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Affording an Office EMR May be Becoming Easier

January 24, 2008
by James Feldbaum
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Affording an office EMR may be becoming easier. Arguably, the cost of implementing an EMR is offset by savings in improved efficiency, but faith in this claim is not widespread. Now, there are more incentives to aid physicians in undertaking the up-front costs of transition from paper to electronic records.

Hospitals seem slow to take action in subsidizing EMR purchases for physicians in the community since the relaxation of the Stark rules. Many hospitals have successful EMRs up and running, often with remote access in heavy usage by their physicians. It would be the logical next step to tie the medical community together with an integrated EMR. Many practices will be hesitant to walk away from their personal investment in their present software (time and money) to incorporate the hospital’s existing EMR. There are problems inherent in integrating dispirit office EMRs to a hospital, but the longer the hospital waits the greater the diversity of software products that will crop up in the community.

The pay-for-performance initiatives will require an EMR in place to participate. The Bush administration has recruited about 1,200 doctors nationally to adopt an EMR in their medical practice in return for higher Medicare payments. Medicare will pay the physicians extra for completing tasks online, such as when ordering prescriptions or recording the results of lab tests. The highest payments will go to those physicians who most aggressively use the technology and who score the highest in an annual evaluation. We will see the third party payors follow suit.

This week, the MHA Insurance Company, which provides medical professional liability insurance to more than 3,000 independent physicians in eight states has joined the growing number of malpractice insurers that will grant a premium credit (of up to 5 percent ) for qualifying policyholders who utilize an EMR system. This discount would be available to both independent solo physicians and group physician practices. Clearly, malpractice carriers see value in the EMR.

The decision to adopt an EMR for the office has always made sense from a practice improvement and safety standpoint. Now, a reducing financial burden might be what it takes for the late-adopters to get aboard.

If we don't change direction soon, we'll end up where we're going.

Professor Irwin Corey (1914 - )



I must admit that when I heard the Stark laws were being relaxed to allow hospitals to provide EMRs for physicians I had a different thought than I have heard expressed to date. With only about seven or eight percent of primary care physicians using an EMR in their outpatient practice but about forty percent of physicians overall using some sort of EMR somewhere in their practice, it seems clear that the EMR is primarily an inpatient phenomenon now.

In the wake of the IOM reports a great deal of appropriate attention has been given to in-house medical/surgical errors and patient safety and the EMR is an essential tool to reducing errors and improving safety, but it is my deeply held belief is that the improvement of outpatient care is where the health system needs to eventually be focused. If hospitals become a major source of funding for outpatient EMRs we risk diverting attention from the needs of the outpatient sector. Additionally, with the hospitals paying for and in many cases ing the EMRs for outpatient practices we may delay beginning the quest for EMRs that not only improve the outpatient doctor's ability to up-code but actually make him/her a better doctor.

I share much of Dr Turton's apprehension. Both the EMR and the Personal Health Record (with shared access by patients) have been a less penetrated market despite the promise of improved patient care through the continuum of care. I have interviewed many practices and have been disappointed that outpatient EMRs are still viewed mainly as vehicles for office practice management. I recently met a doctor who really "gets it". He has developed an exceptional tool for linking the inpatient/outpatient record in the most meaningful patient-centric way. I'll see if I can invite him do make a post on this web site.