It’s not just the cost, doctors say. It’s the time, the effort and the lack, in many cases, of a visible payoff. Even the best software can’t match the speed of scribbling notes on paper. And you don’t need tech support to flip through the pages of a manila envelope.
And yet the promise of electronic health records – they know it’s extraordinary. The idea of gathering scattered information so an ER doctor can quickly learn everything he needs to know to better treat a heart attack victim is a powerful one.
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Some programs have guidance built in to help doctors follow the best known practices.
And collecting all that data allows practitioners to quickly compile and analyze data: How many patients in the practice are diabetics? Who is overdue for an immunization? Who is taking a drug that is being recalled?
This is how doctors talk about EHRs amongst themselves, but it’s not what most public discussions on the topic are like. Typically, the focus is on the cost savings to the system and the potential to monitor and improve the quality of care.
An event June 7 at the Greater Providence Chamber of Commerce brought both those approaches together. Sponsored by Quality Partners of Rhode Island and Providence Business News, the forum asked, “Electronic medical records: Who benefits? Who pays?”
Dr. Caitlin Cusack, senior analyst at the Center for Information Technology Leadership in Boston, has researched the issue at length, and she said the answers are pretty clear: “The physicians pay for these systems, but a lot of the cost benefit goes to the payer.”
Based on data from actual providers using electronic records, she said, the center has estimated that $44 billion would be saved each year if everyone used EHRs because of the reduction in duplicate lab tests and imaging, adverse drug events, medical errors and more.
There are also savings from fewer rejected claims, a reduced need for clerical services, fewer calls from the pharmacy about a hard-to-read prescription.
But the vast majority of these savings, Cusack said, get passed on to insurers, the government, or whoever is now paying the medical bills. Only 11 percent goes to the doctors.
“So there is definitely that edge there that I think everybody is aware of,” she said.
Some insurers have found ways to pass on more of the savings to providers, Cusack said. Blue Cross & Blue Shield of Massachusetts, for example, “has really stepped up to the plate,” she said, offering financial incentives to doctors who adopt EHRs.
Blue Cross & Blue Shield of Rhode Island is moving in that direction as well. A multi-year plan to increase primary care physicians’ pay, starting this summer, will provide substantially higher pay to those who adopt qualified EHR systems – what those will be remains uncertain – and participate in quality measurement and improvement efforts that take advantage of the electronic systems’ capabilities.
Blue Cross is also a major supporter of the Rhode Island Quality Institute, which is spearheading an effort to create a statewide health information exchange and also works extensively with doctors adopting EHRs (as does Quality Partners).
President and CEO James E. Purcell, the only non-physician on the panel, said it’s not really the payers who benefit most from EHRs.
“Ultimately, who benefits is the patient,” he said. “That’s what this is all about. It’s the patient who benefits. And who pays? It’s going to be the patient who pays if we don’t adopt this, because the patient is going to be subject to a much higher probability of medical error without electronic medical records.”
But electronic records alone, Purcell said, are only “one-fifth of the equation,” because at this point they still exist in isolation: The doctor’s office has one, the hospital has another, the imaging center and the pharmacy each have their own, but they’re not all interconnected.
“The real bang for the buck comes when you hook into the health information exchange,” Purcell said.
In the meantime, though, is it worth investing in this technology, which Dr. Steven A. Mallozzi, a primary care doctor at University Medicine Foundation, said would cost his 150-provider practice an estimated $20,000 to $30,000 per doctor to implement? (There are cheaper systems, and many smaller practices have them, but this is not an atypical cost.)
Everything he’s heard from colleagues, Mallozzi said, tells him EHRs will take more time to use than paper records, and there will be no savings from reducing duplicate tests and such, because Veterans Administration system records, for example, remain inaccessible. And the pay increase from Blue Cross will not be enough to offset the costs.
Dr. Chris Campanile, of Hillside Family & Community Medicine, said his eight-doctor practice uses EHRs and finds them valuable in tracking patients, ensuring they get follow-up care, etc. But he also acknowledged that many of the software packages available (there are nearly 300 options, though a handful dominate the local market) don’t have the rich capabilities that he considers important.
Purcell said he expects market pressures – especially from medical malpractice insurers – to make EHRs a necessity very soon, not an option.
Dr. Deirdre Gifford, chief of health policy and programs at Quality Partners, said given the quality and cost benefits, employers should be putting pressure on insurers to promote EHR adoption.
“I would want to know: How are they addressing this issue?” she said. “Ask: What are you doing with my dollars?”
