Electronic health records aren't cutting costs so far

A nurse files patient records. The clunky programs, high costs and incompatible systems in electronic records are factors in failure to save billions.

You know that phrase ‘too good to be true’? Hello medical health records!

Back in 2005, the RAND Corporation said electronic medal health records could save $81 billion a year. And lots of people bought it -- these things would revolutionize the industry.

Well RAND has a new report, and guess what? The potential of electronic records hasn’t been realized -- not even close.

If you are a doctor, it’s pretty easy to understand why electronic health records fall short.

“I often describe it as cutting edge 1995 technology,” says Ashish Ja, an internist and health policy professor at Harvard. “A lot of these electronic records are cumbersome. I’m confident a lot of them are still written in DOS. It’s terrible.”

Not only that, but often one hospital’s system can’t sync with another’s.

To many in the industry, this is no surprise. Dr. Arthur Kellermann -- one of the authors of the RAND study -- says many of these medical health record programs were designed to reflect the old values of our health care system, like billing.

Fast financial processing. Accurate documentation of what was done for billing and coding purposes, because that’s where dollars flow in American medicine,” says Kellermann.

Kellermann says here’s the real danger: As a doc, it’s hard to invest time and money -- about $50,000 to $100,000 -- in a health record system that might not be a permanent solution. So he says lots of providers are sitting on the fence.

That, Kellermann says, just perpetuates the inefficiencies that plague the industry.

“We have a health care system that the Institute of Medicine estimates is wasting $750 billion a year,” he says. "Our country can’t afford $750 billion for stuff that doesn’t make you feel better or get better.

The antidote: Entrepreneurs.

Kellermann says it’s just a matter of time before the right person designs something intuitive and easy that turns the health industry on its head. He’s hoping that someone comes along pretty soon.

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.
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The biggest cost savings from electronic health records comes from saved money from transcription services and the saved space required to store paper based medical records. The savings may not provide enough return on investment for small to medium practices when only considering these two factors. The real benefit is from interoperable electronic health records that allow physician referrals, e-prescriptions and connection to personal health records, and patient portals. Once there are clear standards for EHR Interoperability, this will in fact boost EMR savings.
Rosy Cruz

Voice to text has also changed medical records quite a bit, no longer are medical transcriptionists needed like they once were, but rather editors who piece together the story. There needs to be offline backup of records in case of downtime with computers.

As a medical transcriptionist 23 years I can attest to the money spent in electronic records, and their accompanying entourage. The downside of having compatible records from hospital to hospital is that they will be easier to hack. However, so far no law has told the hospitals and doctors offices they all have to use the same program or system. That would be a monopoly. I had a friend who got his CAT scans put on disc and transported them himself from hospital to hospital, but the records were not compatible, hence, waste of time/money.

Just to add a couple of data points ...
My Optometrist has made the extensive effort to go with an electronic records system. I HAVE noticed that the tech spends a great deal of time during my visit entering data into her computer. Probably 2/3 of the time her attention is on the computer and I'll have to admit that at first it made me feel a little "under attended". On the flip side though, when the doctor comes in to see me, I make a point of asking how my current IO pressures and other tests compare with previous readings and with a press of a few keys we can both see graphs of exactly how things are progressing or see side by side comparisons of scans and field of view tests.

Having all of my data right there in front of me has made it really easy for me to take an active part in monitoring my situation and the Doctor is always quite enthusiastic about looking over the data and explaining it to me. I think it's probably human nature that my showing of interest in my own health care may actually encourage him to take a little more interest.

One other data point - Another specialist I have seen is also undergoing the upgrade to E Records and the result that is noticeable to me is that they gave me a link to a secure web site where I was able to fill out all of that paper work they usually hand you before a visit.
I find this to be a HUGE leap forward in healthcare!

For one thing, I am at home where I have access to a lot of the medical history and medication info they ask for. For another, when I go in for an appointment now the staff is not tied up having to process and file all of that paper work. A quick check of my I.D. and then they pull up my info on the computer, see that I have updated it and then we all move on to other things.

