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Half of all doctors using electronic records, most of the rest considering it

One of the stimulus's lesser-known but more-important efforts was the massive push to get doctors to use electronic medical records. The legislation included $20 billion to help them and, perhaps more importantly, penalties -- in the form of a cut in Medicare and Medicaid reimbursements for providers who are still using paper in 2015 -- for those who didn't make the move. It looks like it's working:

As many doctors and hospitals are rushing to implement electronic medical records and other health IT systems by 2014 (as mandated by the stimulus bill), IT trade group CompTIA will release this week a snapshot of where things stand. CompTIA's research finds that half of health-care providers are using some form of EMR -- 34 percent are using full EMRs while 16 percent have a partial system. Of the remaining, 29 percent are evaluating EMR options while 20 percent have not yet considered using the technology.

There's an argument that we're eventually going to look back at the stimulus bill's investment in electronic medical records as the most important improvement the Obama administration made to the health-care delivery system -- and, if the more optimistic assessments are right, as a crucial piece of infrastructure that allowed us to eventually get costs under control.

By Ezra Klein  | October 26, 2010; 11:55 AM ET
Categories:  Health Reform  
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Comments

so i'm guessing pediatricians make up a lot of the other 20%.

it COULD get costs under control related to unnecessary surgeries, medication etc but it doesn't have any effect on what we pay medical providers as compared to the rest of the world. That's still transparency that we're not anywhere close to.

Posted by: visionbrkr | October 26, 2010 12:17 PM | Report abuse

I am impressed on an almost daily basis at how quickly businesses of every stripe are adapting to the use of the web. Not only to market and sell, but to deliver service, to interact with customers, and to perform all sorts of feats. It's dazzling.

I'm less impressed with spending $20 billion to get the docs to do what many of them are already doing and what more and more of them would have done, and there are a lot of people who will rightly be creeped out about the systematic gathering of their lifetime health history, but that's progress, I guess.

Posted by: bgmma50 | October 26, 2010 12:58 PM | Report abuse

So, medical records will now be as accurate as (for example) mortgage records? Is this another "accomplishment"?

That's not an idle question. The President recently (pocket) vetoed legislation which would have made mortgage records all-electronic -- yet many are willing to make medical records electronic. The logic escapes me, yet the expression of priority (that wealth is more important than health) does not. The problems we have experienced with financial records and the problems the UK has encountered regarding electronic medical records should serve as a lesson...

Posted by: rmgregory | October 26, 2010 1:04 PM | Report abuse

Just today, a bunch of researchers at Beth Israel in Boston released a study that used EMRs to find out that complication rates after invasive endoscopies and colonoscopies were way higher than we thought.

Apparently, 1/100 people end up at the ER because they have some kind of pain or serious concern that something's gone wrong. Given the number of these procedures performed a year, this is a HUGE, hidden expense that we were completely unable to detect until we were able to track patients. Once you can see problems, you can fix them.

Big, big, big win for the forces of good.

Posted by: theorajones1 | October 26, 2010 2:30 PM | Report abuse

I'm waiting for the application that lets people carry around their medical histories on USB flash drives on their keychains.

Emergency room visit? New doctor? Seeing a specialist? They can just plug it in and see your history of blood test results, BPs, medications, etc.

Posted by: stevie314 | October 26, 2010 2:52 PM | Report abuse

Ezra must either be stupid or think we are. So the reason we pay 2-3 times as much per capita for health care as other major industrialized countries is because we don't have the right IT systems? Silly me, I thought it was because the governments of those countries directly regulated the insurers and the providers in order to make health care universal and affordable. But I'm sure that all these countries overlooked the amazing Magic Pony power of technology and could have avoided the grubby business of stopping their insurers and providers from bankrupting their citizens. If only they'd listened to Ezra!

Posted by: redscott1904 | October 26, 2010 3:31 PM | Report abuse

rmgregory:

Uninformed as usual.

Obama vetoed the bill, not pocket vetoed, and the bill dealt with forcing states to recognize electronic *notaries*, not the transaction itself.

Posted by: lol-lol | October 26, 2010 5:33 PM | Report abuse

"so i'm guessing pediatricians make up a lot of the other 20%."


And you'd be wrong. Surgeons are by FAR the lowest adapters of EMRs. I have not yet seen a surgeon's clinic that used EMR at all.

Posted by: platon201 | October 26, 2010 9:20 PM | Report abuse

Not to be pedantic, but one snapshot does not show the stimulus is working. You need to show how quickly EMR use is growing compared to previous years.

Fortunately, that can be done. There is an annual survey from SK&A that gives results roughly the same as the ones you posted.

Annual increase in usage has gone from about 3% to about 10% since the HITECH act passed.

The only other quibble I have is with the statement that 34% have a "full" EMR. I think if you were to dig into what they are calling a full EMR, you would not agree with the description. Consider that at most about 1/3 of docs are regularly e-prescribing. Around the same percent have substantial care analytics and evidence-based support. But these are not all the same systems, so the intersection of the two is probably under 30% Then consider that a much smaller percentage of EMRs are currently linked up in RHIOs to share data (and this occurs mostly in integrated systems with their own internal RHIO, like the VA and Kaiser). So really, we're talking more like 10% tops with a fully functioning EMR. We might crack 25% who can meet the first year's Meaningful Use criteria.

The core point still stands: the legislation is working to accelerate adoption.

Some links:
http://www.skainfo.com/press_releases.php?article=99
http://www.skainfo.com/press_releases.php?article=88
http://www.ihealthbeat.org/features/2010/federal-policies-help-drive-more-growth-in-eprescribing.aspx

Posted by: jdhalv | October 27, 2010 12:23 AM | Report abuse

Scratch that, I read too quickly. The 10% increase is only for physicians in large group practices and those who work for hospitals. These institutions have the infrastructure to handle the complex IT projects.

Small practices (over half of docs are in 1-2 person practices) grew at about 3%, same as before.

Posted by: jdhalv | October 27, 2010 12:33 AM | Report abuse

stevie314, there are numerous PHR's out there right now that let you put your medical history on a USB drive.

The issue isn't that, it is:
A) There are some competing standards (CCR vs. CCD) on how to store your health data discretely. One needs to win out, so most if not all EMR/PHR systems are communicating in the same way. Because, it isn't just seeing it in a textual way, it is having the data in a coded format, so you can detect interactions, contraindications, etc.

B) I don't believe USB key will be how it works long term... much more likely directly off the internet/cloud via secure transmission from a trusted site. Some "random" guy with a USB key that could have any number of viruses, malicious software, or software to send all the data on the computer to other places... no doctor really should 'trust' a device (which is all
a USB key is) they don't know about to be hooked up to their medical system.


Posted by: oliviasdad | October 29, 2010 9:10 AM | Report abuse

Another data point found in CompTIA's research: 25 percent of physicians plan to purchase tablets (e.g., Apple iPads) in the next year. Combine that with the vast numbers of physicians already using smartphones, and you get a “critical mass” of potential physician users of mobile clinical and financial applications walking around hospitals. This represents a huge opportunity for hospital IT leaders to capitalize on the growing physician adoption of mobile devices and to leverage this as a component of their strategy to achieve the “meaningful use” standards as defined in the ARRA-HITECH Act. Deploying mobile computerized physician order entry (CPOE) software seems like a natural means to both ends.

Posted by: PeterHendersonPK | October 29, 2010 4:05 PM | Report abuse

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