With so much information available at the click of a mouse these days, it seems astounding that medical records, which can make the difference between life and death, largely are not.
Fewer than 7% of U.S. physicians have fully functional electronic medical record (EMR) systems and only 2% of hospitals do, according to studies published last year in the New England Journal of Medicine.
The slow rate of adoption stands not only as an obstacle to U.S. health policy goals, it also often poses risks for patients. Among them are adverse drug interactions, duplicative medical tests, and waiting for treatment decisions-even during emergencies-while doctors gather vital information by phone.
With EMRs, not only could these problems be avoided, the systems would "make it possible for physicians to standardize treatment and make sure patients are getting all the alternatives they need," says Dan Coble, president of South University — Tampa. Coble, who is a registered nurse with a Ph.D. in Nursing & Decision and Information Sciences, often reviews research on electronic medical records as a peer reviewer for a professional journal.
Coble also says of the medical record systems: "There could be better disease management" under which chronic conditions like diabetes are monitored closely so that symptoms can be caught quickly, before patients get sick and require major treatments or hospitalization.
With all that upside, what's taking so long? Most surveys cite cost as the biggest obstacle. In physician offices, for example, the price tag for EMR systems is estimated around $15,000 per doctor, just for the technology. There's also training and downtime during the conversion, when appointments often must be curtailed, resulting in lost revenue.
While cost may be the most frequently cited roadblock, however, there are other issues that have kept the U.S. behind many other countries, Coble notes. They range from consumer privacy concerns to competitive and legal concerns among healthcare providers over who ultimately will control the information. In the U.S., physician offices or hospitals typically control patient records. As electronic medical records have been rolled out in many other countries, "The philosophy has been quite different," Coble says. "The patient owns the record."
As consumers do more banking, investing, and shopping online, however, their interest in EMRs is growing. A 2009 survey conducted by Deloitte, LLP, a consulting and accounting firm, found that four in 10 (42%) of consumers expressed interest in personal electronic health records and favored increases in government funding to increase the availability of EMRs.
Anticipating that demand, Microsoft and Google have each rolled out personal health record systems to which consumers can get their physicians to upload data.
As for healthcare providers' concerns about cost, the federal government moved to address them under the economic stimulus package passed last year. The stimulus legislation allocated $20 billion to upgrade health information technology, including through wider use of EMRs. Under the provisions, physician practices are eligible for up to $44,000 in incentives to adopt the technology by the beginning of 2011. The stimulus program also provides payments of up to $2 million for hospitals.
The payments, however, represent only one part of the government's strategy. "That's the carrot," says Jay Srini, chief strategist at SCS Ventures and former chief innovation officer at UPMC Health Plan, an insurance subsidiary run by the University of Pittsburgh Medical Center. "There's also a stick."
Physicians and hospitals that do not adopt certified EMR systems and make meaningful use of them eventually will see reductions in Medicare payments. The penalties are to be phased in over several years, as are the standards for meaningful use, which begin with collection of specified data and then accelerate. Ultimately, healthcare providers would be required to use the electronic systems for disease management, quality improvement, and other practices to ensure that patients get the right treatments, at the right time, and in the right settings.
Advocates of EMR say these practices could go a long way toward improving care and patients' health, while also putting a big dent in total healthcare spending by squeezing waste, duplication, and errors. A widely cited Rand Corp. study in 2005 estimated potential savings at $77 billion a year; the U.S. now spends an estimated $2.2 trillion annually on health care.
As electronic medical records are phased in, there still will be other hurdles to overcome, Coble and Srini agree. One of them is developing the infrastructure and protocols for doctors' offices, healthcare institutions, and other medical providers to share information, Srini points out. "The business model for exchanging information between competing systems will take time," she says.
Still, there's no argument that acceptance is growing. Momentum is picking up, experts say, and patients can look forward to differences in their health care when EMR use becomes the norm. Among other things, EMRs could help family members to track a loved one's care remotely, while enabling physicians to consult on a case from different parts of the world. The systems should let patients get test results without playing telephone tag, and enable them to give ER doctors access to their latest treatment records.
Coble anticipates that concerns about "control" of electronic medical records and healthcare decisions ultimately will give way to "a partnership" between patients and their medical providers. As he puts it: "We have to have consumers be more responsible."
Written by freelance talent for South Source.