Since the passage of the Health Information Technology for Economic and Clinical Health
Act in 2009, doctors and medical practices treating Medicare and Medicaid patients have been under orders by the federal government to implement electronic health records (EHRs).
Those failing to use EHRs risk having their reimbursement rates reduced.
The Centers for Disease Control indicates some 78 percent of office-based physicians were using some version of an electronic records system in 2013, with 48 percent of physicians using systems that qualified as “basic” EHR systems. In 2001, 18 percent of physicians were using an EHR system.
Although more practices are adopting electronic systems in response to federal incentives, many doctors are dissatisfied with EHRs. They say EHRs are an increased administrative burden and force doctors to spend additional time away from patients.
A recent survey from AmericanEHR Partners, conducted on behalf of the American Medical Association (AMA), found just 34 percent of physicians were satisfied with their EHR system.
Another concern is the expense. An August 2015 report from the American Action Forum says installing an EHR system can cost an individual physician more than $160,000.
EHR adoption has been met with differing levels of support, says John Goodman, a senior fellow at the Independent Institute and president of the Goodman Institute for Public Policy Research.
“Every successful electronics system is a system that is voluntarily adopted by the user because it’s meeting real needs,” said Goodman. “All the unsuccessful systems are systems that we’re trying to force on providers from the top down.”
Goodman cites the United Kingdom’s experience with electronic health records as an example of a failed top-down approach. The British government spent $20 billion on its poorly implemented electronic records initiative that it eventually scrapped.
‘Meaningful Use’ Requirement
The Centers for Medicare and Medicaid Services requires practices to show “meaningful use” of certified EHR systems in order to receive financial incentives.
For example, in Stage 1, 50 percent of patients must have the ability to view their data, download it in both human and machine readable formats, and electronically transmit their data. In Stage 2, 5 percent of all patients must view, download, or transmit their data within the given reporting period.
Some practices are struggling to meet these requirements. EHR proponents envision these portals will allow patients to have access to lab results, medical records, will allow messaging between doctors and patients, telemedicine, e-visits, and remote monitoring.
Those technologies are beginning to be adopted, but government policies are impeding the process.
Health care start-up Teledoc connects patients with doctors over the phone, but Goodman says the technology is limited because Medicare doesn’t cover telemedicine services.
“Medicare won’t pay for doctors at the Mayo Clinic to get on Skype and treat stroke patients at a rural hospital,” Goodman said. “And not only will they not pay, the AMA feels that [telemedicine] is improper medicine. Medicare will not pay for telephone consultations. It will not pay for Uber-type house calls.
“So all the new technology that’s coming online that makes health care more convenient, more efficient, and less costly, because it involves new technology, Medicare isn’t paying for it,” Goodman said. “If Medicare did pay for such services, then the electronic medical record would become far more important.”
Security Concerns Abound
Digitizing health records can offer benefits, but patients who have been the victims of security breaches may not have such a favorable outlook.
A report from Tara O’Neill, an analyst at the American Action Forum, highlights the large number of security breaches that have taken place within the health care industry in recent years. O’Neill found 135 million health care records have been compromised since October 2009 in more than 1,200 data breaches, which have cost an estimated $50.6 billion.
O’Neill says her report’s figures were current through June 26, 2015, and another trip to the Health and Human Services website shows the public remains vulnerable. Since that time, O’Neill says an additional 8.5 million people have been the victims of security breaches.
“That comes at a cost of almost $4 billion,” O’Neill said.
Americans may not realize the extent to which their records have been compromised, says O’Neill.
“The total for 2015 is 102 million people, which is roughly one-third of the U.S. population,” O’Neill said. “And looking at the numbers since 2009, about 45 percent of the population has been the victim of a health care data breach.”
Ann N. Purvis ([email protected]) writes from Dallas, Texas.
Tara O’Neill, “Are Electronic Medical Records Worth the Costs of Implementation?” American Action Forum, August 6, 2015: https://heartland.org/policy-documents/are-electronic-medical-records-worth-costs-implementation
Chun-Ju Hsiao and Esther Hing, “Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001–2013,” Centers for Disease Control, January 1, 2014: http://www.cdc.gov/nchs/data/databriefs/db143.htm
Laura Ungar and Jayne O’Donnell, “Feds move into digital medicine, face doctor backlash,” USA Today, February 1, 2015:
“AMA survey: Physician satisfaction with EHR systems has plummeted,” the Advisory Board Company, August 13, 2015: https://www.advisory.com/daily-briefing/2015/08/13/ama-survey-physician-satisfaction-with-ehr-systems-has-plummeted
“Physicians Use of EHR Systems 2014,” AmericanEHR Partners, August 12, 2014: http://www.americanehr.com/research/reports/Physicians-Use-of-EHR-Systems-2014.aspx