Why doctors arent adopting electronic medical records and how to help them adopt electronic medical records

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.







http://twitter.com/PassportMD

Twitter and Blog for PassportMD

just added my twitter comments to the blog...

Keeping an eye on the real story regarding adoption of EHR based on government incentives...really believe that the stimulus falls short for the doctors...just not enough based on the disruption issue for MD's ...

In the end too costly for the docs and too costly for the government - see the push coming from the patient side...presenting digital data via MIcrosoft Healthvault platform, Google , or PassportMD.

Consumers will need to drive digital adoption by presenting this data to docs...docs will access ASP versions or web based versions of free data...no need to adopt expensive technology disruptive systems.

Joan Lunden Joins PassportMD Announces ConcierCare Service

DELRAY BEACH, Fla., Oct. 14, 2008 – PassportMD, the award-winning provider in online health record and wellness services, announced today that television personality Joan Lunden has signed a multi-year partnership with the company. The announcement comes as PassportMD launches its innovative concierge service, ConcierCare™. Ms. Lunden, a mother of seven children, will educate busy moms across America about PassportMD’s concierge service, which helps users create an online health record for family members by collecting records, digitizing images, and assisting with other health and wellness tools.

As the primary caregiver of an aging mother and best-selling health and wellness author, Ms. Lunden understands the challenges that moms in the “sandwich” generation face as they manage the health and wellness of their children and parents.

“My brother took care of our mother’s health care information,” said Ms. Lunden. “When he passed away, I had to recreate her last 10 years of doctor visits and prescriptions. It was overwhelming. PassportMD’s ConcierCare is an invaluable tool for all moms.”

Ms. Lunden will not only help to create awareness of the importance of maintaining a Personal Health Record (PHR), but she will also be involved in future product development and is an active member of PassportMD’s advisory board.

Two New Services: ConcierCare and Doctor Access
ConcierCare is the first concierge service of its kind. With one simple phone call, users are able to have a dedicated concierge collect medical records of each person the account designates, including the user’s children and parents. Health records are obtained in a HIPAA-compliant manner using encrypted channels after users provide a secure, electronic signature. Collection and population of the PHR takes approximately two weeks.

“People understand the value of having their health records accessible and organized, but find the task of collecting and uploading them incredibly daunting,” said Steven M. Hacker, MD, Founder & CEO of PassportMD, Inc. “Our ConcierCare service removes this burden and makes the process simple.”

Another important feature of the PassportMD concierge service is the Doctor Access program, which not only makes communicating with physicians easier than ever, but also has the potential to reduce medical errors. Doctor Access is invaluable before physicians make treatment decisions concerning their patient’s health. A click of the mouse allows users to invite their doctors to share and review their medical records, including diagnostic quality images.

“Creating an easy way for consumers to invite authorized doctors to view selected health information is the challenge of most PHR companies,” said Dr. Hacker. “PassportMD solves this problem.”

Being part of the HIMSS Show 2008

Well, I was definitely surprised. Initially, expecting just a relatively "mild mannered" trade show with computer geeks (like myself), and healthcare technophobes...I found that I was walking through a surreal convention...the world of healthcare technology and big business have clearly met, engaged, and seem to be walking hand in hand in marital bliss...

All I could think of was Comdex and Las Vegas..this show, HIMSS 2008, is clearly much bigger than ever before, it is over the top in fact... The exhibit booths and display of marketing muscle in terms of investment in presence is unprecedented...

I have seen many trade shows in my 20 years of medicine and business and I was blown away by the 2 and 3 story exhibits...Anyone who is anyone was an exhibitor..if you werent at HIMSS this year , you do not exist...

PassportMD was there and generated a significant amount of buzz....we had tremendous traffic and interest in what we are doing in the consumer directed healthcare space...

It was a very exciting event for us and for all those that participated...

Now, for the real news...
Microsoft Healthvault and Google Health ( http://www.healthvault.com/ and ttp://www.google.com/ig?hl=en) were both there...Contrary to popular opinion, I am in favor of Microsoft and Google's presence in the healthcare IT world...Although many privacy advocacy groups and other competitors, editors, journalists, healthcare veterans differ , I believe that their presence is critical to bringing up everyone's ultimate benefits and interoperability...I am impressed by Microsoft and Google's committment to working with other vendors such as PassportMD, and both are committed to privacy and security. I do not believe that Google or Microsoft are going to shy away from providing the very best in options for forwarding the cause of personal health records and to do it in a manner that is admirable...So, Cudos to Microsoft's Healthvault and to Google's Google Health...
I guess the only concern I would have is their vast underestimation of the significance of the problem of today's healthcare situation , their potential lack of understanding and their risk for arrogance and naivete as they enter this market...simply stated, it is not like entering the software or the Internet search market as they did over the last few decades..there are a number of stakeholders and their are real life critical health issues that need to be considered...I am hoping that PassportMD can help as can the myriads of other vendors that can provide some value and perspective to this massive undertaking ...

It is indeed a very exciting time to be in healthcare IT.

RFID Implant cancer questions concerns patients

In the News Update: RFID implant cancer questions concern patients


News that radio frequency identification (RFID) implants could pose dangerous health risks -- even cancer -- has the healthcare and personal health records (PHR) industries wondering how to provide medical professionals with vital patient health records in case of emergency.
A simple, free and non-invasive alternative already exists. Consumers can use Web-based services, CD-ROMs and simple paper-products designed to hold critical data that can be easily accessed or carried, said Steven M. Hacker, M.D., founder and CEO of PassportMD Inc., a leader in consumer-managed healthcare products.

