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Docs not tech savvy, or tech not doc savvy?

Written by David Sullo MD., FAAP

I recently wrote a post about why your pediatrician may not be using an electronic record. Uptake has been slow largely because doctors believe their daily work would not be made significantly easier or more effective with the current systems available. Furthermore, if they do invest in one and it is not a good marriage, it is difficult to then switch systems.

The government has taken the top-down approach to this issue, otherwise known as the “let’s throw money at the problem” approach. Physicians that can show what is termed “meaningful use” of an electronic record are eligible for financial reimbursement from the feds. This has led to some unintended consequences. First, physicians are chasing that money by purchasing systems that may not meet their needs, because time is of the essence (the program expires). Second, EMR developers are focusing on the government’s criteria for “meaningful use,” at the expense of other functionality. This will lead to some very bitter doctor’s offices in about 3-5 years, when the money runs out and they don’t like the EMR they chose. However, the government will have very nice graphs about how their program increased EMR use in physician offices.

My belief is that the government should have taken a bottom-up approach to this issue. A standard database for medical information needs to be deployed. Electronic records are basically a large database. However, each company creates this from scratch, and because of this they are all speaking different languages. This makes it difficult to send data from one system to another, and even more difficult to switch systems within a practice if your first one is a lemon. A good analogy is the Internet. Webpages are written in a standard language (HTML). No matter whether you use Internet Explorer, or Firefox, or Chrome, a given webpage looks the same. Now imagine if this were the case in the medical field. If all EMRs had to use a standard database, it would lead to several things:

First, the communication problem between EMRs would be solved, because they would all be “speaking the same language.” No more costly interfaces.

Second, it would make it infinitely easier to switch EMRs. This would remove one of the main barriers to adoption that currently exists. Just as I can easily ditch IE and switch to Firefox and the CNN website still looks the same, I would be able to ditch one EMR for another without losing my patient’s data.

Finally, because of this ease of shifting from EMR to EMR, developers would have to actually compete on function. I think this would be the development that would allow electronic records to finally hit the mainstream. I have often wondered what an EMR designed by Apple would look like. If the government would remove barriers to competition, rather than try to legislate EMR into existence, we might indeed someday have “an app for that.”

Dr. Sullo is a pediatrician at Genesis Pediatrics in Rochester, New York. He admits to having gone to computer camp in 5th grade when everyone else was playing baseball, and is an “Apple Fanboy.” He does his best to offset the geekiness by throwing in some winter backpacking.

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Docs not tech-savvy? Not so fast…

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:

Cost

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!”

Skewed incentives

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