by Tom aka Rusty
The Obama administration has made a major commitment to the installation and use of electronics in U.S. medical records.
Obama sees electronic medical records (EMRs) linked into electronic health record (EHRs) networks as a major factor in controlling costs and improving quality in the U.S. health care system.
The administration put money behind the thinking, ARRA ’09 (commonly known as the stimulus act) includes significant funds for physician groups and hospitals to purchase and implement EMRs in the next several years. There are penalties for providers not on board within five (5) years.
In order to qualify providers have to buy “certified” systems and engage in “meaningful use” of those systems. (Most providers will select the Medicare track, others (pediatricians) will select the Medicaid option).
And therein lies a huge problem.
The statute directed the various bureaucracies to write implementing regulations for the certification and meaningful use of EMRs and EHRs. The recently published draft regulations are (not surprisingly) long and wildly complex. Make that very long and very wildly complex.
I have been asked by a major health care association to prepare a monograph as a guide for physician groups working to meet these standards, so have been wading through nearly a thousand pages of new regulatory matter.
Keep in mind we currently have a plethora of medical record systems ranging from purely handwritten to dictated and transcribed to partial EMRs to full blown EMRs.
My preliminary conclusion:
1) many physician practices, especially those with 5 physicians or less, will not be able to comply
2) those practices able to comply will probably not get a positive return on investment (ROI) even with federal funds (practice disruption, training time, system support, etc. are all expensive)
3) some hospitals will be able to fully comply, some partially, some will struggle
(Conspiracy theorists may conclude the Obama administration is trying to drive physicians into larger groups, hospital based MSOs and/or Integrated delivery systems.)
My overall conclusion, the program is so complex and the requirements so complicated the overall objectives of the program will not be achieved. Many billions will be spent for some progress, but not the progress desired by the administration.
For further reading:
Medicare and Medicaid Programs; Electronic Health Record Incentive Program
Federal Register, Vol. 75, No. 8, January 13, 2010, pps. 1844 – 2010
(impacting 45 CFR Parts 412, 413, 422 and 495)
Health Information Technology: Initial Set of Standards, Implementation Criteria Specifications, and Certification Criteria for Electronic Health Records Technology Federal Register, V. 75, No. 8, January 13, 2010, pps. 2014 – 2047
(impacting 45 CFR Part 170)
Proposed Establishment of Certification Program for Health Information
Technology, Federal Register V. 75, No. 46, March 20, 2010, pps. 11,328 – 11,373 (impacting 45 CFR Part 170)