Friday, January 26, 2007

The Electronic Medical Records Grant Initiative

Governor Doyle is pushing for the creation of $30 million in grants to increase the use of electronic medical records (EMRs) at medical providers who do business with the state.

The biggest promise of EMRs is that they help reduce medical errors and increase administrative efficiency in the long run.

Rep. Leah Vukmir -- who chairs the Assembly Committee on Health and Health Care Reform -- supports the move, which is a big sign that it could become a reality in the upcoming budget.

There are, however, some noted issues with EMRs that deserve some attention before moving forward with the proposed grant initiative.

First is the issue of cost, particularly for smaller firms. A study in the most recent issue of Health Affairs demonstrated that community health clinics -- which provide service to low income people who are often on Medicaid -- can experience some notable quality improvement from the implementation of EMRs; however, in financial terms, five out of the six clinics studied lost money on the investment.

Hopefully the grant money helps with this, and hopefully it helps the right providers with implementation -- that is, the ones who truly can't afford it and not the ones who are large enough to not really need the assistance.

A second issue is a little more concerning, although less defined, than the first. According to a recent op-ed by Dr. Michael Wilkes, a professor of medicine at the University of California - Davis, EMRs can have "a potential for electronic forgery and dishonesty that allows for increased billing, and quick note production, but may do nothing to improve patient care. In fact, it may hinder care and could lead to major problems."

Strong words, but if what he lays out in his column is the reality for EMRs, then it's deserving.

According to Wilkes, with at least some EMRs, doctors merely enter a standard electronic template into a patient's record when they come into the office. This template, which is linked to the general type of ailment the patient has, then automatically enters into the record everything a doctor would do during an exam of that kind.

The problem is, Wilkes notes, "by inserting such a note in the EMR, a reader like me assumes that all these pieces of the exam were actually done (an exam of the neurological system, a full skin exam, asking about drug use, etc.). In fact, they were not done. Nor should they have been done for a person who came to the doctor for a twisted knee."

This is just a single op-ed on the topic, which shouldn't lead anyone to think this is the way all EMRs work or need to work. But it is concerning, and any state grants for EMRs should include a thorough review of exactly how the EMRs being purchased work.

While EMRs will surely reduce medical error and improve administrative efficiency over time, electronic recording shouldn't mean automated exams, nor should they open the door for providers -- who just may feel cheated by low Medicaid reimbursement rates -- to bill for what was never done.

6 Comments:

Blogger Dad29 said...

It also helps to have honest doctors, no?

If you grant ad arguendam that 5% of docs are bad guys (using that number because it seems to be true across societal groups), then 95% of them are honest.

So 'exception-item' audits should be maintained (or implemented)--but by and large, the technology will be used properly.

January 26, 2007  
Blogger Ken Farbstein said...

Seth--Re your 2nd issue,that EMRs could open the door for forgery and dishonesty that allows for increased billing, and quick note production--Yes, every technological improvement can itself make certain errors more likely. See a case in point in this example of poor care in hospitals.

April 06, 2007  
Blogger Seth Zlotocha said...

Thanks for your comment, Ken, and the link. Your example also seems to suggest, as much as anything, that even with technology present, there is still room for human error. And arguably more room, in some cases, since people may not be as careful with technology, thinking the job is being done for them. Less involvement can equal less focus.

April 07, 2007  
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April 27, 2010  
Anonymous electronic medical records said...

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January 26, 2011  

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