by Tom aka Rusty Rustbelt
Health Care Thoughts: EMR Cluster Mess
The 2009 stimulus bill kicked off the process to install electronic medical records (EMR) tied into electronic health records (EHR) networks. The stimulus bill included financial rewards for installing systems and meeting “meaningful use”standards.
Couple of problems, with unfair heat aimed at the Centers for Medicare and Medicaid Services.
First, it is difficult to really audit the “meaningful use” standards, even if the auditors were available, so we really don’t know if the stimulus money is being used properly. This was a problem baked into the cake.
Second problem , the physician office systems tend to direct docs through a check-a-box, drop-down-box, and standard language environment. The entered information (in many systems) then interacts with a coding program to send billing codes to the appropriate billing system. Now it seems some physicians using EMRs may be coding higher than physicians who are not. (see NYT archives, 9/24 and 9/25/2012)
Is this higher coding fraud, lack of training, incompetence or could it be the docs were under-documenting and under-coding previously. We won’t know for a while, with billions at risk, and the docs at risk for civil and criminal actions.
Third, THE BIGGEST PROBLEM, EMRs just do not seem to work as neatly as the vendors promise and the bureaucrats imagine. Like many panacea remedies, the implementation is tougher than the dream.
And we haven’t even gotten to ICD-10 implementation yet.
Or the privacy and security nightmares sure to follow.