I’m not sure where I came up with the following idea. I had stored it in my list of future posts and I didn’t have any reference for it. So, if I forgot to acknowledge who provided me the comment I’m sorry.
This is the comment that I received from someone, “EMR provides benefits to the patient (better patient care) and payers (cost savings).”
Of course, we could argue these two points until we’re blue in the face. In fact, feel free to argue either point in the comments below. That will be interesting. I’ll just say that there’s the potential for better patient care and the potential for cost savings to the payers. Whether the potential will become a reality will be a fun discussion in the comments.
When I saw the above statement I started to consider the impact of “better patient care” from a doctor’s perspective. Better patient care seems like something that should benefit the doctor. Pretty sad to consider that the customer (patients) getting better service has little effect on a doctor’s business. Certainly there are some hyper competitive markets where this isn’t true. However, I believe that most patients (myself included) aren’t very good (shall I say knowledgeable) enough to be able to distinguish between good patient care and great patient care. Sure, there are outlier cases, but what measures do patient use to distinguish the quality of care their doctor provides?
If you assume the above statement of EMR software providing better patient care (Clinical Decision Support, Drug to Drug and Drug to Allergy interaction checking, etc etc etc), then why as patients (customers) aren’t we asking future doctors if they use these features? Maybe a few people are, but there’s far from an outcry of patients leaving doctors who are refusing to use an EMR.
For some reason this isn’t working:
EMR Use -> Better Patient Care -> Happy Patients -> Better Business for Doctors
I’m sure that some will come and say that it’s just not clear that the EMR benefits to patient care are tangible enough for this “customer demand” to occur. I remember about 5 years ago when on the EMR Update forum someone suggested a “Got EMR?” (similar to Got Milk) ad campaign for doctors to advertise the fact that they had an EMR. So, of course this topic isn’t new. Although, it’s still very relevant.
Although, even beyond EMR, I wonder what a company or website could do to help consumers/customers (patients if you prefer) to better evaluate the quality of healthcare that’s being provided. I don’t have any ideas on this regard. I’m as bad as the next person at figuring it out. However, whenever there’s a lack of good information I think there’s an opportunity. As you’ve probably figured out, I’m all about good information and accountability.
Broken down into its constituent parts:
1. EMR Use -> Better Patient Care (maybe)
2. Better Patient Care -> Happy Patients (well we hope so)
3. Happy Patients -> Better Business for Doctors (well we hope so)
The first is at issue here. At best, a good EMR may free up a doctor’s time and providing more consistent patient metrics, thus allowing the potential to provide better patient care.
Number two would seem a given.
The third also. But perhaps the patient is so happy, he figures he can skip the next check-up. But overall, the doctor will probably benefit from patient referrals.
Better patient care has to be looked at collectively or wholistically. It won’t necessarily improve the everyday simple office visit. I’m a healthy person so I won’t feel I’m treated any better. But lets face it folks.. There is too much information flowing in so many directions for it to be a paper exchange. Leaves too much margin for error. I recently wasted so much time with a doctor’s office over a copay they are seeking that I already paid at the visit. between the all the parties involved we collectively spent over $500 (very conservative) in wasted time trying to locate $25. “Better care” also isn’t felt by the average healthy Joe but you consider the immeasurable benefits gained by reporting, or reducing M/M costs or scrip fraud. If it makes it 10x harder for his kids to get their hands on pills, Joe may sleep better…. leading to healthier Joe. If it can drive down the costs of healthcare overall (or at least stabilize it!), it may mean Joe can save a few extra sheckles for his retirement… He may sleep better… again, healthier Joe. I think Joe deserves this. We have all the great technological tools.. we just have to make them talk to each other….for all of our sake! Face it… It’s long overdue and it can be done. But it won’t be easy.. Until then, Joe will have insomnia
It seems to me at issue is the seperation between actual medical care and DOCUMENTING that care, which is really what EHR’s are all about. Yes, better documentation can lead to better care b/c it gives the doctors better information, faster, and can be more easily shared, but that’s indirect (and patients dont get to see or feel that often). In truth, patients dont really care if a prescription or hand off from their PCP to a hospital was done via fax, phonecall, smoke signals, or electronically from an EHR, as long as it WORKS. They dont care much about the process.
(this is also about the seperation between the business of medicine and care as well: the seperation of the patients as a consumer from the cost of care due to insurance, the lack of competition between valid consumer choices for care, payment based on activity rather than results, etc, but that’s a whole other discussion.)
As a person in information systems and who is responsible for achieving ONC/ATCB certification for a software solution, I have had several thoughts on this:
1) For me to personally endorse the idea of meaningful use/certification, the only reasons that made sense were if it led to improvements, first for the patient (i.e. improve healthcare, lower costs, etc.), and second for the healthcare system (doctors, payers, etc.). I am not sure it really will do any of this, but I am hopeful.
2) I also hope that the people who made the federal regulations had the same intentions. I hope they weren’t just thinking that information systems are a silver bullet that make everything better (and sometimes I worry they were thinking that) – that is clearly not true. I also hope none of this was driven purely by special interests (for example, why penalties in Medicare for not implementing, but no penalties in Medicaid… yet?).
