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I wrote in Monday’s Curbside Consult about a reader’s comments to my recent EPtalk piece. His comments were similar to those shared by many physicians I meet, so I’m responding to some of them. As background, my organization is seven years into its ambulatory EHR journey (many more on the hospital side) so we’re definitely not new to this game.
There is no infrastructure for EHR outside of big groups. CMS subsidized us to buy Ferraris and then we have to drive them in a corn field. A bike would be much faster in a corn field. Meaningful Use should have required EHR vendors to provide infrastructure to connect all the computers involved in a patient’s care. Our EHR doesn’t talk to our hospital and the vendor wants $100,000 to write an interface for a single clinic. Who can afford this?
It’s great that MU requires interoperability, but the infrastructure is still a challenge for many, especially independent groups. We’ve been struggling with this for years as we’ve watched RHIOs go bankrupt, competing HIEs squabble within the same state, and more. My own state was one of the last to have an immunization registry.
Other competing factions make interoperability more difficult even if the infrastructure is in place. Our health system gave away access to our HIE and we still struggled with physicians reluctant to participate due to privacy concerns. Patients are eager to participate, but don’t get me started on the complexity of the whole patient identity problem and data integrity. I’m pretty sure it has taken years off my life.
Some of our rural clinics are still regularly taken down by well-meaning guys with backhoes. A cut T1 line doesn’t help patient care at all, and that’s assuming you can even get a line there in the first place. One site took nearly six months to get an appropriate line installed.
Trying to get all the vendors to work together is an adventure. More money earmarked specifically for physician connectivity would be helpful. I think there were a lot of physicians out there that thought $44,000 in MU money would actually pay for their EHRs. The true cost of doing an EHR (and doing it right) is far more than that, and considering maintenance, the expanding burden of Meaningful Use requirements, and other costs, I don’t see a long-term ROI over paper. Depending on how much you leverage the system you purchased and how much potential it has, you might be neutral at best.
I like your “bike in a corn field” analogy, especially being a farm girl. I may have a good story involving a broken leg and trying to take a motorbike across a corn field, but it will cost you a martini to hear it. Providers were lured into purchasing EHRs with more bells and whistles than they can understand, let alone use.
The late adopters are at a huge disadvantage because vendors now …read more
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