Government Push for EMRs

In 2004, President Bush announced the goal that most physicians will adopt electronic medical records (EMRs) within 10 years. After a third of that projected time has passed, many in the Department of Health and Human Services, particularly the Office of the National Coordinator, are taking this goal more and more seriously. But what does it mean to the average physician who is struggling with cuts in income, more regulations, and many other hurdles to overcome?

Widespread rumors that there is a federal mandate to implement EMRs are simply wrong, and we can only hope that—after the HIPAA experience—they remain so. Although a federal mandate is not likely, the government almost certainly will strongly encourage the implementation of EMRs. It is worthwhile to look at the history. In 1994, President Clinton showed the world a smart card designed to hold a patient’s health information as well as eligibility information. This information was to be integrated into a computer-based patient record system, the popular term at that time. Before that, the prestigious Institute of Medicine's publication "Computer-based Patient Records—An Essential Technology" demanded implementation by the great majority of physicians by 2001. We all know what happened with these EMR implementation plans.

Why is the government so keen to have EMRs implemented? There are three reasons. First, there is a widespread belief within health politics that EMRs save money. Although I have not seen any hard statistics, many people argue that health care costs in general can be reduced with EMRs. Certainly most EMR experts acknowledge waste in the health care system due to undue documentation, duplication of tests, medical errors due to lack of continuity of care, etc. Also, it is argued that health care costs of the Veterans Administration (VA) have increased less than those of the private sector due to the VA's use of EMR systems. Second, there is a movement toward greater accountability. Whether you like it or not, more reports will be required from you, and those reports will be required in digital format. Third, adjudication by payers will be much easier and less costly when the paper trail is replaced by digital communications.

For these reasons, you must be prepared for the government's "strong encouragement" of EMRs through incentives and disincentives. Incentives are additional payments if you have an EMR system. Disincentives are a kind of "penalty" or deductions from reimbursement. The problem with this kind of policy is the establishment of a reasonable threshold. What conditions must your system meet for you to be eligible for the incentives? Is a fax-based e-prescribing system sufficient? EMR systems come in all shapes and sizes. Their costs range from less than $1000 to more than $70,000 per physician. Some are based on document imaging, others do not include e-prescribing, and so on. How can you award those who have moved to an EMR system when the 200+ vendors in this cottage industry offer the equivalent of gearless primitive bicycles alongside complex luxury cars with global positioning systems? This dilemma has led to the establishment of the Certification Commission for Health Information Technology (CCHITâ„¢). Although it was somewhat ill conceived and has had many problems, it is improving. Its great achievement is the establishment of a consensus regarding what constitutes the necessary functions of an EMR/electronic health records system. This means that the time is approaching when meaningful incentives and disincentives can be established.