The last time my father and I visited his doctor’s office, a two physician practice in a small Southern Illinois town, there was something new in the exam room – a computer. The office is moving toward an Electronic Health Records (EHR) system. Rather than making notes on a paper chart the nurse and doctor can enter information provided by the patient directly into the computer system during the office visit. Since this medical practice is part of a network which works with a local hospital, the computer system is integrated with the hospital system, so orders for needed tests are put directly into the data system and are immediately accessible at the hospital. Test results are entered in by the hospital lab and are readily available to the doctor. Prescriptions can be sent electronically to pharmacies with compatible systems, eliminating the potential for loss of a paper prescription by the patient or mistakes interpreting handwriting.
Medicare supports the move to EHR, and provides incentives to both doctors and hospitals adopting EHR systems. Medicare is authorized to pay physicians up to $44,000 for “meaningful use” of information technology. Meaningful use includes such things as prescribing and exchanging health information and transmitting quality of care information.
So why aren’t all physicians and hospitals going immediately to EHR systems? There are several reasons. A major one is cost. Even with the Medicare incentives, the technology is expensive. Implementation costs for a five physician practice are estimated at $162,000, with first year maintenance costs of about $85,500. For hospitals, the cost is much higher – installing a health information system can cost $20 to $100 million. The Medicare incentives are paid only after “meaningful use” is proved by meeting a number of criteria, so they do not help with initial start-up costs. Also, it is not certain that the financial investment will result in a return. If providers do increase efficiency they may see reduced reimbursements from insurers.
Another major concern of health care providers using EHR systems in interoperability – the ability of different information technology systems to communicate with each other. There are a number of EHR providers, so physicians and hospitals signing contracts with different providers may not be able to share information seamlessly. In a medically under served area where most physicians are associated with just one or two local hospitals, they may have considerable incentives to work together to select compatible systems. In more metropolitan settings with multiple competing hospitals and other types of providers the problems of interoperability are likely to be magnified.
Finally, many providers have concerns about patient privacy. Electronic records are by their nature accessible to more people than are paper records, so security is always a concern. Most data systems do have security measures built-in, but, again, the better they are the more they cost, and the more expensive they are to maintain.
As with any innovation, EHR systems require a considerable investment of time as well as money. It takes time to review and select a system, time to instruct staff in the use of it, and time for all concerned to practice using the system before any efficiency gains can be expected.
Despite the costs and concerns of health care providers, it is likely that EHR, like information technology in most other industries, is the wave of the future. EHR should lead to more efficiency and greater accuracy of records for patients, ease of access to records for patients seeing multiple providers, and better health care outcomes overall. Privacy issues must be addressed, and patients would do well to pay attention to the privacy policies handed to them by providers when new systems are introduced.
Confused about how to obtain your medical records? Contact a licensed insurance agent at Medicare Pathways for further guidance on using the EHR system and how Medicare.gov provides you with electronic statements. Call 866-466-9118 for more information now.