Health Care Thoughts: EMR Cluster Mess
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.
http://www.nytimes.com/2012/11/29/business/medicare-is-faulted-in-electronic-medical-records-conversion.html?hp&pagewanted=print
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.
On an anecdotal level, a physician I know ended up having to let their billing person go after EMR. She believes this older billing person was improperly coding things they should have had higher reimbursements for and the billing person was training the other, newer, billing person the same way; even though that billing person was objecting that older person’s way of doing things differed from what she learned in her classes (this practice had two billing people, at the time of hire it wasn’t intended that the older person would have to be let go).
It may be that EMR is forcing older billing people, who learned their job back when reimbursements weren’t changing so rapidly and so don’t keep up with current practice, with newer billing people who do a better job keeping up with changes to billing practices in insurance companies. Different things are likely happening at different practices, but given the age of many office staff this is probably one of the more consistently widespread trends.
I also think it was a big mistake more standardization wasn’t imposed on EMRs. I haven’t heard of many doctors using the system to communicate with each other, and few have any idea how to do so. Many have also opted for the cheapest vendor they can find; they have an attitude that standards are likely to change so don’t want to invest in better software that may become obsolete in the near term. Without fairly standard platforms to train people on and for information to be shared with it will be hard to realize many of the gains that proponents had hoped for.
If insurers make requirements so complicated that it becomes impossible for doctors to be paid without computerized help, would that be called Meaningful Use?
Darrell:
For a couple of decades physicians have used “practice management computer systems” to deal with appointments and super-complex billing.
The meaningful use only applies to the EMR, whether separate from or integrated into the billing system.
So we have taken a complex system and layered another compplex system on top.