By J.C., on August 12th, 2008
The hot topic for many physician practices is the creation of electronic medical records and charts. While these are great for making medical practices more efficient, one overlooked reason for using medical records and charts is for digital storage. One costly part of a physician’s practice is the storage of records. There are laws that vary according to state about how long records must be kept. However, in general, medical records must be kept for as long as possible. From a medicolegal perspective, failure to keep appropriate records and documentation of a visit or treatment that later becomes a patient grievance is a recipe for disaster. Thus most physicians archive and store their paper charts in storage facilities for an eternity. As you can image, these storage fees can add up over the practice of a physician.
Most physician’s store their electronic records in storage facilities that run several hundred dollars per month. Depending on the volume and size of records of a practice, this amounts to several thousand dollars per year. Digitizing these records does have a cost. However, once these files are digitized they are easily accessible by computer. They do not have to be physically stored nor does anybody have to physically go and retrieve the charts.
For those contemplating going digital, I’ll do a hypothetical calculation of the cost savings for a physician practice that has 12,000 charts costing $200 per month to store. Under that scenario a physician must spend $2400 per year or $24,000 per decade. Digitizaton of these charts is not cheap but in the long run can save good money. For example, for about $2000 you can get a high quality scanner and software. Scanning the charts is what costs the most as it probably takes 5 minutes to scan a chart. Thus it takes about one hour to scan 12 charts. Thus about 1000 hours is needed to scan 12,000 charts. Hiring someone $20 per hour would cost about $20,000, which is a lot of money but less than the $24,000 the practice spends per decade in storage.
By Jennifer Bunn, on July 23rd, 2008
The use of electronic medical records has been touted as an enormous economic benefit in terms of cost savings as well as a boon to increasing patient safety. So why aren’t more doctors using them?
Although many doctors employed by larger medical entities are making use of EMRs because the costs of implementing the system are covered, smaller practices with few doctors are unable to afford the $5,000-$50,000 start-up costs, not to mention the approximately $1,000-a-month maintenance fee.
There is also the issue of time lost and decreased productivity during the implementation of the system. It takes a lot of time to enter data on each individual patient into the system. Once the system is fully functional, doctors report that much of their time is still eaten up during clinic visits entering data into the system.
While larger medical centers are willing to pay these costs and train staff to use them, it is just not feasible for smaller practices with fewer resources. Additionally, there is little incentive from the government and insurance companies, although they receive most of the benefit from the use of EMRs.
Another reason for doctors’ worries are that there are many different models of EMRs, some of which are not compatible with each other and are unable to share the very information they were designed for.
So what can be done to encourage smaller practices to purchase an EMR system? Very few doctors report receiving financial subsidies to help mitigate the cost of implementing the system, according to a Texas Medical Association survey. If these systems will save the amount of money that they are predicted to and save as many lives as the companies who make them claim they can do, perhaps the government needs to help smaller practices implement these systems by paying for a substantial amount of the start-up costs.
By J.C., on July 21st, 2008
If you haven’t read Alvin Toffler’s book, Powershift, you probably have no idea what has happened to us in the last decade with regards to the information era. In this historic book, Toffler talks about the “Powershift” which is the information era and how knowledge and information will be the most valuable currency in the world. While traditional economic transformation progressed from agrarian to industrialized societies, the next wave was the information era. “Third World” economies could actually leapfrog the industrialized economy from a rural/agrarian one to an informational society with the advent of computer networks and the internet.
In the healthcare system, such a “powershift” is occurring within the walls of hospitals. Archaic hospital systems are using paper charts and paper prescriptions. Physicians must hand sign an order book which then gets faxed to the pharmacy. A courier then runs up the medicine to the patient’s room. All charting is done on paper and record keeping rooms are enormous. Medical transcriptions are done on a typewriter and placed in the patient’s paper chart.
In the second wave of medical informatics, the electronic network came about. Orders were allowed to be filled electronically. Medical transcriptions of dictations were outsourced to transcription companies who typed these out and they appeared electronically. Physicians could edit, verify, and sign electronic records and transcriptions. Computerized vending machines on the hospital floors could electronically document the use of supplies for the indicated patient. The second wave of medical informatics cuts costs and dramatically improved things and brought us out of the dark ages.
It appears that we are starting the third wave of medical informatics. “Going Live” is the concept where the electronic record is completely “live” and “online” and always being edited. Laboratory and diagnostic results appear real-time; doctors dictations, nurses notes, medical orders, and prescriptions are all done online and appear real-time. Transcription software allows the physician to dictate his note which uses voice recognition and speech transcriptions software to transcribe the note instantaneously where the physician can edit. If he so desires the doctor can electronically type his notes if he likes. There is no paper chart.
“Going Live” is the third wave of medical informations. Gone are the outsourced medical transcription companies. Gone are the paper charts. Gone are the electronic notes that indicate that a dictated note is “pending.” There are no gaps in the care or documentation of the care of the patient. The laptop or PDA-toting physician is here to stay.
As in the global powershift, hospitals and healthcare systems who “Go Live” early on will win more business and thrive. They will be more profitable and be more efficient and thus more effective in the delivery of healthcare.
If you’re interested in other works by Alvin Toffler, read Greg Beatty’s review of Revolutionary Wealth: How It Will Be Created and How It Will Change Our Lives by Alvin and Heidi Toffler.
By Jennifer Bunn, on July 11th, 2008
The cost of healthcare is always a major concern in the U.S. With approximately 47 million uninsured people and soaring costs, the already-beleaguered healthcare system has been a major topic of debate in this, an election year.
In “Options for Slowing the Growth of Health Care Costs” from the April 2008 issue of the New England Journal of Medicine, the authors present several options that they see as potentially cost-saving. Their “top three” picks that they believe have the greatest potential are capitation, strengthening reviews for new drugs and technology, and electronic health records.
Capitation, in which providers of care are paid a fixed amount of money to provide for the healthcare needs of a patient population, has been tried and found wanting. Providers of care have balked against caps placed on their provision of service, and patients have been dissatisfied with being unable to freely choose their own physicians. Given that it is an unpopular choice for many physicians and patients, an effort to expand capitation to more healthcare sectors will likely be an unpopular choice that will meet much opposition.
The idea of a national oversight committee to provide more effective and stringent reviews for new drugs and technology and which would be required before reimbursement was made is a sound idea in theory. However, as the authors point out, “concern about this approach comes from members of industry, who worry about the possible effects of such reviews on the time and costs associated with getting products to market.” This may be a valid point: tying up new drugs and technologies in bureaucratic red tape might unnecessarily lengthen the time it takes to get them to patients who need them. This could be a drawback if the new products have the potential to save money in the long run in terms of making patients well faster.
The authors believe that use of electronic health records can be a cost-saving strategy. “We believe the greatest cost-reducing effect of electronic health records will result from improved coordination among health-care providers and from decision support that improves clinician’s use of tests and treatments.” The major drawbacks mentioned by the authors in this study are the costs involved in implementing electronic health records into practice and, perhaps more importantly, physician’s potentially negative attitudes towards using computers to tell them how to practice medicine.
The authors suggest several potential cures for what ails the U.S. healthcare system, but will anyone be able to agree on which, if any, methods to use.
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