The Stimulus packages (HITECH Act) that are winding their way through the Senate and House call for spending some $20B on healthcare IT initiatives, the lion’s share to provide incentives to physicians to adopt “certified EHRs”. In addition to the very real potential that this legislation will completely shut-down HIT innovation, another issue was brought to our attention by one of the leading Health Information Exchange (HIE) vendors – getting an EHR into every physician’s office could be done for about a tenth of the cost.
So how would they do it?
Using their Software as a Service (SaaS) solution the HIE vendor would:
Establish 200 HIE/RHIOs nationwide that would connect to…
- 6,250 hospitals
- 100 national and regional reference labs
- 660,000 physicians. Among those physicians, 550,000 (their estimate) would have access, in addition to network node, access to a lightweight EMR on the network.
Cost of software: $500M/yr
Their is also the cost of operating an HIE, which in their experience is about 2:1 operating costs to software/service cost.
Cost of operations: $1B/yr
Total Cost: $1.5B/yr to provide a National Health Information Network (NHIN) and insuring all physicians have an EMR.
Roughly 7.5% of what is proposed in the economic stimulus package for HIT.
Granted, these numbers come from a vendor and maybe slanted (though we believe they are well within reason) and these are annual costs, not the one time costs that the legislation is based upon, but those are small quibbles.
What is important here are the following points:
Current stimulus legislation would not likely support an “EMR lite” solution as it is unlikely such an EMR would meet “certified” status. Besides, do all physicians really need a full blown, “certifed EHR”?
Proposed spending on HIT is huge and if dumped into the market too fast, besides being wasteful, could make the situation worse.
Legislation, and its support (via incentives) for only “certified EHRs” will not solve the problem of secure, health data liquidity. IT takes far more than simply adopting a piece of technology to make all of this work.
In closing, below are some comments provided to us by a physician who is currently using a highly regarded CCHIT-certifed EHR. His/her comments clearly show that being certified does not mean delivering end user value.
I have used about 6-7 EMR’s, and I will say that VendorX (editor’s note: name masked by Chilmark) is probably the best, but that’s not saying much. In the kindgom of the dead, the PEA (pulseless electrical activity) patient is king. VendorX is a PEA. I think that they benefitted most from a very charming PR campaign, but when you peel back the propaganda and notice that while you are billing almost every visit as a 4 or 5, but you have to pay for IT, more staff to handle the onerous data entry, and you yourself have a day that is 1-2 hours longer, it becomes a zero to negative sum game.
I think people’s knee jerk reaction to EMR’s has to do with “it’s a computer, therefore it has to be better”. But healthcare is not as easy as stocking shelves or tracking inventories. You have to deal with people, and the fact that taking care or patients while using one of these EMR’s is as distracting as trying to drive with two wasps buzzing around the car.
That and the fact that the EMR’s don’t talk to each other is another serious issue, so I have to scan all the specialists’/hospital records in and manually enter the data.