Obama has held very strong on his commitment of $10 billion a year for 5 years in health care. Obama’s set the audacious goal of full digital health records by 2014. The question is if it’s even possible to invest that much money in health care IT in such a short period and will we be able to reach the goal of full EHR by 2014.
A recent CNN Money article pointed out some important problems with investing so much in health care IT. The biggest of these is finding enough qualified IT professionals that can navigate the complex health care IT systems. There really is a lack of qualified health care IT professionals. Some jobs I’ve seen listed for EMR professionals have gone unfilled for months just because they couldn’t find qualified candidates.
Many reports are also suggesting hundreds of thousands of jobs will be created by this investment in health care IT. This of course would be true if you had enough people to fill those jobs. It’s hard enough for an IT professional to move into health care IT. It will take a lot more training for a blue collar worker to try and implement an electronic medical record.
Certainly it’s not impossible for someone to learn from scratch. I know, because I did it myself. However, it is literally like learning to talk a different language. It takes a lot of work and training and a unique person who can balance the IT needs, the health care requirements, with the business requirements.
I also think that it’s sad to say that $50 billion might be enough to achieve the goal of interoperable EHR by 2014. A look at a small Massachusetts Example gives a good measure of what it will actually cost:
Massachusetts has developed a plan to fully computerize records at its 14,000 physicians’ offices by 2012 and its 63 hospitals by 2014. After a pilot program, the state legislature estimates it will cost about $340 million to build the statewide computer system, with a cost of about $2 million per hospital.
“[Obama’s] timeframe is very ambitious, but there is a need to be able to track data on patients and talk across providers and health care systems,” said Dr. JudyAnn Bigby, Secretary of Health and Human Services for Massachusetts. “The program will allow for greater patient safety.”
Despite being less than what might be needed, it certainly would give it a good start that could build into the future.
I’m still planning on writing a few words about whether I think the investment is worthwhile or not. However, I think it’s important to have as much of an understanding as possible at the goals Obama has proposed for investment in IT for health care.
As a solo family physician, I simply cannot afford the typical 20,000+ price of an EMR. Keep in mind we need billing software, scheduling software, multiple phone lines, rent, not to mention payroll, payroll taxes, malpractice, business insurance, electricity, water, and on and on. I’d love to adopt EHR if it were user-friendly, comprehensive, adaptive, and cost-efficient. While I’m not big on government control, how about simply provide all offices with VistA (like the VA) and be done with it.
Dr. Carter,
I personally just find it really unfortunate that you don’t know that there are a ton of EMR software out now that don’t have a $20,000+ price tag. Certainly there are plenty of those, but there are also some EMR software with new billing methods. Anywhere from free (see my other posts on free EMR) and pay per month or even pay per visit.
I find it completely ironic that you said you wanted an EHR that is “user-friendly, comprehensive, adaptive, and cost-efficient” and then suggested that government provide Vista to doctors. From everything I’ve heard about Vista, those 2 things sound like polar opposites to me. I have heard very good things about availability of records by having one system (ie. Vista at the VA). However, I’ve heard far too many end users complain about Vista being one of the worst programs they’ve ever used and the back end Mumps “database” (which most doctors don’t care about) is painful to work with and a complete liability to the future of Vista.
I will say that I’m very sympathetic to your plight Dr. Carter. How can a doctor really know that there are “user-friendly, comprehensive, adaptive, and cost-efficient” EHR out there when there are over 400 EHR companies out there to consider? The answer of course is that they can’t unless they have a consultant they really trust or they invest a ton of time finding the right one. Even then, it’s a huge challenge for them to find a system that will work well for them.
I hope you’ll at least do a little more research on some of the unique payment models available with many EMR companies before you assume they’ll all cost you $20k. I think you’ll also find that those that have creative pricing models are also the ones that are usually more “user-friendly, comprehensive, adaptive, and cost-efficient.” They have to be to survive.
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Do you know if the 2014 mandate for EMR/EHR applies to podiatrists, optometrists, chiropractors, dentists, clinical psychologists, physical and occupational therapists, speech and language pathologists, etc?
Dr. Cantor,
So, the first clarification is that there is no “mandate” to do EHR for anyone. Really, no one has the authority to mandate it at all. So, they government has resorted to what many people have called the “carrot and stick” approach.
The carrot is in the form of EMR stimulus money for those who show “meaningful use” of a “certified EHR.” A quick search on my website will turn up lots of details on that. Plus, this presentation I did has a lot of details too: https://www.healthcareittoday.com/2009/07/16/ehr-stimulus-arra-presentation-in-austin-texas/
The stick is in the form of a 1% penalty in 2015 and going up to 5% (possibly) over the next 5 years.
I should clarify that the stimulus and the penalties will all be done on your Medicare/Medicaid reimbursement. So, those provides who don’t take these won’t be affected be either.
More to the groups that you’re talking about. If they qualify for the stimulus money then they’d probably be subject to the penalties if they don’t show “meaningful use” of a “certified EHR.” The question is still up in the air if someone will be penalized if they don’t qualify for the EMR stimulus money, but still take Medicare. To see which of those groups qualify I’d have to check the legislation again. I think they said dentists and clinical psychologists don’t qualify, but I could be wrong. I think PT and OT don’t qualify either.Optometrists probably won’t either. Podiatrists I would think would.
One of the challenges of these special groups is that the “meaningful use” criteria was designed for family practice doctors (mostly) and so how that will apply in these specialty groups is going to be a learning experience for all.
I hope this helps. Lots to be said about what’s happening. However, I do think it’s clear that there’s no mandate. Just some potential penalties if you don’t adopt an EMR.
The assumption that healthcare is a tough transition for an IT specialist is rubbish. Every discipline, accounting, engineering, and healthcare feels they are different and standardisation and automation will not work in their sector. Even within disciplines every workplace believes they are special. The issue I have found as an IT specialist in healthcare is the ego associated with the sector. Every health professional believes they are busy ‘saving lives’ when the statistics show 70% of health problems are coughs, colds, and sore holes. Most health care professionals can spend most of their lives in situations in which they never make a life or death decision.
DLeslie,
I don’t agree with you. I think the thing you’re missing is that it’s hard for anyone to switch their manual process to IT regardless of industry. People don’t like change regardless of industry.
The likely difference in healthcare IT is that the owners are often doctors (or influenced heavily by the doctors). In most other industries they are run by business people and so the decision making process for implementing IT or not is a bit different.
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