So why the ominous title of this article in Risk Review: “Electronic Health Records: Can You Practice without Them?” Especially for those physicians who didn’t learn to type before they could write script, this is a real conundrum.
Will physicians be forced to implement them? Primary care physicians in the Partners HealthCare System who have not implemented Electronic Health Records (EHRs) by January 1, 2008, or committed to implement them by January 1, 2009, are out of the Partners network, according to Tom Lee, CEO of Partners Community HealthCare, the physicians network of the Boston-based hospital system (including Massachusetts General, Brigham & Women’s and other Harvard-affiliated institutions).
Even in lieu of a mandate, will those who finance their care (both in the public and private sectors) reimburse preferentially those physicians who use EHRs (for prescriptions and other orders, production and release of quality and safety performance reports, etc.)? On October 26th, Department of Health and Human Services (HHS) Secretary Michael Leavitt announced a five-year pilot in which CMS will pay 1200 physicians in a dozen communities commensurately more (probably in the thousands of dollars annually) to physicians who use EHRs and other safety-enhancing electronic technologies (including ordering prescriptions or recording the results of lab tests). The highest payments will go to those physicians who most aggressively use these technologies and score the highest in an annual evaluation.
What is the difference between the EHRs’ theoretical benefits and their actual functionality? How can EHRs be used to decrease risk, and to avoid using them in ways that might increase risk?
The Practice of Medicine in the “Good Old Days”
For centuries, perhaps even millennia, communication in the practice of medicine has relied upon communication by word (whether in-person or on the telephone) or handwritten medical histories, physical examination findings, diagnostic impressions, therapeutic recommendations and orderings, progress notes and other components of a complete medical record.
Until fairly recently, the practice of medicine (and, more broadly, healthcare delivery) could be carried out successfully using these comfortably familiar communication vehicles and methods. Physicians and their patients were satisfied that they were providing and receiving good care, respectively. There was no compelling need to upset this equilibrium with any disruptive, expensive new technology, regardless of its purported potential to improve the safety, quality and efficiency of care delivery.
*Because of the current, broader use of the term in the industry, the term “electronic health records”’ or “EHRs” will be used in this article to include “electronic medical records” also (please refer to the discussion of the subtle differences between the two in the Ask the Expert article in this edition of Risk Review)
Enter the 21st Century
Unfortunately for many physicians, the healthcare industry (and the practice of medicine with it) is finally getting swept into the electronic information age. Because this change has been so delayed in health care (especially in medical practice) as compared to that occurring in other areas (e.g. financial and transportation services), the transformation is now occurring at warp speed. This is being driven by some of the major household names in information technology (e.g. Microsoft and Google, among many others), which have realized the tremendous opportunities in the (still) relatively undeveloped $2.3 trillion healthcare industry (see the article “Dr. Google and Dr. Microsoft” ; New York Times; August 14, 2007
In addition, those in the public and private sectors who ultimately pay for health care, including physicians’ fees, have come together with unprecedented clout to demand that physicians demonstrate the value (i.e. quality and cost effectiveness) of the care that they provide. Not only the federal government, but almost 1000 major corporate purchasers of care (and the health plans they provide to their tens of millions of employees and their dependents) have joined in a “Value-Driven Healthcare Initiative” launched by President Bush and HHS Secretary Leavitt a little over a year ago now. (http://www.hhs.gov/valuedriven)
Like it or not, physicians who want to continue practicing medicine with any degree of financial success in the next decade and beyond must prepare themselves for the inevitable transition into this electronic information age. There can be real improvements in quality, safety and risk management for those making this transition. To read about one physician’s experience with EHRs, click here. We will introduce some of these benefits below, as well as the key potential medical legal pitfalls and how to avoid them.