Digital med records to take time, money

A stethoscope sitting on a laptop


Kai Ryssdal: The story of the health-care debate is going to seesaw back and forth over the next couple of weeks. Between a discussion on the economic merits and political calculus. President Obama did a little bit of both today. He met with staff at the National Children's Medical Center this afternoon, after which he stepped to the microphones.

PRESIDENT OBAMA: Now there are some in this town who are content to perpetuate the status quo. Who are fighting reform on behalf of powerful special interests.

That's the political part. But he talked economics, too.

PRESIDENT OBAMA: We all know there are more efficient ways of doing it. I spoke to the chief information officer here at the hospital, and he talked about some wonderful ways in which we could potentially gather up electronic medical records and information for every child not just that comes to this hospital, but the entire region. And how much money could be save and how the health of these kids could be improved.

Digital medical records could cut down on office visits. They would let people transfer their records easily. But for doctors, going electronic could be complicated and expensive. And nothing at all like what they learned in medical school. Marketplace's Caitlan Carroll reports.

CAITLAN CARROLL: Thomas Mohr runs Pediatric Partners, a large medical group in Southern California.

THOMAS MOHR: How'd he sleep last night?

He's just finishing up with a young patient.

MOHR: He slept OK. Just on and off.

Mohr's days are full of pint-sized patients suffering from ear infections, runny noses and chicken pox. Lately, he's also started seeing a lot of adults. But they're not here for his medical expertise. They're here to check out his electronic medical records.

MOHR: We had a large group come through from Texas a few weeks ago, and they really want to go with this system. So they brought their physicians who were sort of the naysayers. And by the end they were pretty convinced that this was the way to go.

Mohr's a pioneer when it comes to electronic medical records. His clinic first digitized its files in 2003. It was a disaster.

MOHR: Everytime we upgraded the system with more software, it would lock, and we would lose data, and people would be frustrated. So we scrapped it.

A couple years later, Mohr took a deep breath and tried again. This time it worked. But he hasn't forgotten how hard it was the first time. All the questions and concerns. Very few answers.

MOHR: Physicians are scared. They're busy. So they're scared that it's gonna slow them down.

That's not the only fear. Jonah Frohlich is with the nonprofit California Healthcare Foundation. [See editor's note below.]

JONAH FROHLICH: This is a big investment for them. It's $25,000 minimum per doctor, and it's probably more like $40.

And the industry is so new, there are few standards. Doctors don't know which systems are best and which companies are likely to be around for the long haul.

FROHLICH: It leaves an underlying question here, which is: How do practices make that decision in the first place? Because many of them really don't have very good guidance.

So far, only about a quarter of doctors and hospitals have gone electronic. And with the addition of government incentives, what has been a slow-growing market, could explode into a billion dollar business.

Lindy Benton is the Chief Operating Officer of Sage Healthcare, a medium-sized medical records company. She deals mostly with small practices and clinics. Her reps are busy trying to sign doctors up. But it's a delicate job -- holding their hands, while pushing them along.

LINDY BENTON: The questions that we get most often asked are how much will it cost? How would I set my practice up? Will it change the way I practice?

DR. BOBBY KATZ: I can click and see what they need. This lady needs a refill on sleeping aids. Since I know that they're all here...

That's Dr. Bobby Katz. He runs a busy obstetrics practice in Beverly Hills. Katz chose Sage to take his practice digital. He says computerizing his records has paid off in better medicine. The decision was still daunting, though.

KATZ: You're talking to a doctor who doesn't know anything about this stuff. Fortunately, we have an excellent office manager who did a lot of screening for us.

A small office could spend over a $100,000 in the first five years for hardware, software and IT support. And its critical to get everything you need built into the system from the start.

Sandra Krutell is the manager for Katz's practice.

SANDRA KRUTELL: It can become extremely expensive if there are a lot of add on costs and that, of course, is a pit fall whenever you're dealing with something you're not familiar with; it's not like going and buying furniture.

The systems are complicated. They need to be customized to individual practices. And every new application comes with its own price tag. Kind of like health-care.

In Los Angeles, I'm Caitlan Carroll for Marketplace.

[* EDITOR'S NOTE: After being interviewed for this story, Jonah Frohlich has become the deputy secretary for health information technology for the California Health and Human Services Agency (CHHS).]