3) Standards are a good thing. They are what let me drive down the street feeling at least some degree of confidence that my car won’t fall apart, the water that comes out of my tap is clean, and that my privacy is being protected, to name a few.
4) Standards can be oppressive and barriers to entry that limit innovation, and that should be avoided at all costs.
I believe it is important to define what the results is that we expect. Better business for doctors probably means 1 of 2 things: a.) more patients or b.) more $/time spent.
To have an EMR drive more patients, it would have to free up time in a provider schedule so that he could see more patients, or drive demand so that empty slots in a schedule are filled (or another provider could be added to the practice). The first is a dream, use of an EMR increases the amount of time spent per patient. The second would require the EMR to influence patients decisions on selecting a dr. I’m less certain of this but I think most people choose doctor’s for personal reasons – the doctor is available when you want to see them, you can speak to the doctor, you trust him, he spends an “appropriate” amount of time, you’re not waiting overly long in the waiting room.
This leaves increasing $/time spent as the means to improving business. If the EMR can identify patients for additional (and useful services) or can improve documentation or justify billing at higher levels that would be a benefit to the provider. I do not see many players in the EMR industry addressing these issues.
Cole
While sitting in the exam room today at my youngest son’s orthodontist, I was studying their EHR setup.
Then it occurred to me.
My dentist has an EHR.
My kid’s dentist has an EHR.
My kids’ orthodontist has an EHR.
Why?
No government money.
No external group forcing this.
Dentists seem to have done what doctors haven’t…
OR…
Dental EHRs have done what physician EHRs haven’t…
That is create efficiencies.
I have argued that if EHRs were good (meaning create efficiencies), Docs would have switched to them years ago.
The sad truth is EHRs do not create efficiency.
They tend to reduce efficiency as the Doc ends up inputting all of the data and taking up way more time than was required before.
As Gerry above alluded to, patients don’t give a hoot about an EHR. All a patient cares about is how long they have to sit in the waiting room…no matter how early they show for their appt. AND whether their docs can “fix” them.
Health record portability doesn’t really matter. Yes, diabetics, odd allergies, the elderly, etc are a special case here, but the majority of folks don’t need their records within seconds, minutes or hours.
Hmm, I just received a phone call and lost track of where I was going. I’ll stop here.
John,
I like your comment!
Does it ever strike you that “government-defined” EHR was something that sounded nice and good to them at the time, but clearly the reality is different? It seems pretty evident to me that many of us out here in the real world question the value of such a thing. I so wish docs were able to focus on being docs. Hey, systems are great, sure, but what about the main reason we go to see them??
In agreement with your statement about dentists having EHR also – in fact, a lot of places had “EHR”, just not one that fulfilled the requirements for meaningful use, and not one that could net you somewhere over $40k if you are an EP. You know, EHR’s that were purchased longer before government got involved, because they made the job of running a practice, clinic, hospital, etc. easier, cheaper and safer!
The software solution that the company I work for sells was an “EHR” long before the term was considered catchy, and so were a lot of other systems. Our customers have no requirement to change (being mostly Medicaid), but we worry that without being “EHR” as far as the government sees it, we won’t be able to compete with big competitors who have the money to spend on it. So even for us, and our customers, it’s a little bit of a waste, but it’s what’s “hot”.
Oh yeah, and where is the patient in all of this again? I guess time will tell with research/data gathering if the changes made by this “meaningful use” actually made any difference.
Well, assuming the patient is also the taxpayer (just like we all are), then I guess the patient, the provider, and the payer were opening up there wallets again.
@Jon
Really, before the G got involved, most practices were not using EHRs, there were using PMs.
Two different animals.
It is much easier to show efficiencies from a PM than an EHR.
But, nowadays every EHR seems to magically also be a PM.
What is that saying? “Jack of all trades, master of none.”
5 years ago this was not the case.
You had to either live with a PM & EHR that didn’t talk to each other, or you worked a way to make them talk.
I know of a few businesses who all they did (do) is make a PM talk to an EHR.
“Government defined” is not often a good thing.
Meaningful Use is a ridiculous maze that was created by bureaucrats, but what do you expect: this is what bureaucrats do & crooks would do what they can to rip off the system if it is made too easy.
The rules suck, but those who quickly adapt to them will be the long term winners.
MSangston,
You’re right that they don’t care how it’s done…now. Although, could there be a set of services that would change that game (ie. online scheduling or something)?
Jon,
I assure you that special interests were heavily involved in the legislation and rule making. Although, is there anything in government that isn’t influenced by special interest?
Cole,
Good division of the business issues. Unfortunately, I think that division is what complicates the discussion. Obviously the first part you identify depends on your area and competition between doctors. If there’s only one doc in my area, then it doesn’t matter how good or bad they are, right? Funny thing is that when I lived in an area like this, the doctor was absolutely fantastic.
The second part of increasing efficiencies of doctors is being worked on by some EHR. A few are driven by it.
Jon and John (that’s a lot of John’s in this thread),
Sadly in the short term, the EHR incentive money has definitely hurt EHR adoption. I bet we’d have higher adoption now if they’d never done stimulus money. Long term, I’m still holding out on my prediction.