Give me one good reason why all doctors, medical groups, and all health care providers have to have unique systems.
They don't "have" to have. They "prefer" to have. That's one good reason.
Maybe government should waltz into your business and say, "Hey, from now on, you will use Peachtree, NOT Quickbooks, to do your accounting."
Or, maybe government should come in and say, "We don't like you driving a Ford. From now on, you will drive a Chevrolet if you the cost of operating the vehicle to be tax deductible".
Or, maybe government should come in and say, "We think your medical office is less efficient because it is not located next door to the hospital. Effective next month, your office space will be adjacent to the hospital or you will not receive money under any federally-sponsored plan".
You get the idea.
Why couldn't thay all sign on to the Internet and get a system that provided everything from making an appointment, to record the visit, the diagnoses, prescriptions, billing,etc?.
We have standards for submitting claims (ANSI 835), standards for receiving remittance advices (ANSI 837), standards for verification of patient eligibility (ANSI 270), for claim status (ANSI 276), for transferring data to and from electronic medical records systems (HL7) and for certification of EMR systems (CCHIT). We don't need government deciding which systems providers are required to use.
There is a reason the adoption of EMR has proceeded slowly. If physicians offices, for example, could realize all this efficiency that Obama is claiming will be there, don't you think they would have adopted these technologies YEARS ago? Of course they would. There are benefits, but the costs are huge. And practically EVERY installation has to have ADDITIONAL staff (not fewer) to manage the process.
The reality is that EMR implementation is complex and disruptive and radically alters the way a provider's offices work. From the ground up.
Many providers -- I estimate 15% -- will choose to retire prematurely over adding EMR, which will lead to an immediate shortage of health care providers. The financial incentives are helpful but don't begin to cover the cost in many practices. And "complete" health records are, by necessity, years away. There are small providers - e.g., some chiros, ODs, PTs, certain other specialties, which will NEVER be able to justify making that move.
So, you're going to force it down their throats? I don't think you want to do this when we're already facing a shortage of people entering these professions because they don't want to be controlled by the government...
When Obama says, "Oh, we're going to save billions with this added efficiency", it is a damned lie.
Here's an example. The HCFA1500 (now CMS 1500) claim form that has been in use for years has 33 fields or "boxes" for information. This is adequate to get a claim paid through any insurance company's system.
Yet, the ANSI 835 format, the electronic format for claims, has thousands of fields. Anytime you submit a name and address, you have to submit an "entity type" to explain what kind of name/address that is. If you submit a "name" you have to submit an "ID Code Qualifier" that explains what kind of name it is.
Now, I've been in the software business since the 70s and the medical software business since the early 90s. So, I think computers are a good thing. They will provide more data, better data, more consistent data, but in the end, it is unclear to me whether EMR systems improve the efficiency of a medical facility.
When I discussed this with a client of mine who spent $500,000 on new systems a few years ago, her remark to me was along these lines -- "Oh, we could never go back. It is fantastic". I say, "Well that's great to hear. What's your favorite benefit from your $500,000 EMR system"? She says, "Oh, the biggest thing is we don't lose time looking for lost charts anymore".
I'm sorry, I'm not sure that's worth $500K. One day, EMR will be great for everyone. I'm just not sure you can push it out much faster than it is already being deployed with good results. |
