By David Sullo, MD
Electronic medical records (EMRs) are slowly making headway into both hospitals and doctor’s offices. My office has now been paperless for six years, and there are many benefits. However, I cringe when I see the mainstream media declaring “if those old-fashioned doctors would just get with the times, medicine could all be electronic!” There are legitimate reasons why many pediatric offices have not gone electronic, most of which get overlooked in the press. Here’s a few:
Yes, these systems are quite expensive. There is software, computer terminals, a wireless network, antivirus software, several printers, a central server to hold the information, a battery backup for said server in case the power goes out…you get the idea. Usually we’re talking six figures when all is said and done.
Lack of standards
Right now, each EMR has it’s own way of storing data. As a result, it is nearly impossible to share data from one system to another. If a practice buys one system, and is displeased, switching systems means losing data, or printing every chart out of the old record and scanning it into the new system. As you can imagine, this makes doctors highly apprehensive about buying a system and getting stuck with a lemon.
The outside world
Some local pharmacies still do not e-prescribe. We are able to access information about a patient’s insurance plan (copays, etc) electronically from some insurers, but not from others. Summer camps require health information “on their form only,” even though we can print out the same information from our system. My favorite is the state, which is receiving federal funds to encourage EMR adoption, and then decides that things must also be “on their form only!”
The federal government has allocated funds to partially reimburse offices which have gone paperless. However, the criteria to receive these funds are heavily weighted against pediatricians. An office is required to have a certain percentage of Medicaid patients, of which most pediatric offices fall short. Even if they qualify, they are still only eligible for 2/3 of the money that an internal medicine office would receive through Medicare for the same program. So pediatrics, which is the lowest paid medical specialty, also gets the least help in subsidizing purchase of an EMR.I hope it is clearer now why doctors, and pediatricians in particular, might be slow to adopt this new technology. Rather than aggressively pushing adoption of an imperfect system, we should improve the system until incentives are not needed. In my next post, I’ll talk about a few basic fixes that could achieve this.
Dr. Sullo is a board-certified pediatrician and a Fellow of the American Academy of Pediatrics. He is a practicing pediatrician in Rochester, New York