Saturday, March 21, 2009

Electronic Medical Records and the 2009 Stimulus Bill

I was contacted by representative of Medical Software Advice with information about the Stimulus Bill and the $19 billion to incentivize medical practices to adopt and implement Electronic Health Records (EHR).

"We expect many hospitals, ambulatory care centers and solo practices to take advantage of the subsidy and implement an EHR over the next few years. This is going to have a large impact on the health care industry and patient care."

In an accompanying post, they discuss the potential onslaught of EHR failures following the Stimulus Bill.
The EHR subsidy has absolutely stimulated demand for EHRs. But we're concerned that free EHR software won't lead to meaningful use. it comes down to this: when they get something for free, humans are less likely to value it. We are concerned about the "luddites" that fear technology and change.

Late adopter providers may jump on the subsidy, but will they:
  • take a leadership role in championing the technology?
  • adapt their workflows to best practices in the software?
  • pay for extra training for their staff and themselves?
Don't get us wrong; this is not a software problem. We are huge proponents of EHR technology. Software and the companies that develop it are not to blame. It's the late adopter mindset that concerns us. We have outlined our concerns, as well as five critical implementation best practices at:

Dr. Rob at Musings of a Distractible Mind writes on this very topic in "Doing It Right."
Electronic Medical Records are coming. The economic stimulus bill (furious spinning kittens notwithstanding) assured this.

There will be even more money for implementation. We look forward to our checks (and are not counting on them yet).

Now it is time for the flies to start gathering. Wherever there is lots of money, “experts” pop up and new products become available that hope to cash in. Doctors, who are never lauded for their business acumen, will be especially susceptible to hucksters pushing their wares. It seems from the outside to be an simple thing: put medical records on computers and watch the cash fly in.

Anyone who has implemented EMR, however, can attest that the use of the word “simple” is a dead giveaway that the person uttering the word in relation to EMR is either totally clueless or running a scam. It’s like saying “easy solution to the Mideast unrest,” “obvious way to bring world peace,” or “makes exercise easy and fun.”

Run away quickly when you hear this type of thing.

So how’s a doc to know who to trust? What product should he/she buy and whose advice about implementation should they follow? There are many resources out there. Here are a few I think are especially worthwhile:

  1. Buy a product that is certified by Certification Commission for Health Information Technology. CCHIT is a government task force established to set standards for EMR products. Its goal is to allow systems to communicate with each other and enable more interfaces in the future. The bonuses for docs on EMR are contingent on the system being CCHIT certified (think of it as something like the WiFi standard).
  2. The American Academy of Family Physicians’ Center for Health Information Technology and the American College of Physicians both have tools to help member physicians decide on an EMR. Your own specialty society may, too.
  3. Several professional IT organizations have programs to improve EMR adoption, including HIMSS and TEPR.
  4. Austin Merritt has written a good article of advice on his website Software Advice that underlines the importance of implementation.

The best advice I can give, however, is to visit a doctor’s office who is using an EMR successfully. This office should be as close in make-up to your office as is possible. You should be able to look at how they do it and see yourself in that situation. Never buy a product before visiting at least one office like this (no matter how good the sales pitch). When you visit, make sure you ask them about the implementation process. How did they do it and how hard was it?

Austin Merritt and the folks at Software Advice wish to spark a conversation on the topic. This will affect the office experience of patients. I have one doctor who uses EHR and has for many years, but my neurologist is very reluctant to the idea.

We'll see what happens in the coming years.

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