The Government’s vision to create a Health Information Exchange (HIE) has the potential to provide a comprehensive patient history at the point of care. In addition to this data exchange, Internet and “meaningful use” of electronic health records will have a positive and significant impact on the delivery of healthcare and its associated costs. This new arrangement will improve the collaboration among providers and health facilities.  The integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, and University of Pittsburgh Medical Center are extensively utilizing technology to improve access.  These big groups are combining doctors, clinics, hospitals and often some insurance and capturing the financial savings from electronic health records.

However, despite all the benefits, adoption of technology is slow in most of the small practices.  It is surely a change in “status-quo”, and as such small practices do not get financial incentives to use computerized medical records and for some practices it is very time consuming process to convert paper records into electronic records.

“And there are privacy and patient centered concerns as well” said Dr. Donald Tavakoli; a Philadelphia based Psychiatrist. “Obviously for psychiatrists, mental health issues and therapy notes raise a major concern of “discoverability” and differ from the rest of medicine (at least in some people’s minds).  Not to mention, typing with a patient in front of you, which happens a lot with electronic systems, takes away from the doctor patient relationship.  On the other hand, legibility, access to records, and streamlining for billing purposes can increase efficiency and decrease redundancy in testing etc.”

Dr. Tavakoli said “technology being incorporated into practice is a good thing as it increases access (as DocAsap proves), increases efficiency, and decreases risk of errors.  And at the end of the day, it is inevitability.  Increasingly, I’m hearing about things like Ipad’s being considered as notepads for clinicians, which could offer simply touch screen checklist items to mark off during evaluations, this not only reduces medical error but healthcare costs as well.  And it is possible increased technology and Electronic record systems dovetails with increased “checklist” medicine.  The big concern is that in healthcare, sometimes the art of medicine can have immeasurable value, and the doctor patient relationship is crucial (and mental healthcare tops that list, especially with psychotherapy, but it is true in all of medicine).”

Please check Dr. Tavakoli’s profile at DocAsap

Today’s NYT article on the hurdles that small practices might face with EMR implementation in lieu of the HITECH Act corroborates our earlier post about the steep learning curve in implementing the systems.  One provision of the HITECH Act that gives us optimism that the government will help small practices install EMRs is the funding allocated for regional healthcare IT resources.  Still, it’s not clear from the HITECH Act how these entities will be formed, how many IT resources will be allocated to help doctors install EMRs, or how they will operate.  We hope more clarification will come from the Obama administration in the coming months.  As an aside Allscripts prepared this pdf brief on how the HITECH Act affects their customers that might be helpful for doctors trying to understand the impacts of the act on them.

One interesting HCIT-related clause in the $787 billion stimulus bill states that the Feds will work toward the “Promotion of the interoperability of clinical data repositories or registries.” While the still-evolving HL7 and other patient data standards are getting the most push from interoperability advocates, there is not currently a universally agreed-upon standard for storing and sending patient data in the U.S. much less internationally.  In W. Ed Hammond’s Health Affairs article on data interoperability, he highlighed the main obstacles of data standardization so far, such as doctor’s idiosyncratic ways of storing patient information, the still-evolving nature of HL7, and the difficulty in getting EMRs to support one data format.   The stimulus bill currently has those issues in mind by letting the CCHIT and HITSP work together under the auspices of the ONC to pick a data standard, and only reimbursing CCHIT-certified EMR purchases.

This data standardization push is welcome, as the current reality is that doctors and patients have a very hard time keeping track of past clinical data unless the patient has stayed in the same hospital network his or her entire life.  Currently, the biggest repository of patient data resides with the payers (i.e., insurance companies and Medicare and Medicaid), as they typically can aggregate data from hospital and doctor visits, pharmacy benefit managers, and wellness/disease management programs across various providers over time.  However, for patients who are part of regional insurance companies who move to a new region, or simply those who switch insurance providers, many will most likely will lose their clinical data forever, as there is no easy way for a patient to record and transfer data their health data to a new provider.   While the EMR and data interoperability initiatives imbedded in the stimulus bill eventually seek to help doctors provide better care by having access to past clinical data and help patients hold on to their personal health record, these benefits will be years in the making.  Still, the stimulus bill gets high marks from us in its extensive protections of data privacy, as those sharing patient data for marketing or non-sanctioned purposes can be severely penalized.

Various analysts have begun to detail how the $787 billion American Recovery and Reinvestment Act (aka the stimulus bill) signed this afternoon will affect healthcare IT.  While some analysts are skeptical regarding the immediate effects of the bill since only a small percent of the $19 billion allocated to HCIT will be disbursed in the next year, the $17 billion in EMR reimbursements will no doubt have a large positive effect on EMR adoption in the long-term (via NextThingsFirst).    Additionally, many of the bill’s provisions surrounding privacy protections will be felt much sooner.

Certainly, the hope inside the Obama administration is that greater EMR penetration will reduce costly administrative burdens and clinical errors (and therefore costs) while giving patients more ownership and security over their personal health information.  Indeed, Dr. Ron Paulus, CIO of Geisinger, stated in a recent Wharton eHealth class how his hospital has used EMR systems to provide better care at cost-efficient levels while protecting patient privacy.  Still, while the stimulus bill addresses the main reason for EMRs’ slow adoption to date – their cost – some are concerned about lengthy implementation times, especially for small practices.  Certainly, having heard from Dr. Peter Gabriel of Penn today regarding the time it takes to fully implement an EMR and get staff trained properly on the systems, we believe that small practices will need considerable help from federal, state and local authorities to realize the promise of EMRs and make successful use of them at their practices.  We believe that the Obama administration should be mindful of assisting doctors with installing EMRs, training doctors on using the systems and incentivizing regular usage of EMRs by doctors, in addition to refunding EMR purchases, in order to spread the benefits of EMRs throughout the U.S. healthcare system.