Sunday, July 17, 2011

Electronic Medical Records -- the new email frontier?

The statistics regarding the impact of EMR (Electronic Medical Records) on efficiency seem far less than encouraging. As commented privately to me, in more than one occasion, significant net drops in provider efficiency are the norm, despite the hype.

The push for EMR adoption on the part of the government and payers is about data, not provider productivity (at least not the kind of productivity that improves a provider's bottom line). A 6% penalty on Medicare billing or a $64,000 incentive is small compared to the real cost of EMR adoption for many providers. The gap between what providers are being sold on and reality could hardly be broader in the industry...

So, the reality is that today's EMR is a really hard thing to do well, as also evidenced by the reported high numbers of failed EMR conversions and large number of second EMRs (replacing a first EMR).

Electronic Medical Records -- the new email frontier?

In contrast, using encrypted email can be much easier for adoption and even provide an EMR basis IF it can complement rather than replace an email system. It should require no changes in the user GUI, no learning, no commitment in other areas, no change to any other aspect of the operation, and should have low cost compared to the base system (email).

This is exactly what ZSentry at has been providing, as a complement system to Google Apps, Outlook, iPad, and other existing email solutions, enabling HIPAA and HITECH Safe Harbor (the next need after HIPAA) practically "out-of-the-box".

And ZSentry can also be used as part of a local EMR, allowing secure communication in and out of it. One such hybrid ZSentry/EMR system has recently been certified by the DHHS in the US ARRA program.

So, Yes, albeit the statistics on current EMR efficiency are not encouraging, we can start with simpler systems that are, well, simpler to work with.

How about the future?

If we see the statistics of CNC (Computer Numerical Control) adoption in the early 50's in the US, in the 70's for word processors, and other IT application examples, including the Internet itself, we will see the same trend of less efficiency, frustration, followed by exponential, unbelievable at the time, improvements in efficiency, cost, quality, and every other parameter (except when people look at direct employment reduction as a downside, rather than as an opportunity for progress).

Now, ask yourself how much would it cost to run an IT company the way a physician runs his office today?

For example, how many people-hours/day are used faxing in a practice today? And faxes are not even HIPAA-compliant...How long can this waste go on?

It's just natural that the future comes with a shock-wave. But automation-driven efficiency improvements grow fast and are worth the trouble. The U.S. Census Bureau took eight years to complete the 1880 census, but just one year for the 1890 census. The difference then: automatic tabulation with Hollerith cards.

Now, fast-forward to the US health-care sector in 2011. What's happening with the SOHO and SMB health-care markets? They are shrinking fast since ca. 2000, and becoming far more competitive in price. For example, the share of solo practices among members of the American Academy of Family Physicians fell to 18 percent by 2008 from 44 percent in 1986. And US census figures show that in 2007, just 28 percent of doctors described themselves as self-employed, compared with 58 percent in 1970. Many of the provisions of the new health care law are likely to accelerate these trends in the health care sector.

Because efficiency will become even more critical for the survival of solo and small practices, they may be more likely to use simpler, secure email first and move to EMR as possible. I doubt they will continue to use fax, or even dare to ask their patients to run to the pharmacy with a written prescription, or refill by phone. Larger health-care providers may also see faster returns by using simpler systems first. Keep It Simple -- and I see no need for adding a second S at the end.

Ed Gerck


Ed Gerck said...

(from mike, submitted online)

The blog makes a lot of good points.

The small practice may well be holding off going to EMR for many of the reasons cited, as well as various factors such as inertia, procrastination, fear of change, and the often rational rationalization that technology is improving, so why not wait for better. Especially, sense the short term payoff is negative -- hardly an incentive to quick action.

Ed Gerck said...

(from bob, submitted online) accurate as it is scary.