"It's a twist George Orwell couldn't have imagined -- that some 'big brother' computer chip injected under the skin may jeopardize your health," Hacker said. "Products like PassportMD provide a safe, secure and non-invasive alternative. It's free and the information is immediately accessible without access to a phone or Internet connection."

Glass-encapsulated RFID transponders from companies like VeriChip are implanted under the skin. A special scanner must be used to reveal a 16-digit code that's then entered into a Web database to retrieve the patient's medical information. Earlier this month, it was reported that some lab animals implanted with chips developed cancer and sarcoma. Other possible adverse effects include tissue reactions, migration of the implanted chip, Magnetic Resonance Imaging (MRI) incompatibility, electrical hazards, infection and even compromised information security. Already used to identify lost pets, some 2,000 people worldwide have RFID chips implanted for PHR applications.

Products like PassportMD.com provide safe and secure access to patient records. Subscribers can create a free personal health record by following a simple, 10-step tutorial. The PHR can be printed on a wallet-sized card or can be accessed anytime through a password-protected Website. Unlike chip-based solutions, PassportMD allows subscribers to store, access and print living wills or advance medical directives. By upgrading to the premium service, subscribers can use PassportMD's unique "Doctors Notes on Demand" service that lets consumers easily request, receive, store, print and access their doctors chart notes.

"Life-saving access to personal health records should be the solution to a medical problem -- not the cause of one," said Mitch Bernatsky, President of PassportMD, Inc.

http://www.passportmd.com/

Another Bill, Another Day, Another Dollar

This Bill is not the one you receive in the mail from the cable company.

This is a bill introduced and has some bi-partisan support, it is called the "The Independent Health Record Trust Act, which was introduced into Congress in mid-July by Rep. Dennis Moore (D-Kan.) and on last count this week has bi-partisan support from 49 House members, aims to create independent health record trusts, or IHRTs, that would manage the electronic medical records of patients upon voluntary participation by consumers signing up for these electronic accounts." as reported by Marianne Kolbasuk McGee in InformationWeek .

I dont know about you...but most patients and people I know.. are not going to jump to give their personal medical information to the government to control. What an interesting name the bill has though... "trusts", this should conjure up images of George Orwell smirking over us.

Patrick Kennedy also introduced a bill earlier this year to incentivize doctors to adopt electronic medical records. So, our politicians are taking heed.

Unintended consequence. It does serve a greater and grander purpose ;the so called unintended consequence. This is the unintended consequence for the overall good, (not Marxist, I promise) but, educating and raising the bar on awareness of the need for people to generate their own Personal Health Record or PHR.

In the end , the PHR will be the stimulus for healthcare revolution. A revolution that will not take place until control of healthcare information and the healthcare dollar is given to the people, "the masses"...so, in my eyes, this is a good thing.

Control of your healthcare information is the "opioid of the masses", just watch.

E health project that is failing, clearly a bigger Personal Health Record (PHR) is not better

When we first read about Dossia's intentions we applauded it. Now, we see the realities of multi-corporate "cooperation".

It is easy to see why large initiatives fail...widespread usage of a commodotized PHR will be inevitable , but , will probably be through slow adoption, acquisition and mergers rather than super large initiatives. Large government initiatives or large multi corporate partnerships are good in theory, but , practically speaking, precedents suggest otherwise..

Read the recent article entitled: Another E-Health Project In Disarray
Partners in initiative known as Dossia squabble over money, deliverables. Will the health industry ever get this right?
in http://www.informationweek.com/news/showArticle.jhtml?articleID=201001393
and I quote "An ambitious program to provide electronic health records to more than 2.5 million people is starting to unravel, as the partners in the multimillion-dollar initiative turn to legal action against each other."

Hurricane Season is here, have you done your PHR?

As we approach the time of year that hurricanes pay us visits... all of us in geographically susceptible regions, must be thinking about preparation.

Personal health records should be atop the list of "first aid" preparation particularly the elderly.

Think about it.. a hurricane hits, your pharmacy is closed, you dont recall your medication list, interactions, dosages and more. You need to have this information accessible. If Katrina taught us anything, it was preparedness makes a difference. Several doctor's offices were closed, people could not reach their doctor's for help regarding their history. Additionally, most doctors have paper based charts, and those in the wake of Katrina, lost many of their files... This was part of the problem that was brought to the forefront of the medical community's attention. It was a precipitant to wake up and move towards an electronic patient record.

A new interesting website hosted by the American Red Cross is http://www.Safeandwell.org , this website was created to help natural disaster victims get updates on the status of family members, friends and loved ones and to potentially communicate with those involved in rescue efforts.

Is there any reason to not take the time to sign up for a phr? I dont think so, privacy perhaps is the biggest concern, but most phr's are committed to not sharing personal health data.

As you know , we have a free phr service located at http://www.PassportMD.com and although there are many others that are very good as well, I can speak to the purpose and success of PassportMD. It is free and you can print off your medication list before any natural disaster and keep it in your wallet or with you at all times.

Take a few moments to do this and to tell your friends about this, it is very important.

If you do not feel comfortable being prepared for disasters using a phr, let me know why so we can address those concerns and correct them if they are an issue with our service.