Health care IT: Heading for a Curve
Old saying: You can't drive a crooked road looking in the rear view mirror. That thought came to mind as I walked the huge exhibit floors at Atlanta HIMSS. The thought resurfaced as I listened to today's NPR, Diane Rehm show discussing Electronic Medical Records.
Lots of time-worn assumptions about Meaningful Use: "It will slow docs down, said the MGMA survey." "AAFP asks CMS for significant changes to 'Meaningful Use' criteria," reports iHealthBeat. "Can I afford an EHR if I am nearing retirement?" "Beware of the EMR 'Ponzi' scheme," said Dr. L. Gordon Moore. "Too Much, Too Soon! Too Aggressive, Too Expensive, Too Rigid, Too many Quality Measures . . .," HealthcareITnews.
Looking backwards into the mirror, it once took days to install EHR programs on office servers, weeks of physician and personnel training and months of work flow adaptation. Larger practices hired someone to do IT maintenance; smaller practices could not afford the average $50,000 per physician total cost. Software was inflexible, and often the goal was point and click using the same template for every physician regardless of practice style. The true cost was even higher because of cost overrun surprises, and commonly physicians lost income from seeing fewer patients. Often physicians under-coded, under charged, in order to finish a visit more quickly leading to lower billings. Only gradually did things improve, often leading to productivity rifts between physicians and validating the comment "six months of hell."
And so, many critical statements are deserved through true experiences---from the past. But much has changed for the better. Software as a service means no server; less need for a dedicated IT employee. More band width equals better viewing of images, faster downloads. Better software design includes natively web-based, integrated packages with document management, EHR, and RIS/PACs options. Interoperability provides universal connections with PHRs and Health Information Exchanges. And, all of this is inexpensively down loaded; free trial period; configurable by each physician and for each physician's practice style. There are several such companies that have good products for this market: (link example, link example, link example, link example, link example, link example) All of these products differ in some way---but more exist and more are in development, however your conclusion should be that affordable, existing products can satisfy meaningful use. We can safely ignore whining from vendors who resist change.
To answer the complaints stated at the outset:
1. "It will slow the doctor down." Not if you use a minimally invasive approach with software that does not force all physicians into the same mold. Begin by getting rid of charts using document management. You can use your own forms, scanned into your web-chart; bar codes will sort them into tabs automatically. A few days' thought will lead you to think about your work flow and allow you to design templates within which you can---if you wish---point and click. If you are judicious in coding, you may wish to use point and click entry for complex cases and a scanned template for simple cases. Or, you can dictate into the system. The point is that no all physicians practice in the same way, and they will not be forced into someone else's algorithm. No doubt, there will be a week or two of learning curve for each physician; but not all physicians will begin at the same time to spare the practice a train wreck.
2. "Can I afford this nearing retirement?" "Too expensive?" The new math is not the old. A caller into NPR cited $50,000 to $100,000 per physician. That may have been true but is no longer. The new SaaS products will download (think SalesForce.com) and have a trial period after which prices will begin as low as $250 per month and will satisfy "meaningful use." More complex modules can be added if needed but also at much lower cost than before. Each physician will have money left over for other needed tasks from their ARRA stimulus funds even if they approach retirement.
3. "To many patient information requirements?" Perhaps regulations are not aggressive enough, but certainly not too rigid and having too big a bite. Given the software available for both EHR and PHRs, requirements for patient communication are easy to satisfy. Every practice can upgrade an existing website to use such as NoMoreClipboard.com, NMC. This program communicates with all EHRs and will transmit and receive both digital and paper (FAX) patient information. NMC is also available from cell phones and ER computers as well as through office EHRs. The central fact is that we expect patients to be engaged in their own care, and we cannot expect them to perform without equivalent information.
This has been a long blog. More next week on digital decisions.