enough".