Moving to the "Right Thing"

In the September issue of HealthLeaders magazine, technology editor Gary Baldwin offered some insightful observations on the topic of electronic medical records. As the cover story noted, physician office practices are finally beginning the challenging but much needed move toward real automation. This modernization is being driven by regulatory and market forces, and is now spreading to the small group practices that dominate the industry. Now, in the approaching "EMR Wars," some predict a coming shakeout in an overly complex and crowded EMR marketplace.

Baldwin's take on the deficiencies in the EMR industry is largely on target. But here's an alternative view on where the industry is and where it is headed: Instead of struggling with "Too much of a good thing," the real issue for small and mid-sized practices is finding and moving to "the right thing." Fortunately, a new generation of automated recordkeeping technology has now emerged. Called electronic health records, this approach offers physicians both lower costs and fewer IT risks, while putting the focus of medical technology back on the patient. To fully appreciate the differences between traditional EMRs and the coming EHR generation, let's take a quick review of where we've been and where we're going.

EMR Realities
The United States government wants the healthcare industry to convert to electronic record keeping by the year 2010, but in reality it will take much longer to reach that objective. Today less than 10 percent of all medical practices have automated their recordkeeping, and while some physicians embrace the EMR concept, many others are taking a "wait and see" approach, for some very good reasons.

Because while few doubt the healthcare industry must and will automate, a growing number of observers now recognize that EMRs pose a number of serious economic, technology and patient care challenges. As HealthLeaders magazine has noted, there are literally hundreds of EMR systems on the market today. Some are good solutions, others less so. Some are from well-known vendors and others are from relatively unknown suppliers. Each system offers a particular set of features and functionality, and it can be difficult for physicians and their administrators to know what they need or to pick the right solution. And of course, virtually all current EMR systems are unique solutions that use highly proprietary technologies. As a result, medical offices cannot easily share medical records between these EMR systems, and no single and consistent EMR solution is on the horizon. Worse, by buying and installing a system today, a medical practice is in a sense betting on the future viability of that specific technology and vendor--a real long-shot in today's crowded and immature marketplace. Implementing an EMR system can be expensive and time consuming. Deploying an EMR system typically involves the purchase and installation of hardware and software, and can cost anywhere from $10,000 to hundreds of thousands of dollars, while often taking weeks or even many months of intense effort to get up and running. For most practices, that's a major investment and both time and money.

But with today's EMR model, upfront costs are just the beginning. EMRs tend to be large and complex systems, and can be difficult to design and integrate into a typical medical office. That same complexity also means that most healthcare offices will need to hire at least one IT staff member to handle things like setting up Virtual Private Networks, creating HIPAA security tunnels, importing existing medical records, and dealing with other EMR system requirements. The long-term maintenance requirements of complex EMR systems also require doctor's offices to sign additional vendor service agreements or to keep IT personnel on their own payroll. Automation is coming to the medical office, and EMRs were an important and necessary first step in that IT journey. Now the next vital step in that evolution should be a move towards a more open, cost-efficient and patient-centric solution.

Fortunately, the "right thing" is now emerging in a new form of automated recordkeeping: the Electronic Health Record.

The Promise of EHR
Electronic health records represent the next logical IT step for the healthcare industry. Some people use the terms EMR and EHR interchangeably, but these are two very different technologies. While EMRs are by their very nature complex, inflexible and proprietary, EHRs are built on technologies that are fundamentally more open, more flexible, increasingly cost-effective--and focused on the patient. EHRs are based on the philosophy that patient records should be shared--quickly, easily and securely--by all healthcare providers who deliver care to a patient. EHRs leverage the new generation of Web and client server technologies, providing dual redundancies, and giving authorized healthcare personnel convenient, 24x7x365 access to electronic records from anywhere in the world. The EMR approach also lends itself quite naturally to an emerging and more cost-effective economic model. While EMRs require heavy capital and operating investments, forward-looking suppliers can offer EHRs in a service-based model that does not require medical offices to buy expensive new hardware and software systems. Instead, the service-based approach leverages emerging technologies in a transactional business model. So there is no need to buy, install and maintain a massive new IT infrastructure. Medical offices purchase only the level of automated services they need, and pay on a more affordable and predictable per-transaction basis. While EMR systems can cost upwards of a quarter of a million dollars and take months to install and configure, a service-based EHR solution can cost less than $10,000, can be implemented in a single day, and can be populated with existing patient records in less than a week. So this fee-based transactional model eliminates the need for large capital outlays, and allows doctor's offices to realize an immediate return on investment.

To realize the full potential of EHRs, the industry must work to develop a centralized and standardized approach to data forms and protocols, much as was done with the Internet a generation ago. That will happen, and the good news is, we don't need to wait for an industry shakeout to take place. Practitioners can start using flexible and affordable EHR solutions immediately, then watch as the industry evolves naturally towards this more open and logical technology.

Conclusion
Make no mistake: automated recordkeeping is coming to the doctor's office. EMRs were a first and logical step in that journey, but our industry stumbled somewhat in assuming that EMRs were the only and ultimate route to the paperless office. EHRs now offer a far less expensive and complicated solution. EHRs make use of today's most powerful Web- and transaction-based technologies. They free medical offices from the burden of IT systems, and let doctors focus on delivering the highest-quality care possible. Best of all, EHRs lay a solid foundation for a truly patient-centric health care industry.

If EMRs were too much of a good thing, EHRs are just the right medicine for our IT future.

Don Thomas is founder and president of SoftLight Development, Inc., a source of process, system and IT services for the healthcare industry. He can be reached at dthomas@softlightdev.com.