Technology Alert: Summer 2005
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A quarterly publication of the California Medical Association • Issue 1 • Summer '05 |
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ELECTRONIC HEALTH RECORDS:
 Prepare Now,
Buy Later
 hen the federal government announced in 2004 its 10-year plan to create a national electronic health information infrastructure, it promised nothing less than the “transformation of health care in America.”
Since then, considerable time, energy, and money have been expended to move from the basic electronic medical record (EMR) to a more robust and interoperable electronic health record (EHR). Unlike basic EMRs, which allow doctors to create electronic medical records for their own internal use, more robust and “interoperable” EHRs will allow clinicians to exchange medical information with patients and other clinicians electronically. This revolutionary development is now at the forefront of U.S. health care policy, and the subject of several pieces of proposed federal legislation.
Efforts to create data and interoperability standards have shifted into high gear. Vendors have stepped up their marketing efforts. And physicians in every specialty and practice mode are discussing in earnest the challenge of moving medical records from paper to an electronic format. Insurers are also increasing pressure on physicians, as more are requiring doctors to submit data electronically.
CMA is taking a leadership role in shaping this emerging medical information infrastructure. We participate as a key adviser with government, business, and professional policy-making entities that have a stake in this historic transition. As a result, CMA is in the unique position of being able to offer members sound intelligence on the legal, operational, and financial issues associated with the move to EHRs.
CMA's challenge is twofold. “We must provide first-class consumer information to physicians and also, on a policy level, ensure that control of data does not become another tyranny imposed on physicians by government, insurers, or other corporate forces,” says CMA CEO Jack Lewin, M.D.
“We recognize how complex a proposition EHRs are for most physicians,” he adds. “We know that today's EHRs are an emerging technology. Their predecessors, EMRs, are hard to buy, hard to master, and difficult to cost-justify. At the same time we are absolutely certain that every medical practice, regardless of size, will have to implement an EHR system to remain economically viable.”
Key Drivers
By far, the biggest force driving the move to EHRs is patient safety—reducing the number of people who die or have poor outcomes because of medical errors. The U.S. has the best physicians in the world and the best diagnostic and therapeutic tools available. But the infrastructure needed to put these tools to optimal use lags far behind our passion to implement them. Physicians operate in a health care system that is not organized to help them deliver the level of care that they recognize as both achievable and appropriate. But with faster access to complete, patient-centric information, we can reduce unnecessary deaths and improve treatment outcomes in all environments.
A second force behind the move to EHRs is the payor- and insurer-driven rise of pay-for-performance (P4P) programs, which reward physicians for following specified treatment guidelines in providing chronic and preventive care to patients. Another force behind the move to EHRs comes from patients, who will be able to view their personal health records (PHRs) online. Some experts predict that patients will become addicted to this kind of access in the same way they are hooked on accessing information on the Internet. If so, “wired” medical practices will have a distinct competitive advantage as a result of patient choice and higher reimbursements.
Challenges
Interoperability standards are being rapidly developed, but they are not established. Even when data standards are set, it will take time for vendors to adapt their proprietary technologies to accommodate those standards. Inevitably, there will be a shakeout among vendors. Experts predict that as many as 80 percent of the current EMR vendors will not survive the shakeout because they will not be able to make their proprietary systems interoperable.
Early adopters of this nascent technology are paving the road to the future, but they are exploring expensive, risk-filled territory. The greatest hurdle for small practices is reengineering work flows to accommodate the transition from paper to digital systems. The potential for lost productivity—regardless of when you make the transition to EHR—is a very real risk: Today's systems are high-priced and require large investments to remain fully functional. It takes considerable time and effort to implement EHRs properly, and if the system you choose is among those that don't measure up, you'll have to repeat the process and incur additional expense.
CMA's Advice
CMA recommends a prepare-now, buy-later strategy—recognize that EHRs are the wave of the future and begin assessing your EHR needs. Evaluate your practice, research EHR systems, and, above all, proceed cautiously. That way, when standards solidify, prices drop, and reliable vendors are identified, you'll be ready to purchase a truly interoperable system that meets your needs.
“Unless you operate a large practice and have plenty of computer experience under your belt, you need to be aware that EHR systems are still in a state of tremendous flux,” cautions Dr. Lewin. “But everyone should recognize that this is not an issue physicians can avoid. Doctors need to start thinking immediately about how they will integrate EHRs into their practices.” To guide physicians through this complex decision-making process, CMA is committing considerable resources to analyzing market trends and to providing physicians with the best possible purchasing advice.
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Contact: Nileen Verbeten, 916/444-5532 or nverbeten@cmanet.org.
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