Who pays for the EMR system?

By: Dominic Bodoh

During the past several months, there has been an increase emphasis and discussion upon health information technology. The most noticeable discussions regarding Health IT are those revolving around the implementation of electronic medical record (EMR) systems. These are systems that capture and share electronic information related to a medical patient between hospitals or doctors. With more than $20 billion of the stimulus package earmarked for this specific purpose, the media has been awash with outlining the benefits of these systems, and there a several.

EMR systems are being pursued because they will provide a means for doctors to share information regarding a patient without risk of confusion due to poor penmanship, short hand, miscommunication, etc. The information will be captured and distributed in a format that will reduce the possibility that two or more doctors will prescribe conflicting treatment or drugs. This is a very important benefit. How many people would like the assurance of knowing that the drugs they are taking will not have a detrimental side effect when combined? For the patients’ sake, this is the most important reason hospitals and doctors should pursue an EMR system.
While EMR systems may be a new item of discussion for the media, they have been in existence for a number of years. The reason these systems have not received traction within medical community is due to the cost required to implement and support them. The average cost of the software usually runs between $20,000 and $50,000 per physician within the adopting practice. And this price does not include consulting, implementation, training, or hardware costs. It is not unheard of to hear that an EMR implementation required nearly $1million investment.

Thankfully, the recently passed stimulus package provides approximately $20 billion to address some of these implementation and technology costs. However, it does not address the post deployment costs required to maintain and support these systems. Practices or hospitals adopting an EMR system will have to continue paying an annual licensing cost per physician as well as maintain a technology staff or contractor capable of supporting the hardware. These costs can range dramatically from practice to practice based upon the EMR product selected as well as the IT infrastructure of the practice. But these are not the greatest cost incurred by the adoption of an EMR system.

An EMR system can be implemented into one of two business processes. The first involves and administrative employee deciphering a doctors hand-written notes and charts and inputting the data into an EMR system. The process is similar to the processes utilized in most hospitals or practices today. The second process involves the introduction of a computer into the exam room. The process requires the doctor to be responsible to inputting the information. Both of these processes have their weaknesses and increased costs.

If a practice continues to have an administrative employee input the physicians’ notes into an EMR system, the practice is sacrificing some of the key benefits available to the doctors. Namely, the physician would not be notified in real-time that two prescribed drugs may have negative side effects when taken together. Additionally, this process does not remove the possibility that the doctor’s notes may be misunderstood or transcribed incorrectly. Some practices have recognized these effects and chosen to counter act them by having a doctor transcribe his or her own notes and charts. However, this approach leads to the physicians seeing fewer patients and requires practices to increase their medical staff to meet their need. This also requires a proportional increase in the investment of an EMR system.

The alternative approach would be to introduce a computer to the exam room. This would allow physicians to input their notes, prescriptions, and diagnosis’ directly into the EMR system without having to increase the medical support staff. But what does this do to patient care? As any individual who uses a computer knows, computers have a tendency to act up on occasion, and usually at the most inopportune moments. How many patients would appreciate it if the doctor had to pause or stop an exam so that a technician could come fix the computer? The other concern would be who the doctor more focused upon: the computer or the patient? Would the doctor be more concerned about navigating and completing the correct fields on the screen or listening to the patient describe symptoms? Most patients would prefer a physician that is focused upon them.

Neither of the business processes related to the use of an EMR system appear to have the patient’s best interest in mind. The first approach requires additional costs in staff which requires an increase in healthcare costs. And the second approach requires a reduction in the interaction between the physician and the patient. Until these concerns can be addressed, the implementation of EMR systems may be premature.

Healthcare is a service industry and as such the focus should be upon doing what is best for the patient. With a large number of Americans lacking the means to pay for it, raising the costs of healthcare is not an option that should be considered. For this reason, the push to implementation EMR systems should be slowed until the development of best practices can be established. The technology is nearly there, now it is time to reorganize the business. Until such practices can be identified, the patient is the one paying the greatest cost for the EMR system.