Thursday, January 13, 2011

The Electronic Health Record: Better Process, Still Need Outcomes

If you are like the non-techie Disease Management Care Blog and only distantly aware of electronic health record (EHR) market trends, you are not alone. It too is unable to distinguish between "XML" and "ONC," and thinks "meaningful use" describes how the DMCB spouse gauges her husband's assigned chore output. That's why it was worthwhile checking out David Kibbe's and Brian Klepper's readable Health Affairs Blog posting "Unfreezing The Health IT Market." While it's unnecessarily fawning over the Obama Administration's enlightened HIT wisdom, it also renders a handy summary of some 2011 trends that us EHR newbies may only be vaguely aware of:

Cheaper and Better: Increased processing power, lower unit costs, more vendors and greater competition have pushed that oft-quoted $50,000 per physician price tag down to a "$150 to $400 per physician per month" price range - free if the doc and nurses are willing to put up with ads. This year may be the EHR adoption turning point.

Modular Plug n' Play: In lieu of Extormity monster-like EHR systems, buyers can tiptoe into limited solutions that handle a single function, like electronic prescribing or quality reporting. This not only "breaks the ice" for skeptical docs, but helps fulfill those remunerative meaningful use criteria. Another reason why this may be the turning point.

Universal Language: While there are many reasons why different EHRs from different clinics and hospitals won't speak to each other, different data formats won't be one of them. It's called "XML." This will be an important issue for Accountable Care Organizations.

Mobile Devices: Unhip desk tops and cables are being replaced by app-festooned iPads with wireless connectivity. This coolness factor may also help spur greater EHR adoption

Clouds: Personal health information is moving from local mainframe storage to remote networks made up of remote servers. While not specifically mentioned in the blog posting, it makes the DMCB wonder about the implications for registries (make it make it easier to assemble the information?) and the personal health record (who is responsible for aggregating and organizing all those CAT scan results, labs and op reports?).

Enlightened Government: While many may doubt the Obama Administration's dedication to free markets, it appears a more level and transparent EHR playing field has led to genuine competition.

All well and good, says the DMCB, but it's still waiting for conclusive, lasting, generalizable evidence that the processes described above lead to meaningfully better and statistically significant improvements in clinical outcomes at lower cost with a better patient experience.

Maybe that'll be something the DMCB can report on in 2012. We'll see.


Anonymous said...

I have to wonder who will be allowed to buy those ads. It seems that every time someone from the drug/food/device/etc. industry so much as looks at a physician a bit too intently, the whistle-blowers and watchdogs start screaming "conflict of interest" (sometimes rightly, sometimes wrongly).

Can you imagine the pandemonium that would result if doctors' EMRs were effectively subsidized by these same groups in the form of ad purchasing? Or do you think that this level of support would be palatable to most?

Anonymous said...

Please show where you got the EMR graphic?

Thanks for the info though, I'm not surprised.

Dr Matt Levin
Solo FP using an EMR for "meaningful usefullness" since 1997

Jaan Sidorov said...