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.







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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.

should Doctors withhold a patient's record?

Doctor's receive requests for their patient's records every day. This is part of their practice and in fact, some doctors, have staff to just perform the function of copying and sending their notes to their patients or to the insurance companies, lawyers, or other doctors that request their notes.

Can doctors refuse to transfer or release their patient's medical records?

No, it is un ethical for a doctor to refuse to promptly respon to a valid request for a record transfer. So, if your doctor is not complying with your request, then you might want to have a discussion with him.

I think most doctors are aware of this and I am unaware of doctors that intentionally withhold their patietns medical records. It should be emphasized that most states allow for doctors to charge a reasonable fee for the work and costs associated with releasing, copying, and sending records.


Here is some shameless self promotion... webservice like PassportMD.com , makes it easy, in a Hipaa compliant fashion, to request , receive and automate the process of getting your doctors records, notes, charts , etc and store them in a centralized, secure environment that can be accessed from anywhere and printed off from anywhere.

Toward Electronic Patient Records

After a decade of debate, electronic records for patients through their doctors is gaining acceptance. EMR's have arrived. I think that it is generally now a "given" about electronic records that it is no longer "if" but now is "when" will my doctor, my hospital or "myself" be a participant in the electronic and digital revolution that is encompassing all of healthcare.

I spent two days touring TEPR2007, the annual trade show for EMR vendors and came to the conclusion that there are a myriad of choices from software vendors, middleware and hardware. The paradigm shift is inevitable and in full swing. EMR's are being standardized and as a result commoditized. Bells and whistles unique to particular vendors but at the end of the day, they all do the same thing.

Certification of vendors as long as not costly prohibitive to prevent creative development by smaller vendors is a good thing. Standardization is a must.

I predict XML will be the winner as the standardization tool with integration and flexibility to maintain CCR, HL-7, X12N, NCPDP and I also think PDF's will move to forefront of medical information sharing capabilities.

Key concepts in the PHR world will be access audit trails and transparency of data, 2 factor authentication and exciting work will be developed as a result of RHIO's and Markle grants.