A recent report, published online in the New England Journal of Medicine, found that doctors who use electronic health records (EHR) say overwhelmingly that such records have helped improve the quality and timeliness of care. Yet fewer than one in five of the nation's doctors has started using such records. Most doctors in private practice, especially small practices, lack the financial incentive to invest in computerized records. In fact, only 8.6 percent of small practices (1-3 doctors) have started using EHR, as compared to 50 percent of large practices (more than 50 doctors).
The key reason for slow EHR adoption rates seem to be economic: providers, already squeezed for reimbursement by payers, lack the financial incentive to make a significant - often as high as $20,000 per doctor - investment in EHR, and undergo the painful and costly conversion process from paper. Experts agree that EHR would be adopted faster in a consumer-driven health care system, where innovation benefits the entrepreneurial provider. In the absence of a consumer-driven health care market, the government, i. e. , the taxpayers, subsidize technological progress, shifting the system selection and pricing decision-making from health care providers to bureaucrats.
That decision-making today is not easy: 54 percent of doctors without EHR said that not finding an electronic health record that met their needs was a “major barrier" to adoption. Why doctors cannot find products that meet their needs in a market saturated with 400 EMR vendors? Is it because these products tend to be designed for hospitals - big customers - instead of small practices?
A recent article in The New York Times ("Most Doctors Aren't Using Electronic Health Records") concludes with this testimonial: “Do I see more patients because of this technology? Probably no, " Dr. Masucci said. “But I am doing a better job with the patients I am seeing. It almost forces you to be a better doctor. " Is it reasonable to expect a technology to force you to be a better doctor or see more patients a day? Does the number of patients per day measure adequately health care quality or even productivity? Does technology play such an ambitious role in other professions? Would you expect a journalist to say something like “Do I write more articles because of Microsoft Word? Probably no. But I am doing a better job with the articles I publish. Microsoft Word almost forces you to be a better journalist. "
In a consumer-driven market, fewer patients would visit a practice that lacks modern documentation processes and more doctors would develop realistic business-driven requirements for EMR. The market would guide the EMR vendors and the process of EMR adoption would become dramatically simpler and easier in terms of matching functionality, convenient conversion process, and affordable pricing.
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