One of the ways in which ObamaCare is supposed to save money is by creating a nationwide system of electronic medical record-keeping (EMR) that will allow doctors and hospitals to track patients and their health needs and share information more efficiently. Indeed the $800 billion economic stimulus plan passed by Congress earlier this year sets aside $19 billion to help hospitals and doctors’ offices go electronic by 2014.
As the Baltimore Sun reports today, the manufacturers and would-be manufacturers of EMR systems are salivating at the prospect of the federal cash infusion, and rosy predictions of all the money that could be saved over the long run abound:
According to a study published in the New England Journal of Medicine in March, only 1.5 percent of nearly 3,000 non-federal hospitals in a survey have a comprehensive electronic health record system. Estimates range widely as to the expected annual savings if patient records move completely online, but it could be as high as $77 billion.
Those are the projections. Here’s the reality, explained by Pennsylvania family physician Winslow W. Murdoch on the KevinMD blog:
Let us not forget however, that garbage in produces garbage out…
Unless the relevant medical decision making data is properly vetted and reviewed by the patient, with one on one help by a clinician, it becomes garbage in. An experienced primary care clinician who knows the patient best and has all medical information flowing through their office is the best person to input and screen new information important for medical decisions. They would also potentially shoulder the lion’s share of the burden of data input responsibility and therefore cost of implementing an EMR. These are the same practices that are the most financially insolvent, many on the brink of shutting down.
One of my patients was recorded incorrectly at the hospital as having reported a reaction to x-ray dye, and a breast cancer history. Whenever he goes to the hospital, these continue to be reported on his computer record. The odd times I have had to order a test that required x-ray dye, my staff and I waste hours in order to convince the facility to do the study. I have repeatedly told the hospital IT department that this needs to be corrected, only to be told that there is no current mechanism to correct this.
To implement an EMR carries a real cost of well over $100,000 per doctor and much more for primary care practices. There are currently scores of vendors. Each vendor stores information on their own proprietary software. Only half a dozen vendors are expected to survive. If your vendor goes out of business, you go back to square one.
Consider these issues the next time you feel like your doctor is slow in adopting health information technology.
Already there is a growing shortage in America of family-practice physicians and internists–the general practioners you consult first when you have a health problem and the physicians who typically know you and your health needs best. Low compensation and the crushing burdens of paperwork required in already existing government-run health programs such as Medicaid and Medicare make family practice an ever more unattractive choice for young physicians. Now the federal government wants these doctors to set up costly EMR systems for which they will be only partially compensated at best?
Another way in which ObamaCare will mean inferior medical care for most Americans.