Jim Schibanoff of the Milliman Care Guidelines, Scott Armstrong of Group Health, John Hammarlund of CMS, and Joe Scherger of Lumetra discuss physician adoption of electronic health records.
Q: Jim Schibanoff, we’ve talked a bit about the cost and investment requirements of adopting these systems. I’m curious also about the impact on providers of learning these new systems, learning how to use them effectively. Is this potentially a larger burden for healthcare providers?
Jim Schibanoff: Well, it’s great to hear Scott describe Group Health’s experience, the after, because most physicians are dealing with the before, which they see as great disruptions to their routines of care, more inefficiencies in their practices. They feel under financial pressure already and here it’s taking more time to use this electronic health record. So getting over that hump is a significant issue. And in systems like the VA, Kaiser, I believe Group Health, there is much more of a group culture. There’s a financial mechanism, a delivery mechanism. The physicians are more integrated into the system, as opposed to all the physicians in private practice who are in one or two physician offices and may go to one or two hospitals.
Will Fox, Principal and Consulting Actuary at Milliman; Scott Armstrong, Group Health CEO; Joe Scherger, MD, Consulting Medical Director at Lumetra; and John Hammarlund, Regional Administrator for the Centers of Medicare and Medicaid Services, all address this question.
Q: Where is the return on the investment for the patient’s pocketbook resulting from the savings involved in health care information systems and electronic health records? When can patients see some tangible, monetary benefits themselves? We’ve talked about benefits to the providers and so forth, what about the patient?
Will Fox: I think that’s a big key. How often, if ever at this point, are patients told what these things are going to cost? When they get an X-ray for back pain, do they know how much it costs?
Scott Armstrong, Group Health CEO; Rich Moyer, MedInsight Project Manager; George Scriban, Microsoft HealthVault Senior Global Strategist; Ron Sims, King County Executive; John Hammarlund, Regional Administrator for Centers for Medicare & Medicaid Services; and Gail Graham, Veterans Health Administration Director of Health Data and Informatics, address this question as panelists at Healthcare Town Hall.
Barry: It would seem that having consumers have exclusive or primary control over the records and portability, therefore, would eliminate incentives for healthcare providers to invest in record systems insofar as it’s going to liberate the customer to go wherever. So the question is, is that a tension for you as a provider, a disincentive for you as a provider?
Scott Armstrong: I don’t really care who owns the data. You know, this data, I think, and these systems, are going to be ubiquitous in, I don’t know, six, eight, ten years, and that this discussion right now about who controls the data I think is just really a short-lived discussion.
George Scriban, Microsoft HealthVault Global Stratgeist, addresses this question as panelist at Healthcare Town Hall.
Q: George, is this a situation where industry standards will resolve issues, or is it more of a winner-take-all situation with HealthVault as Windows of the future for healthcare?
George Scriban: Well, it’s an interesting question. Obviously, I don’t think this is a winner-take-all situation simply because the business here isn’t so much trapping data. The business, particularly for a platform like HealthVault, is actually liberating it. Right?
Q: Gail Graham, in the case of the V.A., who owns the patient records in your system?
Gail Graham: Well, by statute, V.A., as the custodian of the record. But the information is actually owned by the patient, and the control and the release of that information is owned by the patient. We do have legal parameters for how we keep it and the duration for which we keep it. But disclosures of that information are established in the Privacy Act and in HIPAA. And I think for us, too, our patients have a long history of maintaining a copy of their record that dates back to their military service. So even before provisions of HIPAA allowed for amendment and getting copies of your records, it was a very commonplace thing for the veterans to keep a copy of their medical record as they moved around.
Q: What have early adopters of electronic health records experienced? What key factors determine their success?
Jim Schibanoff: There’s a combination of what’s actually occurred, what medical evidence shows about what electronic health records do to improve care, and then what is the promise. We tend to hear more about the promise of the future than what has actually been proven to be effective. The thing that has been proven to be effective is in the hospital setting where physicians use the computer to write orders that are legible, cannot be mistaken in the decimal point, or the number can’t be mistaken. Medication errors are drastically reduced, and the turnaround time from the time that the order is written until the medication is delivered to the patient is markedly reduced. That we’re agreed upon.
Everything else is a hope and an expectation depending upon factors that we’ve already heard. Just putting computers into a broken healthcare system makes it faster—and broken. You need to improve the healthcare system as you make it electronic. You can’t have one without the other.
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