Healthcare Crisis: EMR Non-acceptance in the U.S.

Bill Bysinger, for HealthLeaders News, June 12, 2007

It has been almost 20 years since electronic medical records systems were introduced into medical practices, yet we have the lowest adoption rate of all the developed countries in the world. Most of Europe, Japan, China, Australia and even Russia have adoption rates above 50 percent and in many countries above 90 percent.

We are supposed to be the world leader in adopting technology, but recent studies have put our practice EMR adoption rate at somewhere between 15 percent and 18 percent.

I submit the root cause of the problem is the culture of the healthcare industry. Healthcare in the U.S. especially at the practice level is a cottage industry. Medical practices don’t make business decisions based on productivity or process improvement, which dominates other industries. Instead, they make decisions based on how much money do they have to spend and what will it do for the providers personally (and immediately).

The practice segment that needs process improvement the most and is the slowest to adopt electronic medical records is the practices with less than 10 physicians, and even more disturbing little adoption is taking place among primary care providers. This small practice segment is the majority of the total practice market.

It is intriguing to compare primary care providers with dentistry, another segment of the healthcare industry. Dentistry practices implement technology as a way to automate processes that drive profits. Dental schools help to orient practitioners in technology implementation and therefore it is continued in dental practices.

On the other hand, medical schools spend little time on business process, philosophy, or even how to own and run a business. Consequently, we have practices that are barely surviving, doctors leaving the profession, and some finding safe harbor working for pharmaceutical companies or as advisors to vendors.

All this adds up to process improvement and quality not being well understood. Therefore when technology like electronic medical records are introduced in the medical practice market, most physicians are afraid to invest and have no idea how to use automation to make process improvement or generate profit.

As well, the government is reluctant to mandate health information technology even though it has been proven in many studies that automation and electronic information at point of care improves quality, lower costs and creates a higher level of patient safety.

So if this is so obvious, why can’t we fix it?

I believe we can--with some visionary leadership in both government and industry.

A mandate like HIPAA for electronic medical records and personal health records must be forthcoming. Everyone including the president, senators, and congressional representatives talk about the importance of health records, but do little to encourage change. Why not create a mandate for EMRs by 2012? This gives practices five years to comply. Lawmakers could create a disincentive tax for practices that cannot prove they are implementing EMRs by the specified date.

Here are six more ways to make electronic medical records the chief tool for correcting the high cost of care:
1. Provide immediate tax incentives for a dollar-for-dollar write-off against the cost of electronic medical records for every practice in the country. (This is another proposal that has been talked about for over 10 years without action.)
2. Provide higher levels of Medicare and Medicaid reimbursement for those practices that can demonstrate the use of electronic medical records.
3. Create state tax and licensing incentives for physicians that use electronic medical records.
4. Create a mandate among every medical society to promote the use of electronic medical records and provide cost incentives on membership and services to those physicians that use and promote EMRs.
5. Make health plans require physicians in their networks to be on electronic medical records by a specific date.
6. Medical liability carriers should provide significant premium discounts to physicians who use medical records due to increasing patient safety and insuring better clinical documentation.

Steps like these--rather than empty rhetoric--will prove to consumers and the industry that lowering healthcare costs and improving quality are among the highest priorities.

Compare these actions with the numerous government-sponsored conferences that espouse healthcare change, but are void of vision and action to bring about change.

If health information technology is so important, let’s get with it. Consumers and practitioners should not have to wait another 10 to 20 years to see some glimmer of process automation and quality improvement take place at the point of care.

Finally, I challenge all medical schools to step up and demand that healthcare business and health information technology take a prominent position in their curriculums and that we begin educating 21st century physicians that understand process automation and process improvement through technology.

We cannot be proud of the fact that we have the best physicians in the world and are ignoring the value of electronic medical records as an enabler of better care.

The U.S. is the leader in applied information technology in most industries in the world, and we stand in last place in applied health information technology among developed countries in the world. This makes me ashamed of my industry and more focused on evangelizing change in our broken practice paradigm of paper records and manual clinic information processes.

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Bill Bysinger is the principal of WGB Advisory a healthcare and technology management consulting company and the co-founder of eMRnet, an EMR services company. Bysinger was involved with the HIPAA legislation from 1993 to 2003 and is very familiar with healthcare compliance and regulatory reform. He can be contacted at bbysinger@emrnet.com.