The Pluses, Minuses of EHRs
The Pluses, Minuses of EHRs

Bill Light
Frustrations with system include doubts it saves money

Electronic health records have revolutionized the way doctors treat their patients, but, as with many innovations of the Digital Age, some things just don’t compute. 

As the government spends billions of dollars in EHR incentives for physicians, the learning curve for doctors can sometimes be frustrating and costly.

“I don’t think there’s any doubt that we do a better job when we’re documenting (electronically),” said Bill Light, MD, general medicine physician with Baptist Medical Group, The Light Clinic. “What we can’t prove yet is that it saves money. A lot of people use that to say that it’s not worth doing. We haven’t been able to show that you can save money for the overall healthcare system by adopting EHR.”

Sentiments such as Light’s echo across the medical blogosphere, with some physicians saying that the government’s standards of Meaningful Use, which include criteria for everything from how patients are registered at the front desk to how lab results are received, are overly complex and being implemented too quickly for a conclusive study of the results. 

The blog EMR Straight Talk cited concerns from groups like the American Medical Association, American Academy of Family Practice, College of Healthcare Information Management Executives, American College of Physicians, and the American Hospital Association.

Some physicians were at the point of giving up $30,000 government incentives, according to the blog.

Light said the incentive money was never the point for physicians in the first place. In 2004, his office bought an EMR for $150,000. The incentive money for him and two other physicians helped defray that cost, but did not cover it completely.

Nor did it cover the cost of hardware upgrades his office needed after the EMR was installed.

“There are always kinks,” Light said. “There’s kinks with connectivity, there’s having fast enough Internet. There are problems with compatibility. When you upgrade to a newer version, your old printers don’t work anymore. You’re always having to be ahead of the IT curve.”

Light’s clinic has met stage 1 of Meaningful Use, and he expects to meet stage 2 in January 2014 after the implementation of its new EMR, Epic.

Some EMRs are Cadillacs, he said, and others are lemons. Physicians’ frustrations often lie with the quality of the system they purchase. 

“The implementation is slow to progress because there’s a lot of bad systems out there,” Light said. “Doctors get sucked into a bad EMR from a salesman and then end up not using it.”

Light knew of one physicians’ group that purchased a more expensive EMR than the one he bought and stopped using it after only a few weeks.

Light said he was excited about Epic because, unlike some EMRs, it involves a single database instead of separate databases for billing, treatments and other areas.

Hospitals may find EMRs too useful to be bothered with frustrations over Meaningful Use.

“When I’m meeting patients, I’m frequently meeting them for the first time,” said Heather Swanson, MD, a hospitalist for Methodist Le Bonheur Healthcare. “In a paper world I typically didn’t have access to their records. I was relying on the patient to provide their medical history.

“In an electronic world, I have access to all of their medical history and prior treatments. That gives me a lot of information that I can use before I ever talk with the patient. For me, the time I spend with a patient can be much more focused on what’s going on with them acutely. I don’t have to spend so much time gathering information. Personally I think it makes me more efficient.”

She also likes that Meaningful Use means that patients will have greater access to their own medical records.

Methodist has been using an EMR since 2004. Currently it uses Cerner and is in stage 1 of Meaningful Use with plans to meet stage 2 perhaps later this year.

“It’s a learning curve just like anything,” Swanson said. “Most of us have developed a work flow that was based on doing things a certain way, usually on paper. I would say with a new system we’re all less efficient at first. We’ve been using our EMR for several years now, and I definitely feel like my efficiency has improved.”

Light said his biggest concern about Meaningful Use is that so far it is not reducing the cost of healthcare system-wide, something it was designed to do.

“I see the reports, and one of the reports said that it was proposed to save money and so far it has not saved money,” Light said. “It cost the government $10 billion to do the process, but they’re not saying anything because doctors are up-coding.

“Part of the problem there is that (doctors) document more in the chart and therefore they upgrade to a higher code, and so they get paid more money than if they didn’t use it. It offsets any cost savings in the system.”

But with the potential for penalties to be leveled against physicians in the future for not using EHRs, he said it’s better to work through the problems now.

Swanson agreed, saying individual patients benefit too much to complain about technical issues.

“I had a patient who came in recently, and while I was talking to her I became worried that maybe she had a blood clot in her lung,” Swanson said. “I can actually enter the order while I’m in the room with the patient, and in this case they show up with a stretcher before I even left the room to take her to get a CT done.

“In a paper world I’d have had to leave the room, write it on paper, give it to a secretary who would enter it in a computer. I shave off hours during the day by being able to enter things myself. I even order things from home.”