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Riding the EMR Railroad

Larry E. Patterson, MD
FROM THE CHIEF MEDICAL EDITOR

Unlike some physicians, I've been looking forward to electronic medical records for a long time. When I built my first office in 1991, I put conduits leading to each exam room for future wiring. When I built my second office in 2002, I equally prepared it for EMR. Very soon, it's going to be 2010. I have a very progressive, modern practice. I still don't have EMR. Why?

It costs too much. Plain and simple. I've looked into it, and every analysis I do suggests it's just too expensive. It's not just the upfront costs, which would be way over six figures for my practice. Beyond your investment in a full- or part-time IT guy, you've got maintenance contracts. When I bought my first practice management system in 1990, I learned we had to pay 15% of the purchase price each year to keep it running. A software vendor recently mentioned that these days upwards of 25% a year is not uncommon. This is on top of reports of many physicians who lost lots of money when the EMR system didn't work as anticipated. Failure rates reportedly range from 30 to 50%.

But Obama's going to fix all this for us! Starting soon, we'll get up to $44,000 per doctor in our practice for investing in EMR. Never mind that I've not yet seen a dime from my 2008 PQRI work, the government is here once again to help me. If you don't want to get the bonus, guess what? They're going to penalize you for not playing along. So I'm stuck: being railroaded into EMR, but still not quite sure of the destination.

A few (cough, cough) questions remain. With apologies to my Tennessee readers who may have already seen this, here are 10 questions from an excellent editorial by Robert D. Kirkpatrick, MD, past president of the Tennessee Medical Association, from the April issue of Tennessee Medicine:

10. What kind of system should I buy?
9. Which system will the government pay for?
8. What will the standards be so these systems can talk to each other?
7. What happens to physicians who already have a system?
6.Will the one sold at Sam's Club (price, you guessed it, $44,000) be OK?
5. What if the system doesn't work? Can I take it out and go back to paper?
4. If I take the system out, do I get credit for trying or will I be subject to penalties for not having an EMR?
3. By whom/how/when/where will my patient data be accessed?
2. When will the answers be available?
1. How do we know these things will make any difference?

Don't get me wrong… I'm the guy who's been wanting to go with EMR for nearly 20 years. I just need more answers before I board the train.