Electronic Health Records

Electronic Health Records (EHR) are the new ‘water cooler’ topic for the medical community.  With the Medicare EHR Incentive Program final date to register and attest for an incentive payment looming (Nov. 30), the conversations can only be increasing.  There is no choice, providers, hospitals and all affiliated parties have to get on board, or the train will leave without them.  The problem is – which train, so to speak.

Or in this case, which software program to adopt, is just the tip of the iceberg. After the software program is chosen, the problems don’t get any easier.  There is implementation, training issues, staff buy-in, HIPAA concerns, efficiency problems, fraud, and that’s just to name a few without going into the specifics of the software themselves.  To state the obvious, this switch over to electronic health records will not be a seamless one.

Problems with EHR Implementation

The problems with the process of EHR implementation can’t be pinpointed to one thing.  It’s actually reflective of our current market state, which is severely fragmented with counterintuitive, misaligned incentives.  What has happened is the vendors are leading the charge and calling the shots.  Medical practices are having to adapt their business models to a software program.  How much sense does that make?  The software programs were being written before the medical community had time to completely recognize all internal and external stakeholders. As a result goals are not achieved and the end result is a “Tower of Babel.”

We now have numerous Electronic Medical Record (EMR) vendors that have no standard amongst themselves.  Yes, they all may declare to have ‘meaningful use’, but not a ‘standard of assembly’.  Remember the days of complete paper records?  The assembly process in Medical Records was the same, regardless of what facility you visited. The medications were always in the same spot. It was a simpler world.  That same chart assembly (medical record function) should have been used in computer standards. Oh wait, there are no standards.  Just as CPT language became the standard for all medical billing programs, so should all EHR vendors have some type of standard record set.

In 1966 the first edition of the CPT code was created. In the late 1970s around 250 different procedural code systems were in use.  It was not until 1983 that the US government and the AMA entered into an agreement to have the CPT adopted as a national uniform standard for Medicare.  Hmm, it would be nice if we would learn from the past.