Wednesday, June 9, 2010

President Obama's EMR Fiasco

My morning cup of coffee included an email from SERMO where there was a post regarding EMR usage.

I thought it worthwhile to include this commentary from
Stan Feld, MD, FACP, MACE

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"President Obama's goal for healthcare reform is to increase the quality of medical care, increase efficiency of medical care and decrease the cost of care. The goal is admirable. The route he is taking is wrong. In the process he might destroy the medical workforce.

The route the electronic medical record (EMR) stimulus package should take should be flexible and educational for patients and physicians. It should use modern software technology instead of subsidizing old inflexible technology that is set up to be punitive to physicians and patients to the advantage of the government and the healthcare insurance industry.

The term "quality medical care' is used loosely. It has not been appropriately defined. The practice of evidence based medicine has been used to define quality medical care. The problem is evidence based medicine is changing daily.

A better definition should be the best clinical outcome with the most efficient financial outcome. It is assumed that practicing evidence based medicine will lead to the best clinical outcome at the most efficient cost.

Clinical guidelines are defined by "experts" interpreting evidence based medicine. I am/was one of those experts and appreciate its short comings.

Some guidelines are essential and should be inflexible. Others are ever changing and must be flexible. In bureaurocratic systems it is difficult to create flexible rules. Also, all patients are different. Clinical judgment plays an important role in treatment.

Physicians should not be penalized for using clinical judgment. Nonetheless, physicians are penalized in a pay for performance evaluation for deviating from inflexible clinical guidelines. Since some clinical guidelines are always changing the weakness of the approach is obvious.

Physician performance should not be evaluated on static measurements. It must be evaluated on physicians' medical judgment. Clinical judgment is a function of a physician's ability to relate to his or her patients. (patient physician relationship)

Healthcare is a team sport. The patient physician relationship failed but was not measured. .

The poor performance was missed by the static digital healthcare evaluation imposed by an inflexible EMR. The importance of the patient physician relationship and not including patient responsibility in the clinical outcome should be part of any performance measurement. A performance measurement should be a measurement of both the patients' and physicians' performance.

Now that the federal government plans to spend $50 billion to spur the use of computerized patient records, the challenge of adopting the technology widely and wisely is becoming increasingly apparent.

There is no question we should have universal electronic medical records. It should be a teaching tool for patients and physicians. The EMR should be inexpensive and flexible. It should not a tool to judge and penalize clinical performance. President Obama is being ill advised. His EMR stimulus program is going to result in a waste of $50 billion dollars.

The software the government is going to spend $50 billion dollars on is going to be too expensive, inflexible and not widely distributed.

"Instead of stimulating use of such software, they say, the government should be a rule-setting referee to encourage the development of an open software platform on which innovators could write electronic health record applications".

EMR software platforms in the cloud should be developed. This link by Christopher Barnatt is an excellent utube explanation of cloud computing. I suggest all watch it.Amazon uses the cloud to sell books. www.Salesforce.com's business model tracks sales force activity at a minimal cost to the company. It is flexible and maintenance free.

"Such an approach, they say, would open the door to competition, flexibility and lower costs — and thus, better health care in the long run.

"If the government's money goes to cement the current technology in place," Dr. Mandl said in an interview, "we will have a very hard time innovating in health care reform."

The rules can be immediately changed. The cost to a medical practice could be minimal. Its effectiveness is maximal. The cost to the government using modern software technology could be between 1-10 % of what the stimulus is proposing to spend. If it is fashioned as an educational tool to patients and physicians the payback will be maximal, quality of care will improve and the cost of care will decrease.

The opinions expressed in the blog "Repairing The Healthcare System" are, mine and mine alone

Stanley Feld M.D.,FACP.MACE

http;//stan.feld.com

Thank you Dr. Feld for this great summary.

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