I CAN appreciate what a work-load nightmare it must be to switch such a data intense business over to an "Electronic records" system like this, especially if the software system you have chosen is just plain bad. Growing pains would HAVE to be expected. I have already seen the improvement in patient experience though and I think it would be naive to have expected mass cost savings so soon in such an enormous undertaking.
I'd say we are just 5 minutes into the first quarter of this game and that is far to soon to be throwing one's hands into the air in despair and surrender.

Coy: I am curious as to whether you are a health care provider, an administrator/finance person in the medical field, or IT. I appreciate your comments: however, as a physician who has experience with at least a half-dozen different EHR's, I can attest that: physicians do not like them (especially older physicians who had good documentation in place before the advent of EHR's) and most feel that they are inefficient, add time to the patient encounter, detract from interaction from the patient, and do not always show clearly what the physician's thought processes were. It is way too easy for some to "tick off" the review of systems thus rendering it pretty meaningless information. Currently I am working with the DOD's system (AHLTA) in a family practice clinic. It does not "talk" to the system the DOD purchased for the ER records OR the inpatient records (unlike the VA's system, CPRS, which does both). Therefore, my techs have to print out ER records or discharge records with each patient,---so much for paperless! None of my comments even begin to address the cost issues which, frankly, have scared away a lot of potential users. Pam Cobb, MD UAMS '78 Columbus, Ohio

EMR is a complex and difficult proposition but will be worth it in the end.

Providers have a lot to lose. Doctors, Chiropractors, Nurse Practitioners, Physical Therapist and others, are faced with a market in tumult. They are trained in healthcare, not technology and the issues are complex. Marketing departments present products that have a lot to offer but may well make claims that are just hopeful or at worst dubious. Providers are vulnerable and have a lot of responsibility. They can lose lots of money, even their practice, if they make a wrong decision -- or they could lose a patient.

For EMR product vendors this is a hurricane. The various federal certification programs are new and still settling down. Tablet computers are new and wonderful. They are the obvious preference as a platform for medical encounters but they are still rapidly evolving and are a moving target for implementation. Existing systems are being converted but conversion doesn't yield a product with the same facility that redevelopment will deliver. Conversion and redevelopment both demand financial depth. Small companies don't have that depth and in the recent economy finance sources can drive a hard bargain. Several major EMR vendors have been sold in the last few months and support for MyWay, one of the oldest and most widely used EMR systems, will end soon.

EMR is an inherently complex and difficult proposition. It has many stake holders and many different kinds of users interacting with the system. Security is important and complex. Accuracy and completeness are really important. The ability of humans to interact with the system smoothly and without much training is very important.

Providers, nurses, patients, and administrators all have different needs and expectations. Providers are trained in lots of different places, each with different values and differently nuanced procedures. Each practitioner is a individual with preferences of how to interact with patients and how to record those interactions. Nurses serve both providers and patients and place many different demands on an EMR system. Patients have widely varying levels of motivation, knowledge, and skill and need to be flexibly accommodated. The many different kinds of administrators have different needs and expectations. Some need to drill into the details and some need accurate and reliable statistics. All are vital. Everybody needs to be served.

EMR still holds great promise and is worth the huge investment of time, energy, and money that it will require. It will cost much more than we thought. May of those involved will spend many late nights. EMR will not cure all the ills of our healthcare delivery system but it will help provide better medical care, make better data available, involve patients in their treatment, and it will -- eventually -- ease the task of administrating medical offices and hospitals.

The electronic health record has other costs: it slows down medical care personnel who try to make their notations at the time of patient visits. Other personnel see the patients and try to make their notations after everyone has gone home, which leads to mistakes in recall and personnel burnout. The legibility of the EHR is great compared to handwritten but doesn't counterbalance the new issues. And few EHR's are really ready to hit the ground running: they only spawn a population of IT specialists who MIGHT fix the bugs.

It should be remembered that one persons waste is another persons income. This can make the motivation of those on the receiving end of the $750 billion in wasteful spending somewhat low.

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