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Saving the healthcare industry: EMRs are the 'beginning, not the end'

Saving the healthcare industry: EMRs are the 'beginning, not the end'

July 01, 2009 | Chip Means, New Media Manager

CAMBRIDGE, MA – Economically healthy industries empower workers to make decisions, compensate based on productivity and use a lot of information technology. The healthcare industry doesn't do any of this – yet.

Stimulus funds for IT could save the day and the economy, according to Harvard economics professor and Obama campaign advisor David Cutler, who spoke at the Tuesday afternoon session of the HIT Symposium at the Massachusetts Institute of Technology in Cambridge.

Every industry except healthcare has figured out how to become more efficient by replacing administrative work with information technology, he said. Nurses spend a third of their time documenting – a procedure Cutler said often involves printing digitized information and re-entering it into another IT system.

With the right IT systems and processes, he said, the business of healthcare could change to focus more on compensation and empowerment, making hospitals and practices more profitable.

Cutler said the promise of electronic medical records lies in three areas that can greatly improve the economic health of a hospital:

  1. Simplified billing – The greatest potential for reducing administrative costs lies in eliminating the process of spending all day talking to insurers and drug companies. Electronic claims and e-prescribing can replace that process, he said.
  2. Decision support – "Meaningful use has almost certainly got to mean decision support in place to avoid mistakes," Cutler said. "Mistakes alone cost us $100 billion a year."
  3. Learning which treatments are effective – IT can provide organizational insight to demonstrate what is and isn't working.

Some physicians fear that if healthcare becomes too automated, the nation will have "cookie-cutter medicine," said Cutler.

"What we know in every industry is that computerization is good for high-skilled people – it frees them up to use their expertise to do what they should be doing." Doctors estimate 40 percent of their time is spent doing needless administrative work, he said. "If I cut your administrative task time in half, I've increased the time you have to see patients by 20 percent."

Simply putting the systems in place isn't enough. "Electronic medical records are the beginning, not the end," said Cutler. "What has to happen is IT has to lead to a change in healthcare as big as it led to in other businesses. If it doesn't, everything we do now will be a big failure."

 

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reefdiver says:

August 20, 2009 | 10:43AM GMT

Why EMR is NOT the beginning

Mr. Cutler makes valid points about how IT adoption has greatly increased the productivity and efficiency of many industries. His conjecture that healthcare has failed to follow the IT evolutionary cycle, leading to the healthcare/cost crisis fails to recognize the same significant issue that so many other pundits---and a flotilla of EMR software vendors---seem to miss, as to root cause. And neither legislation, stimulus funds nor an army of government administrators will be the solution. Why not? Ask any busy, practicing physician...you'll probably get the answer.

Mr. Cutler's premise, as with so many other experts, is that IT adoption will reduce inefficiencies by eliminating administrative waste. Without question, that is possible. But traditional EMR's are certainly NOT the beginning. Any more than HMOs and managed care were the beginning; than insurance industry reform was the beginning; than requiring a primary care physician to be gatekeeper of all care, was the beginning; or than generic medications, risk-sharing, "health czars" or government mandates and oversight was the beginning. None of those enhance the physicians productivity positively either.

EMRs have been around for almost 20 years. According to many studies, still less than 17% of practicing physicians fully or partially use them for all patients. The PROMISE of EMR adoption---reduction of errors, increased efficiency, better productivity, elimination of dictation costs, savings on paper chart management---has NOT been broadly realized, especially in the fee-for-service segment, and even less so among high performance and specialist practitioners. In addition, more that 50% of EMR’s implemented up to now have failed---either abandoned, replaced or de-installed. Is there any reason to believe that just adding billions in federal subsidies will suddenly change this adoption/failure cycle?

The BEGINNING of more efficient healthcare system via adoption of IT starts with the physicians themselves. Changing the way they practice medicine, requiring them to become the actual data entry clerks for the plethora of data and reducing their productivity and ability to see patients because of the data entry requirements and putting a computer between them and their patients during the exam will NEVER get broad traction with many busy practitioners. That's a shortcoming of traditional EMR. There is a tradeoff between a doctor's time to see patients, and the granular, efficient entry of the discrete data collected during each exam via nested menus, pull-downs, click boxes and multiple screen entries. Notes generated by these traditional EMRs often contain cookie-cutter language and superfluous, voluminous information that must be sifted through to find meaningful data. That’s the tradeoff: see more patients, or enter all the data into point-and-click systems for fewer patients.

Practitioners and practices will adopt AND USE technology that aids their productivity and doesn't force them to change the way they interact with patients. Hybrid EMR was designed to do just that. Adoption is strong among high performance practitioners and specialists. Success rate is nearly perfect. Why? It is designed to work the way physicians do, in whatever way they document exams now...and completely digitize the practice workflows and process. Healthcare IT adoption begins with PHYSICIANS and how they work. Hybrid EMR follows that. Traditional EMR starts with the software and data entry requirements…and asks the physician to do lots of data entry. Which one will be “the beginning”? Why don’t we ask the physicians?

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MCNGlobal says:

July 06, 2009 | 3:34PM GMT

Good Article

Nice job outlining the benefits here. I especially like the comment that "Every industry except healthcare has figured out how to become more efficient by replacing administrative work with information technology" -

One of the biggest setbacks for upgrading healthcare IT is the lack of standardization and intercommunication. It's such an exciting (and potentially lucrative) market that tons of people are vying to become the standard, leading to further fragmentation, frustration, and gumming up the implementation process. With players like Google and MS in the PHR industry it's interesting that EMRs have not become more compatible. My big question is who is going to win out?

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