About That Free EMR

It's Coming. No, Really. Eventually. Uh, Maybe. But It's Not Free.

July 21, 2005: The New York Times reports that on August 1, Medicare will offer physicians a "free" electronic medical record. The Department of Health and Human Services (HHS) has created an office-friendly version of VistA, its EMR for the Department of Veterans Affairs. I get a flurry of interested e-mails from physicians, vendors, and other journalists. There is much excitement. I wanted to commandeer a copy and review it for you.

July 28: HHS clarifies that VistA-Office isn't free. Whoops. There will be a $2,700 licensing fee per physician and probably thousands more in implementation costs. HHS also warns that it might miss its August 1 deadline, which has already been pushed back a month from deadlines published earlier on the Center for Medicare and Medicaid Services (CMS) Web site.

August 1: Deadline day. All is silent. No changes or announcements to the CMS Web site or to the media.

August 3: I place a call to the CMS press office and ask for an update on the release date for VistA-Office. The person who answers the phone says, "What's VistA-Office?" then transfers me to someone's voice mail. The spokesman calls back quickly to assure me that it is simply a matter of clearing up some
paperwork; the product should be available anytime now. He urges me to check the Web site daily.

August 8: No news. No product.

August 10: No news. No product.

August 17: No news. No product.

August 22: No news. No product.

September 9: Karen Bell, MD, division director of the Quality Improvement Group at CMS, announces at the Health Information Technology Summit that the product release is "indefinitely delayed." There is still no update to the Web site.

September 19: HHS announces that it is releasing evaluation copies of the software to some vendors. They'll use the feedback to further improve the product. No mention of an actual release date.

Honestly, I commend HHS for trying to provide a less expensive EMR alternative to physicians. I do think EMRs make care more efficient and safer. In the words of my friend Thomas Carson from Md-IT, one can applaud the spirit, if not the execution, of HHS' plan.

But EMRs are never simple - as I think HHS is finding out. If they can't even get the product out of their offices, how can they expect physicians to have the time to get it into theirs?

And a price tag of $2,700 per physician (plus the time it will take to customize the product for each practice type) is hardly a great
bargain. That's lower than the average price of other EMR systems made specifically for outpatient practices - about $5,000 per physician, according to Physicians Practice research - but not so much lower that physicians should necessarily jump at it. Indeed, some very simple commercial EMRs and document management systems are comparable in price.

Oh, and Medicare is also readying its 2006 fee schedule, complete with a 5 percent across-the-board pay cut.

Plus, since VistA-Office was originally constructed for a completely different context, technologists already are warning that physicians adopting the product should brace themselves to hire software coders and consultants to get the software to work in their offices. The whole point of a government-sponsored EMR was to provide a cheap alternative to private
practices, in order to jumpstart the transition from paper. Yet there's no telling what you'll end up paying to customize and implement it.

Fifty-four percent of physicians told the AMA that they will defer the purchase of new information technology if Medicare's 5 percent cut goes through. If Congress and the federal bureaucracy are serious about improving adoption rates, they need to put their money where their mouth is: They need to stop seeing physicians as the villains and understand that healthcare policy over decades has put physicians in a place where technological investment isn't always an option.

What do you think of the government's plan to provide a "cheap" EMR? Write to me at pmoore@physicianspractice.com.

This article originally appeared in the November/December 2005 issue of Physicians Practice.