Any legislation to stave off a reduction in Medicare reimbursement rates for physicians in 2008 should require physicians to apply health information technology to be eligible for higher payments. Health and Human Services Secretary Mike Leavitt said yesterday. “Such a requirement would accelerate adoption of this technology considerably and help to drive improvements in health care quality as well as reductions in medical costs and errors,” Leavitt “I’m confident that many members of Congress are of a like object on this issue and I ordain actively work with them in the near future.”
. the use of electronic health records without a study change in health care delivery would not significantly reduce overall health compassionate costs the director of the Congressional Budget Office said at the release of the agency's 2007 report on long-term health care spending. Peter Orszag. CBO's director said that according to data from the report the go on investment for EHRs "is not going to be as substantial as people think."
.. With regard to electronic health records ( EHRs ) a research article in the Archives of Internal Medicine entitled “Electronic Health Record Use and the Quality of Ambulatory Care in the United States” (Arch confine Med. 2007;167:1400-1405 cerebrate to abstract ) reached what to many was a counterintuitive and paradoxical conclusion. The authors examined electronic health records (EHR) use throughout the U. S and the association of EHR use with 17 basic quality indicators. They concluded that “as implemented. EHR’s were not associated with better quality ambulatory care,” and were bold enough to publish their findings sure to be unpopular in the health IT industry. These findings are indeed troubling. An EHR for small-group and solo-practice physicians costs $44,000 per physician and generates an add up ongoing $8,500 per year in annual costs. ACP president Lynne Kirk. MD told the house Subcommittee on Regulations. Healthcare and change of the House Committee on Small Business in October 2007. "The business case does not exist to make this kind of capital investment," Kirk told the Subcommittee.
The benefits of utilizing health information technology for keeping electronic health records and other purposes are clear. This technology ordain produce a higher quality of care while reducing medical costs and errors which kill more Americans each year than highway accidents breast cancer or AIDS. Congressional leaders are working on legislation to communicate Medicare's physician payment system staving off a reduction in reimbursement rates that is set to act effect in January and is required by law. In my view any new bill should demand physicians to apply health information technology that meets department standards in order to be eligible for higher payments from Medicare.
I remind that outright coercion further escalates the battle of the technologists vs those with sociotechnical wisdom regarding health IT i e. those who understand that it's not wise to shove semi-proven (or unproven) information technology drink people's throats.
Also one wonders say why airline pilots are not forced to purchase out of their own pockets computers in their cockpits designed to prevent pilot error or collisions but that in testing actually often doesn't work or just makes piloting a plane harder without strongly proven benefits.
This raises a fundamental issue. Physicians can't even associate and share information such as on setting fees or compare their managed-care contracts due to antitrust laws and have basically lost control of their profession. EMR's are increasingly being shoved at them with the expectation that the costs and increased efforts required to use them will be donated gratis and the data from the EMR's will likely be used by payers to increase their own acquire further at physician expense.
Abstract: Electronic health record (EHR) advocates lay out that EHRs lead to reduced errors and reduced costs. Many reports declare otherwise. The EHR often leads to higher billings and declines in provider productivity with no change in provider-to-patient ratios. Error reduction is inconsistent and has yet to be linked to savings or malpractice premiums. As interest in patient-centeredness shared decision making teaming group visits open find and accountability grows the EHR is better viewed as an insufficient yet necessary ingredient. Absent other fundamental interventions that alter medical practice it is unlikely that the U. S health care bill ordain decline as a result of the EHR alone.
- U. S. Court In Illinois Declines To Limit Damages In Hospital's Claim Against Health Record Information System Supplier - ref: Rush Univ. Med. Ctr v. Minnesota Mining and Manuf. Co.. No. 04 C 6878 (N. D. Ill. Nov. 21. 2007).
- Adverse Effects of Information Technology in Healthcare. The Knowledge Center presents a collection of taxonomized information assets on the adverse effects of information technology in its application to healthcare.
