In comments to an earlier BNET item about Aetna’s “personal health record,” Merrill Goozner of GoozNews asked an excellent question: “[W]hy is there so much physician opposition to EMRs?” EMR, of course, is shorthand for “electronic medical records,” a main focus of the incoming Obama administration’s supposed $50 billion healthcare IT investment.
Well, the answer is a fairly simple one: Most physicians aren’t willing to take a financial hit to embrace digital patient records that might improve care. In a piece just a few days ago that took a close look at the Marshfield Clinic’s ambitious, $50-million-a-year EMR system, the NYT’s Steve Lohr noted:
For most doctors, who work in small practices, an investment in electronic health records looks simply like a cost for which they will not be reimbursed. That is why policy experts say any government financial incentives to use electronic records — matching grants or other subsidies — should be focused on practices with 10 or fewer doctors, which still account for three-fourths of all doctors in this country. Only about 17 percent of the nation’s physicians are using computerized patient records, according to a government-sponsored survey published in The New England Journal of Medicine.
As it turns out, Lohr has been beating this drum for some time. A year and a half ago, for instance, he noted that smaller practices rarely see a financial benefit from EMR adoption, even if they improve patient care:
The experience of Dr. Richard Baron, who practices with three other physicians in an office in Philadelphia, provides a glimpse into the predicament. In 2004, Dr. Baron and his colleagues made the transition from ink and paper to computers and electronic health records. They were doing what health care reformers had been advocating for years. But the arithmetic of investing in health-information technology is daunting, especially for small practices like Dr. Baron’s. His office spent $140,000 on personal computers, including tablet PCs, servers, software and installation.
The office’s annual technology costs, he said, were about $50,000, including maintenance and technical support, and he plans to upgrade the three-year-old computers at a cost of $54,000. Those costs do not include the lost productivity in the first year, when the staff was learning to use the new technology.
Dr. Baron’s office has saved money — in transcribing medical reports, for example — and his practice now handles its 6,000 patients with three fewer office employees. He described other benefits, mainly the ability to find information quickly for patients, hospitals, insurers and labs with a few keystrokes.
The technology, Dr. Baron said, has also helped make him become a more adept physician. But it has not yet paid off in dollars and cents: the savings in salaries is less than the costs entailed in computerization. “It is a high-risk venture,” he said, “and you do it at your own financial peril.”
And just six months ago in another piece on the slow adoption of EMRs, Lohr noted:
Dr. Paul Feldan, one of three doctors in a primary care practice in Mount Laurel, N.J., considered investing in electronic health records, and decided against it. The initial cost of upgrading the office’s personal computers, buying new software and obtaining technical support to make the shift would be $15,000 to $20,000 a doctor, he estimated. Then, during the time-consuming conversion from paper to computer records, the practice would be able to see far fewer patients, perhaps doubling the cost.
“Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see patients, we don’t get paid. The economics of it just seem so daunting.”
Certainly there are other factors at play as well. EMRs change the practice of medicine in ways large and small, and some physicians are doubtless reluctant to alter their habits. Privacy concerns remain alive in some quarters, and I’ve also heard anecdotal reports that some doctors fear that EMRs will give health-insurance companies a new way to look over their shoulders. A few critics have even argued that EMRs degrade patient care in various ways.
But the fundamental economics are still tilted against widespread adoption, despite Medicare’s so-far halting attempts to encourage EMR use. Big health-insurance outfits like WellPoint, UnitedHealth Group and Aetna have been even bigger laggards on this front. It’s not that electronic records don’t save moeny — they most certainly do — it’s just that the economic benefits of improved care currently accrue to patients and their insurance companies, not to doctors. Big incentives likely to be included in Obama’s healthcare-IT plan may finally tip the scales, but I’ll believe it when I see it.
Further reading: EMR Adoption May Be Less Than Meets The Eye
