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Clinton and Obama "Debate"

February 1, 2008
by James Feldbaum
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Both candidates in last night’s Democratic Debate (1/31/08) agreed that one of the nation’s priorities needed to be dramatic healthcare reform. Both candidates referred to the electronic medical record specifically. Both believed that the funding would come from better care of chronic illness and appropriate access to routine medical care. Clinton believes that “high quality” care can save $120 billion. She quoted the Rand Company estimates that IT can save $77 billion by itself.

It is intuitive, as well as documented, that access to information, close patient follow-up, and patient (and family) participation in disease management translates into better care. So why are we as a nation, profession and individual practitioner so slow to act? Is it just the money? Is it inertia? Are we doctors just too overworked to have the time to initiate change even when we see the value in it?

In last weeks post I referred to the incentives being offered by our malpractice companies to adopt an EMR. Today in the Wall Street Journal (http://online.wsj.com/article/SB120175692402331541.html?mod=googlenews_wsj) there was an article about Bridges to Excellence’s (a coalition including General Electric Co., International Business Machines Corp. and Verizon Communications) initiative to pay doctors hefty bonuses for creating "medical homes" for patients. . Last year, the program paid out roughly $10 million in bonuses to doctors in the 18 states where it is active.

The article pointed out: “The new initiative would reward primary-care physicians significantly more than 2% to 6% of their revenue in bonus payments, but they would be required to make much bigger changes and adopt a more integrated approach to coordinating patients' care. Such steps include following up on referrals to other physicians, systematically tracking tests, flagging abnormal results and adhering to widely accepted medical guidelines to monitor and treat diabetes and other chronic conditions. By using such processes to improve and better coordinate care, doctors can receive $125 annual bonuses for each patient covered by a participating employer, up to a maximum $100,000 a year. Based on previous work with doctors' practices, Bridges to Excellence executives estimate such improvements in quality save $250 to $300 per patient in the first year.” We know that in year one, the savings are there, so let's share half of that with physicians," says Francois de Brantes, the program's chief executive.”

U.S. Health and Human Services Secretary Mike Leavitt is unveiling a plan to expand doctors' use of electronic medical records. Speaking at Des MoinesUniversity this week, Leavitt said electronic records are key to improving patient care and reducing errors. However, he estimates only 15% of physicians at small practices have access to electronic records. To solve the problem, Leavitt proposes a $150 million project that would reward doctors that begin filing patients' health history electronically. Those who do so would get more Medicare money, though Leavitt would not say how much. Leavitt envisions a system that would allow patients to go online and research a physician's track record and costs. Physicians would have to pay for the technology on their own. Upfront costs for implementing such computer systems he estimated can range from $20,000 to $40,000.

Idealistically, one can not argue with the vision. And yes, there may be a future payday for those practitioners who invest in an EMR. Less frequently appreciated, however, is that this initiative can be perceived as just “one more thing to do” for already overburdened practitioners who sacrifice personal and family time just to keep up with an increasing volume of patient care. I am pleased that the financial hurdles are being addressed, but let’s not ignore our responsibility to design our EMR systems to be intuitive and painless to implement.

There is a great deal of difference between an eager man who wants to read a book and the tired man who wants a book to read.
G. K. Chesterton (1874 - 1936)
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James Feldbaum

Jim Feldbaum is a physician consultant specializing in clinical transformation, CPOE, and...