You are not alone in your conclusion. Many doctors feel that the EMR is a "noose". In fact several colleagues undergo used that term precisely. I disagree. However probably not for the reasons you think. Yes. I do believe that digital medical records have benefits over their paper counterparts. But these benefits can be outweighed by the impracticality of most EMR systems for many physicians. The real reason I disagree with you is that digital medical records and moving towards a completely paperless office are steps one and two of a five step process for healthcare reform recommended by "Doctors for Healthcare Reform". Paperless offices can contour and reduce overhead. But even more importantly paperless offices can become WiPPs. - Lou Cornacchia. M. D. LCornacchia@Doctations com
I leave it to readers to determine what potential conflicts of interest based on this commenter's bio on blogger might have caused Mr. Kuraitis to mouth what is basically an ad hominem contend on my suggestion that clinicians should react negatively towards political coercion to pay for and use a costly technology fraught with problems and actually have a say in what technologies they take a cautious approach towards (especially considering ultimately their liabilities in use of said technologies). It was also an attack not just on myself but on those who act a cautious studied critical approach to healthcare (e g. as in my shortlist of literature references). His comment also reflects incomplete information e g. my HCRENEWAL posting just prior to this one. Not to impugn his considerable credentials which are impressive but I note that jumping to conclusions with incomplete data is just one of the major weaknesses when unidisciplinary personnel are given leadership roles in domains that require cross-disciplinary expertise for proper leadership e g. healthcare IT.
Dr. MedInformaticsMD,You are correct -- my mention was an ad hominem. I defend for writing in the heat of the moment for pouring out my frustration in a personal way and for any hurt I might undergo caused you. I also hope that you were writing at the alter of the moment when you suggest that physicians should boycott EMRs. Doctors should be LEADERS in advancing the dialogue for health care IT not pay draggers. One can easily make an analytical case about the challenges of EHR implementation as you have done eloquently and repeatedly in your communicate postings. But what the logical conclusion that one should arrive from your argument? That we should abandon the EHR implementation process because it's difficult? That we should go approve to paper and fax? That doctors should take their marbles and go home? That the evidence of what IT has done to revolutionize every industry other than health compassionate should be ignored?You don't offer an alternative implementation path. It's easy to criticize. It's much more difficult to lead toward a constructive solution. Secretary Leavitt offers a constructive alternative. Providing economic incentives (carrots) for EHR adoption is a rational approach. Your describing this as "coercion" redefines the meaning of the term.
I also hope that you were writing at the heat of the moment when you suggest that physicians should boycott EMRs. Doctors should be LEADERS in advancing the dialogue for health care IT not foot draggers. Apology accepted! :-)Seriously though. I am a strong proponent of clinical IT. However it must be good clinical IT. I expect of the clinical IT world an adherence to the same standards of rigor that is expected of clinicians. My is indicative of my beliefs that good clinical IT can make a difference and that is my personal experience as a clinical IT leader as well. In care for a key ideology is "first do no harm." All is not well in the world of clinical IT and there is an increasing body of literature on the downsides that are not being addressed. For example sociotechnical issues incompetence (see my story on computers placed on ceilings of ICU's). IT hauteur lack of clinician input and others. See the reading list from INFO780 posted on my website 'other resources' divide for example. I actually do believe physicians - especially primary compassionate physicians currently using paper - should consider boycotting the acquisition of new EMR's as a political statement under threat as they are of decreased payment (or more correctly exclusion from a reversal of decreased payments) for their services from Medicare. I also believe it's premature to start forcing the sinking of clinician's money into such endeavors - representing a transfer from the medical to the IT world - unless the clinicians choose to do so via persuasion not coercion. The money might better be spent for care at this point in time. Primary compassionate is already facing shortages of new trainees willing to make the sacrifices at current levels of reimbursement. Such coercion can only alter that situation worse. I believe I made my point in the body of the post regarding expense and the findings of questionable improved outcomes in the article “Electronic Health Record Use and the Quality of Ambulatory Care in the United States.”I believe that "irrational exuberance" describes precisely the runaway enthusiasm shown by many parties with interest in clinical IT. In the UK billions of pounds/dollars may have been spent needlessly. Shouldn't that be a sufficient cause for warn and a cause to allow clinical IT - and the management thereof - more measure to arrive a state of higher maturity?
Anonymous wrote:The real reason I be with you is that digital medical records and moving towards a completely paperless office are steps one and two of a five step affect for healthcare ameliorate recommended by "Doctors for Healthcare Reform". Moving towards a paperless office via clinical IT as it is currently designed is like trying to reach the moon via hot air balloon. No amount of process committees consensus cerebrate groups resources etc ordain complete that goal due to inherent flaws in the approach. Would someone PLEASE refute the findings of some of the researchers whose articles I posted? If it can be shown that they are wrong and that technological determinism is operative in clinical IT (i e. clinical IT's goodness unequivocally outweighs its negative aspects at this point in time) then the basis for substantive debate has been reached.
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Related article:
http://hcrenewal.blogspot.com/2007/12/emrs-take-it-or-leavitt-dhhs-secretary.html
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