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    Friday, October 13, 2006

    Poking Along into the 21st Century: Why do you suppose only electronic medical records have been so slow to catch on?

    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.

    Fewer than 1 in 10 use such records in the most effective way -- as part of a system that collects patient information, displays test results, helps doctors make treatment decisions and allows health-care providers to document prescriptions and medical orders electronically, the study found.

    This is why:

    Researchers attributed the slow adoption rates to the expense of the systems and the disruption they cause initially, forcing doctors to change the way they work.

    "There is very compelling evidence that at the end of the day, once you have good implementation and you're done, your systems work better," Jha said. "But getting there is not easy, and both the financial and disruptive elements have held a lot of doctors and hospitals back from taking this on."

    They are expensive. A complete system - that integrates billing, e-prescribing, records, and tech support can cost anywhere from $20,000 to $50,000 per physician. And that doesn't count the hardward. And yes, it is very stressful for all concerned to make the switch. Some staff members and doctors are never able to fully make the switch and end up having to be replaced. (Well, the staff members anyway. ) My electronic medical record is a very basic and simple one, yet when one of my staff members is gone and I have to have a temp in their place who isn't familiar with the system, it slows down the office so much that I often think it would have been better to just close it down for the day or week and save myself the wages.

    There are other obstacles as well, which boil down to regional trends. In Ohio, for example, the state pharmacy board has decided to make it difficult to send prescriptions electronically. Physicians must purchase a pharmacy board approved electronic medical record in order to send prescriptions. Many of the top electronic record programs are not on the list. That 's an obstacle that elminates one of the greatest incentives for electronic records.

    Also, in many regions, hospitals are emerging as the dominant forces in selection of electronic records systems. They're seeking to have integrated networks in which everyone in the community (or hospital community anyways) uses the same hospital-based electronic record. That means that each doctor's medical records are housed on the hospital's servers and that everyone in the hospital (or at least every doctor in the hospital and probably lots of administrators) has access to them. Some doctors embrace this idea, but others are leary of having their patient records owned and controlled by someone else. Many are waiting to see how this shakes out. No one wants to invest tens of thousands of dollars in a system only to have it prove to be useless when community standard becomes a hospital-approved and sponsored record. Nor do they want to jump into a hospital partnership that could go south in a couple of years if it proves too much of a financial burden for the hospital.

    posted by Sydney on 10/13/2006 08:45:00 AM 4 comments


    This is another reason to seriously look at the VA VISTA system as a national standard. It is open source. It can be modified for local needs. It is tested and proven to meet the needs of a large integrated health care system. Why are we all wasting time and effort trying to find the perfect system. The perfect system doesn't and never will exist. A good system is right under our nose. Software vendors are becoming like the pharmaceutical companies. They are spending millions trying to convince us that their brand is better. We can't afford it - let's use the generic instead.

    By Anonymous Anonymous, at 9:34 AM  

    On the other hand, check the Purkinje EMR.

    I did some integration work for them back in 2000, otherwise standard disclaimers apply.


    By Blogger Tom Leith, at 12:51 AM  

    There are actually some reports on electronic-record use. Just remmeber the Err is Human report.
    Interesting, will patinets have the access to the records and if they will, then how?

    By Anonymous Symptomat, at 11:56 AM  

    Also interesting will then transcring service disappear in 2014?

    By Anonymous Symptomat, at 11:59 AM  

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