Electronic-Health-Records
Dan Munro 1/19/2012 @ 11:52PM 

Here’s another one guaranteed to deliver a huge financial windfall, right? In fact, the net effect of EHR implementation in 2012 – and likely through 2015 is more simply to begin the accounting side of care quality (not billing – that’s long been the purview of Practice Management software – already in fairly wide distribution). As long as clinical records are paper-based – we can’t apply analytics at scale for establishing quality metrics – across a nation. Moving to EHR’s will allow analytics on an unprecedented scale – and for that – I’m a huge fan/supporter. In the short term (like the next 3-5 years) we’re really just starting to make that technology investment. In the short term, the loss of productivity to small practices (where a large % of healthcare is delivered) as they move from paper to electronic is a really big hit. Really. Big. Hit. This isn’t a simple case of moving from paper and pen to word processing. These electronic systems affect the entire provider-patient workflow. Ask any doctor or practice that has implemented an EHR system. The first year costs relative to lost productivity eclipse the software/hardware costs by a really wide margin. Secondly, the cost savings everyone highlights (duplication of lab tests and related procedures) is absolutely a worthwhile goal of moving to EHR’s, but that can only happen when the health records are mobile and interoperable. Is there any precedent for this on a National Scale – in 5, 10, 20 years? At this very first stage of implementation (and through 2015) these EHR’s are not necessarily connected or automatically part of any larger network (local, regional or national). No real gains here – for several (if not many) years. Do we need to do this. Yes. Are we hitting NHE yet? Not so much.

When you sum all this – our current healthcare system at a glance looks like this:

So, while I am in fact rooting for all of these efforts to succeed wildly, I’m just not seeing how they can deliver the really massive savings – you know – like ever. In hindsight, it’s easy to see why. Obamacare is the sausage we got through the legislative grinder – but its legislation around the edges. It’s not the real legislation. It’s Legislation Crudités. As I’ve argued before, we have two major weapons in our battle of the healthcare bulge. Legislation and innovation – and we need a 1,000 cc’s of both – mainlined to the heart of some really big, systemic problems – STAT! We have not fundamentally changed the really big elephant in the room.