Electronic records rant

It's no secret that I'm a news junkie. You can plainly see this from my blog. In addition to my patient rounds, I do my blog rounds and news rounds. I became really upset when I read this article from the Washington Post called, "Doctors Slow to Adopt E-Records for Patients."

About one in four doctors use some form of electronic health records, suggesting that a technology frequently billed as a way to improve the quality and efficiency of care has yet to win widespread acceptance, according to a study released yesterday.
As these type of articles in the media go, the following paragraphs build the case why an electronic record is a good idea -- it "collects patient information, displays test results, helps doctors make treatment decisions and allows health-care providers to document prescriptions and medical orders electronically." In addition, they "improve patient care, reduce errors, curb unnecessary tests and cut paperwork."

Yes, I get it. Even though I am one of the 75% of docs who do not use electronic health records (yet), I agree with everything that has been said above. I think all docs agree that going electronic is the future of medicine.

So, what's the hold up? Why isn't everyone using it now? There are two main hangups, in my opinion. The first one is covered later in the Post article, and it is who will have access to this electronic infomation? Also along these lines is who owns the information inside the computer?

"The big problem is that the vast majority of electronic medical-record systems do not give patients the right to decide who has access to the records," said Deborah C. Peel, a psychiatrist and founder of Patient Privacy Rights, an Austin-based nonprofit that wants greater safeguards. "They do not give patients the right to segment sensitive portions. . . . The electronic medical records in use now have been designed primarily for the convenience of physicians."
For example, if I'm talking with a patient and entering information into a laptop, and this information is stored on the hospital server three streets away from my office, who has access to this information - besides me? How comfortable would you be if I told you your medical data is on a hospital server and possibly backed up on an offsite server, while now, your information is in my paper chart under lock and key in my office? Just something to think about.

The BIG reason docs have not jumped on board is plain and simple -- COST! This is something that is never talked about in the lay press. The federal government has made a goal of most Americans on an electronic health record by 2014. Like a lot of other things from the federal government, this is an unfunded mandate.

Even for a small office like ours, the cost can be between 50-100 thousand dollars. But, hey docs can afford that, right, because I see them driving their expensive cars and have their expensive houses?

Medicare is a govenment program which is health insurance for people over 65 years old. As you all know, the number of Medicare patients is rising very day, because as a nation, we're growing older. Many physician offices depend on Medicare for a good portion of their income. In 2007, Medicare is slated to be cut by 5% unless Congress intervenes by the end of the year.

This cut will hugely effect docs across the country. Just as an example, here's an article from the Concord Monitor.

The New Hampshire Medical Society estimates that the cut will cost the typical family practice $20,000 next year, which could force some doctors to stop accepting new Medicare patients.

The association and its counterparts across the country have until December to persuade Congress to stop the cut. Lawmakers have, in years past, heeded similar requests, but local doctors remain worried.

"Primary-care doctors are really mom-and-pop shops," said Dr. Gerard Hevern of Suncook Family Health Center. "Most of us do it because we love it . . . but we do it on a shoestring. When you begin to erode that margin, it really impacts in ways that are profound."

So, bottom line, I totally agree that the electronic health record is the wave of te future, and all docs will eventually get on board. What the press neglects to cover is the real story of why this is not happening now. I know I'll continue to read articles like the one today in the Post, and I'll continue to get upset. But, here is the real story of why so few use electronic records now.

Addendum: Dinah from Shrink Rap has some additional thoughts and some great comments in her post entitled "For The Record." Check it out! Also, thanks to all of you reading via Grand Rounds this week. I invite you to check out the rest of my blog.