Response To Medicare On Succesful EMR Adoption: NOT A Price Issue

There’s a fascinating article on the EMR and HIPAA blog that I couldn’t pass up.

It addresses one governmental (i.e. Medicare) solution to the traditionally low adoption rates of physicians of EMR’s: lower the upfront costs to essentially zero with the VistA system built by the Veterans Administration.

The clincher for me was the following observation:

While Medicare’s plan is to offer the software for free, one must ask what free is. Currently, free is software but not training, installation, and ongoing support.

My commented response, heavily informed by the collective wisdom garnered from the recent NextGen Users Group Meeting, is reproduced below:

Interesting development.

The issue with support and adoption rates are key, and intertwined.

If you want an EMR to do several, fairly high-level tasks, it is going to be a relatively complex beast, and you will HAVE to have IT/customer support. That’s as much a given as water being wet.

At a minimum, an EMR will need a database to organize patient data, and enable data actions like checking to see how certain populations are doing by certain criteria, for just one example of tons (the exception being a word processor, which is not what I’d consider an EMR). Most docs want it to also do prescriptions, which means a fax or electronic prescribing capacity, another drug database (constantly updated), ideally with formulary checking, and interactions alerts.

EMR’s should, in my opinion, enable phone messaging and intra-office tasking, notifications of when patients are due or overdue for key health maintenance tasks, forward looking reminders on past tasks not yet confirmed to be done, remote log-on/work from home capability, airtight data backup, and incorporation of paper info (old chart and new notes from outside).

ANY of these tasks will require tech support. ANY combination of these, to function smoothly…it’s mind boggling to think it even possible to work smoothly without tech support and maintenance — which the physicians cannot possibly do on their own, unless they become full time IT folks, at which point they’re not practicing medicine anymore.

The answer to adopting an EMR isn’t to make it cheaper.

The key is educating physicians and their offices: this can absolutely be done, but it WILL be the toughest transition a practicing doctor will ever make. It is NOT about a training session or two to get acquainted with a fancier word processing program, tied to a snazzier billing software for the front desk.

In tech terms, EMR is not a “kludge”; it is a fundamentally different way of doing what a doctor used to do, that will enable doing 10 times more eye-popping and productivity enhancing and patient safety increasing activities than ever before.

A vague sense of it being an new wrinkle on an old way of documenting…will result in the emotional equivalent of walking into a harvesting machine. An hour or two with the manual — like what you might do with a new word processing program — is nowhere near enough. 10-12 physician training sessions, about an hour each, of progressively more challenging practice cases, is more like it.

Until doctors and their offices realize this isn’t a step up from a Ford Focus to a Mercedes, it’s a leap up from driving a car to flying a jet, successful adoption rates will remain low. And price of the product will have very little to do with it.

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