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Gencom Northwest is an independent healthcare technology business specializing in electronic medical record (EMR) system installations. EMR software companies call us a third party vendor because the doctors hire us to setup their EMR system instead the software dealer. The doctors then have an unbiased point of contact and purchase software from an informed vantage point. We help doctors discover what technology they need from our data bases. After EMR selection, all the other office operations such as telephones and multimedia are integrated together.

What would help us is to know what kind of opportunities are available to us through this national EMR technology roll out program?
Also, are purchase incentives offered by any government plans opened to healthcare offices? For example, if prospective clients know about a federal program to help finance medical office EMR technology, sales would go up. That leads to more hiring and better economics.

We have been able to put people to work on EMR projects and also hire some for on the job training . The job training is paid and is our way of turning back to the community.

More information on this subject would be appreciated. Best Regards, Eric s. Wilgus Owner

Over 100k for 5 years for a small office. The problem is with over inflated software prices and companies saying "you have to spend the whole 44k with us". Shop around our software for physicians runs around 20k and hardware is not expensive if you know where to look all you need is a server and depending on how advanced you want to get with a tablet pc or just a work station your office should all read have. Its amazing the different perspectives of the same issue. If yuor going to buy from the big boys your going to pay big boy pricing.

Relevant topic even before Pres. Obama's speech. Obviously not enough time to do justice to the history of EMRs. And please use the word "pioneer" a bit more carefully. We've run a paperless "electronic office" for 7 years, but of course we are not in CA, so who cares....

Computer technology for medical records was not "pioneered" in 2003. There have been dozens of companies doing computer technology that I personally know of since 1977. The story above did not show a proper study of the history of computer technology and innovation which has been ongoing for decades. Check me on it as should have been done prior to using the word "pioneer".

The role of the government in promoting the conversion to EHR use should be (1) to set standards that the market can put into play (sort of like establishing the USB standard for computers, so that devices can all write to that standard and therefore interoperate in a plug-and-play fashion), and (2) set up incentives to move from paper to EHR, as well as disincentives to stay behind.

A good example of market forces creating new opportunities in the EHR space is the development of new, alternative business models which allow next-generation web-based fully functional EHRs to be deployed to physicians free of charge to those physicians – use of ads and other alternative revenue sources can accomplish this. Practice Fusion is an example of such a product.

Under the ARRA (the “stimulus bill”), a national Health IT Policy Committee is established, which is developing a policy for the first time ever. It is based on a set of values and goals, and from that the Committee has defined “meaningful use” of EHRs. Certification criteria for EHRs follow from these “meaningful use” definitions. This approach is a welcome relief, and a good example of how government oversight can establish policy that break the logjam that had developed previously in the EHR domain, which resulted in industry self-protection of legacy, closed, very expensive systems (which had been part of the problem).

There is a lot more to this story than is covered here. There are resources emerging called EMR Implementation Specialists. EMRConference.com for instance is putting together conferences all over the country that help doctors facing this shift in the industry with the entire process from understanding the stimulus money, to vendor selection, and most importantly letting them know about these new EMR Implementation Specialists who can take them step by step through the process. These consultants know the truth about a lot of what is going on including that going electronic is not synonymous with cost savings and that many of the concepts being pitched by politicians are not reality. As the president of one the earliest EMR Implementation Specialist firms I was recently featured on NPR member station WFCR along with several of the other key players who are driving this electronic effort.

I'm glad to hear a little data in this story, but the piece it failed to mention is electronic records don't produce a significant cost savings. The Rand study which estimated a $77B/year savings is a 3.3% savings. That's not going to move the needle.


Medical paperless been doing it for 7 years... has never lost any records and the support is top notch fanatical about getting a solution and not pointing fingers.

Finally, a market driven approach to our health care problems. I just hope that the government doesn't get its mitts on this. Not only does government involvement slow things down but they can prematurely hurry things up. In this economy we don't need our medical investments being inefficiently spent.

One can remember the Clinton administration going down the digitization path in their Healthcare plan but all we got was HIPAA, another government regulation that barred the path of progress. I suspect that the digitization you reported doesn't need to follow HIPAA or at least only needs to comply with a HIPAA lite.

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