Okay, so here's the issue...we all know that there needs to be a government incentive to really drive the adoption of electronic medical records but until now (as recent as of today), there have been no real serious solutions. The problem is that the politicians are not really listening to the medical community...the proposed amount by Obama is not close to enough for a doctor to really slow down his practice with interruptions and create a new dependency on an unknown technology and a new dependency on what would be a required new position for any medical practice..ie technology consultant...Doctors by and large really dont have a clue about recurrent licensing fees, hardware, software, third party vendors, broad band, wireless, ethernet, local servers, remote servers, asp models, and more..they just dont have the time to learn all of the issues that accompany the implementation of a successful digital practice...as a result the doctors , understandably are extremely uncomfortable, with turning over the reigns of their practice, the very core of their practice..ie their patient's medical chart..to an unknown entity ie..the emr software vendor..or to the technology consultant or technology independent contractor they have to retain to implement all of the changes that would accompany their shift from the comfort of paper charts to the "promise" of electronic charts...so..bear with me..I will give you my thoughts on how we approach this..but for now...let me lay out what has been proposed by politicians to encourage adoption of emrs (electronic medical records) ..
1. Obama Stimulus plan...docs can get 44,000 over 5 years if they bring in electronic medical records into their practice. This is not nearly enough..granted it is a start but the real costs for a practice..per year per physician is realistically a minimum of 35-40K...so 5 year cost..taking into consideration hardware, additional third party software licensing fees, technology support fees, annual maintanence fees from software vendors, connectivity fees...and this doesnt equate given that productivity in the form of profit per patient visit does not increase for doctor...so this will never happen.
2. MAssachusetts SB 2863 - link medical school loan repayment to health IT competency...this is a good start..but addresses mostly the younger docs , ie those that have the greatest likelihood of adopting emrs anyways...
3. Wisconsin SB 40- tax credit for providers that purchase EMR's...again good start..but at the end of the day..it is pennies back against dollars spent.
4. New York SB 6808- offering incentive payments for porviders who use emr systems... a necessary implementation..and should be national...ie doctors that use emrs in their practice should receive bonus payments.
5. colorado SB 196- reimbursement to encourage services via telemedicine..again..good start but certainly wont jump start physician adoption of emrs.
So...all of these are better than nothing..but not much.
Here are my thoughts...If the government is really serious about having doctors adopt emrs than this is what must happen:
1. Medicare (as the leader for all insurance companies as it relates to setting fees for service) needs to do the following:
Medicare needs to reimburse physicians that have implemented emrs in their practice a separate fee above and beyond the standard fee for service..this code , not unlike a surgical tray code for supplies for a surgeon, or a facility code for an ambulatory care center, must be significant enough for physician to track and record..at least $5 extra per visit.
Medicare needs to pay the physician back for all expenses related to adopting emrs..not just software, but hardware, maintenance , other third party fees, and technology support and maintenance fees, back up and storage fees. It is not enough to say they will get back 44k after 5 years...as this is just not enough to make the change a reality...it is not worth a doctors time to institute this for the equivalent of 8.5 k per year for 5 years...since that number represents less than 2% of most physician's gross..and if you adjust for the expense benefit ...it is really much much less...
So, what does this mean..let me tell you..it means that our government does not have the means to allocate the funds sufficient to implement the change that the President is hoping for and promising...So then what do we do? Well I will tell you...
A great start was removing financial obstacles from private industry and pharma as it related to stark law exceptions. The Stark law technology exception and IT safe harbors to the anti-kickback statute enables hospitals to subsidize as much as 85 % of upfront ongoing costs for EMR software for physicians, so this exception needs to be more broadly applied and specifically more applicable to physician office setting, let the vendors and the hospitals fund this for the government without the concern of anti kickback penalties.
The one big mistake I see happening is tying implementation of healthcare IT to state licensure...that is surely a catastrophe waiting to happen. Stats like Massachusets and Minneosota have started this...but we all know , it will be delayed and eventually repealed..given that you cannot obligate the docs to do this until you have provided the financial means to do it as outlined above...if you force them and they are not ready or do not have the means to do this, or there is no infrastructure set up and tested in advance..then we will probably be visiting many of our old family docs as unlicensed doctors...
The last issue is my bias and for purposes of full disclosure...I founded and am CEO of PassportMD ( http://www.PassportMD.com ) ...a leading personal health record company...so the issue is..at the end of the day..when politicians realize it is not financially feasible to push the doctors to adopt..they will realize what I believe and that is that the easiest way to get adoption (and probably the cheapest as noted after reading my above comments) is to have the consumers push it to the doctors..so in this scenario, the quickest path to get health records digitized is through web based applications like PassportMD and Healthvault , mostly because it is without costing physicians a penny, but must have insurance payors incentivize the consumer/patient/beneficiary to adopt a web based online health record. And then let the consumer brin/push this to the doctor and have the doctor add to this via web access without incurring implementation , technology, hard ware, software and support fees.
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