EHRs Are Coming - Like It or Not

While attending a national conference extolling the benefits of electronic health records (EHRs), I received an e-mail from a South Carolina physician. He shared his recent brush with technology:

"I spent my one day off in the blistering sweat of springtime in Charleston in my 4' x 5' server closet attempting to troubleshoot my server, [which wouldn't] reboot after last night's backup."

So will geeks be the salvation of private practice?

Technology is not a panacea. But many forces coming together will pressure private physicians to join the electronic revolution.

First, state and federal governments facing monstrous budget deficits are waging a fierce battle against rising healthcare costs. They are looking hungrily at physician Medicare and Medicaid reimbursements.

Second, publicity about preventable medical errors continues to hound the healthcare community.

Finally, the number of consumers without health insurance rose to more than 41 million last year, according to the Kaiser Family Foundation, making it increasingly difficult for almost 15 percent of Americans to have a nonemergency room visit with a physician.

These converging trends put physicians on the defensive in Washington.

"Why should we protect you?" politicians ask physicians. "What have you done for us?"

Yes, it's annoying. But government officials are grasping for fiscally neutral solutions to vexing healthcare problems. EHRs are thought to be one solution.

President Bush, one of the loudest advocates for the physician community, is pushing doctors to join the EHR bandwagon.

"We've got 21st-century medical practices, but 19th-century paperwork systems," Bush said at an NIH healthcare forum.

EHR-promoter-in-chief David Brailer, MD, argues that computerization of the nation's health records would save the U.S. approximately $170 billion a year, reducing paper processing costs, unnecessary tests, and approximately 50,000 deaths that occur each year due to medical errors.

Hospitals, insurers, and large physician groups are coming aboard. Small and mid-sized groups are convinced that an EHR may be worthwhile, but overwhelmed by the choices, cost, and implementation.

The e-mail from my physician correspondent explains why. Technology often needs a helping hand, and in a small practice that hand is already too busy.

So Brailer has spent the past year traveling the country meeting with physicians and listening.

He says the private sector needs to provide a seal of approval for EHRs. There must also be technical standards so you know that whatever system you install will be compatible with others. The federal government is handing over the creation of standards to a private contractor. If that issue is resolved, the value of EHRs will become apparent to physicians in private practice, and they too will join up, Brailer believes.

The federal government wants to make practicing without an EHR like owning a restaurant that does not take credit cards: you can serve great meals, but getting paid is almost impossible.

As EHRs become the norm, that will set in motion developments that will restore much of the economic strength and clout that you once possessed. If you install an EHR that you own or control, you will have something you've never had before: hard data about your practice. You could more effectively negotiate contracts with payers and insurers. As another physician wrote us as part of the 2005 Physicians Practice Technology Survey (to be published in September), "With an EHR, we are capturing charges more accurately and have better documentation for appeals." Another writes: "We passed a malpractice audit and even got a percentage off our premiums."

If Brailer and Bush are really serious about EHRs, they'll consider these incentives:

• Offer higher Medicare reimbursement rates for physicians with EHRs;
• Require commercial payers to boost reimbursements based on pay-for-performance tracked with an EHR; and
• Create tax credits especially for small to medium-sized physician offices, to soften the initial costs.

In the end, the politics, the economics, the renewed position of power in the market, and the improved quality of care for your patients all support the same conclusion: EHRs are on their way.

In the meantime, doctors like our friend in South Carolina could use a little help.

This article originally appeared in the July/August 2005 issue of Physicians Practice.