Cost control
February 19th, 2010
The full savings potential of electronic health records (EHR), or lack thereof, is not entirely clear. But there may be certain instances where EHR can lead to savings. A new article in Forbes examines a few such instances. Here is an excerpt:
The Milliman Group did two studies on so called “multi-payer” portals that work with multiple insurers and found that portals such as NaviNet save doctors an average of $20 per patient, per visit. The savings for an insurance plan covering 500,000 people is estimated between $14.5 million and $15 million a year.
Now extrapolate that out to the entire population of the United States. We’re talking more than $9 billion in annual savings.
You are quoting issues of the 1980s. Both of your points are pirmarily Republican talking points and do not speak to the functional inefficiencies within health care delivery. What about how conflicts of interest affect care and the accuracy of research? Companies extraordinary use of patent claims on gene assessment and other methodologies. Capitalism is totally running a socially driven system. Its ludicrous! Look at how the financial system collapsed in 2008. All the voluntary reporting mechanisms failed. Same issues exist in health care and the result is poor QA and outcomes.
Something that few people talk about, Quality of the Health Care Provider. My spouse is a health care provider, many times I hear or see first hand the total disregard for human life. Poor procedure, unclean environments, lack of urgency the kind of things that lead to people dying an early death caused by a health care worker. There is little regulation until someone makes a mistake. Between poor health care coverages, poor providers and overwhelming increase in cost, its a wonder any of us are still alive. Lastly, I find is appalling that certain parties and politicians find it proper to waste lives, allow people to die in pain or otherwise when it is with-in their power to help or even save them. There is no difference between witnessing great suffering and causing it, when it comes to human life if you do not aid in the solution your the problem.
EMRs depersonalize patients by presenting them as boxes to be checked and blanks to be filled in and, of course, make privacy of medical information even more of a joke than it is now. In addition, EMRs present the patient as nothing more than collection of data. My own doctor, whose office spent $500,000 for an EMR system, says when he looks at each EMR, it’s only clinical information – “I can’t tell who that person *is*. Yet, excellence in diagnoses and treatment includes far more than just clinical information. It includes knowledge (not just test results or boxes checked) of patients’ histories, family situations, current work and home situations, psychosocial stresses – all contemplated and processed in a cognitive fashion by a well-trained physician.
Government medicine doesn’t allow for that. It’s goal is to reduce costs through standardization, reduction in services, and delegation of diagnoses and treatment to the less-trained. Patients, however, aren’t “standard” – and never will be.
To see the future of socialized medicine in the U.S., look at what’s happening now with the British National Health Service (you won’t see this in any American media):
http://www.dailymail.co.uk/health/article-1016262/Grandmother-dies-NHS-cancer-treatment-withdrawn-paid-privately-life-extending-drug.html
http://www.dailymail.co.uk/news/article-1054606/Patients-turn-black-market-buy-cancer-drugs-pay-NHS-treatment-warn-experts.html
Cash is king. It always will be. If patients paid physicians directly, as they did pre-Medicare, instead of paying thousands of government workers (and unnecessary workers in doctors offices to process claims) healthcosts would plummet. Doctors would be responsible to their patients, not to the government. There is no better watchdog of a patient’s wallet than the patient.
@Marc Wilton, MD
Marc, I like your comments. Here’s a few other thoughts:
1. The depersonalization problem comes from giving IT folks too much leeway in designing EMR systems. No disrespect to IT folks meant here – their way of thinking works great in their own field but just doesn’t translate well to ours. I designed the templates for our EMR myself and avoided overuse of blanks and drop down menus, opting instead for “physician narratives”. That allows us to document well the human element to a patient’s background that you correctly point out is often missed.
2. Because of CPT billing requirements EMR entries are often quite long and contain too much “white noise” – too much demographics, too many irrelevant details, etc. I have seen 5 pages EMR notes for a patient that came in with impacted ear wax!
3. Docs MUST take the lead in EMR implementation. If we oppose EMR and CPOE because we dwell on its shortcomings then our history with managed care will repeat itself. We will allow non-physicians to create and force upon us a completely unworkable system.