Health

Poll: Why aren't more physicians adopting electronic health records?

Why do you think medical institutions slow to adopt electronic health records? Take our poll.

According to a piece in the MIT-published online publication Technology Review, only 15 to 18 percent of U.S. physicians have adopted EHR (electronic health records). If you work for a medical establishment that has yet to adopt the technology, we'd like you to weigh in on this issue by taking this poll.

About

Toni Bowers is Managing Editor of TechRepublic and is the award-winning blogger of the Career Management blog. She has edited newsletters, books, and web sites pertaining to software, IT career, and IT management issues.

50 comments
MountyTech
MountyTech

I am married to a physician which is a partner in her practice. The number one reason why they have not, is the cost. Most of the practices that have implemented EMR are affiliated with a hospital. Therefore the hospital picks up the cost.

Deadly Ernest
Deadly Ernest

here's a few why they should, and some advantages. My personal GP, here in Australia, has been using an electronic system for five years or more, not exactly sure when they started using it, but it was in obvious full usage when they shifted to their new building back in early 2005. They are part of a group of practices in four rural towns in the area I live in. The practice here is typical of all four, five doctors (one has seven) two visiting dentists, visiting specialists - ultra sound, psychologist, nutritionist, podiatrist, dietician, eye doctor (spell checker won't find the right word for me), pathology services. records are transferred between practices as required when people move between towns. Advantages include; x-rays and specialist reports are sent electronically to the doctor and received within 48 hours of being taken, some quicker. Doctors type their records, scripts are printed by the system, as are medical referrals and certificates. No confusion with the chemist about what a script is, or what test is wanted at the specialist - I still don't know what it means, but I can read it if I want to look it up. The big advantage, if I have to see a doctor at another practice within the group in another town while in that town, it only takes a few minutes to get my whole file. I can see big advantages to such a system. But can also see why some are hanging back. Now, some have spoken about unproven tech, this group have been using this system for five years, I think you can say it's proven tech. Why the same system isn't being used in the US, I don't know - but it could easily be used there, if it wasn't bought from there in the first place.

tomkinsr
tomkinsr

Benefits to EHR would be ready availability of information. Here in Canada, you see a GP. The GP then refers you to a specialist and only after they have sent you home, exchanged some FAXes with some specialists to find one with an open appointment that they then call you to tell you when and where to go and then they have to FAX a quantity of the GP's records to that specialist to prepare them for seeing you and down the rabbit hole we go. So, an EHR should also have access to the scheduling system of the various medical professionals, so that the records can be sent in concert with your appointment that would be arranged by the GP. If the record data were used anonymously, then drug information could be tracked such that long after a drug has been approved for use, it's efficacy can be monitored and if there were a bad batch, tracking the drug and the affected patients down would be easier as well as realistic. For the case of epidemics and pandemics, EHR would also facilitate containing outbreaks and narrowing down ground zero so that sample collections if required could be made appropriately. In industry, we ship everything to schedule, from the tiniest component to really large stuff, hardly anything sits on a shelf anymore, so why should the data sit on a shelf in a manilla folder. You can purchase a large screen LCD TV for around $300.00 at your local best buy that was made three months ago in China. If it wasn't for our efficiencies in moving both data and material, that LCD TV would cost over $1500.00. Time for the medical profession to get with it.

tomkinsr
tomkinsr

I canvassed my GP here in Canada, her response was that it cost too much, she was happy with her paper as it never had a power failure and she didn't want to hire someone to look after all that stuff. I put her down as a Luddite. Tablet's are possibly an enabling technology in this area. I have found that almost all dental practises make extensive use of computers and other technologies in their practises. My children's orthodontist uses a fingerprint scanner to check in all patients on arrival and emails appointment reminders through a CRM of some kind. He makes extensive use of imaging, both X-ray and digital camera. Overall, I would suggest that doctors do not get it.

Alzie
Alzie

Accuracy- Any time an extra person handles information there is a chance for an error. I'm thinking a transcriptionists here. Cost- An extra person on staff to handle transcribing the notes. Cost- purchase and training involved with the software. OS reliance- I read about a doctor's office that was using Windows 2k because the software would not work on XP. Apparently the software writer would not provide an update but would sell and new software package to the doctor. Durability- short of a flood or fire notes are permanent.

reisen55
reisen55

EVER look at the miles and miles of patient data folders in a medical office? Those racks of moving cabinets, with literally thousands of documents. The cost of conversion and scanning these documents to an electronic format is huge and time-consuming. Government thinks that everything can be done by passing a law and waving a magic wand, but the actual act of DOING THE DAMN JOB is neglected.

steffick
steffick

Having worked and been a patient in US health systems with electronic medical records, including the Veterans Health Administration, which has had EMR for quite a while now, and several university systems, I think the benefits in terms of cost-saving are being oversold. As has been said, many practices with EMR take their primary notes during the visit on paper and either enter them into the computer themselves or have them transcribed and entered. In the VA, patients have had very negative reactions to doctors staring at computer screens and entering data during the appointment. While I haven't looked in the literature, many questions could be answered by examining what happened with the VA as it converted from paper to EMR. The US has a myriad of privacy laws, one of the most important being HIPPA. I have personally been treated in system with EMR where my primary care physician's staff claimed they were not allowed to look up lab results ordered by my specialist - both of whom were in the same Internal Medicine department. Doctors always have a reason to re-run tests, mostly that time has passed since the previous lab test so things may have changed in the interim (particularly for chronic conditions), they don't trust the radiologist they don't know personally, etc. There is no central mechanism in the US to link together separate private practices, so there will still be duplication of tests done by a local doctor who then refers the patient to an academic medical center. While there are some prohibitions between sharing information listed in actual laws, lawyers have often given advice to hospitals that these prohibitions are more strenuous then they were even intended to be - I had one system ask me to sign a release saying it was OK for my specialist to share information with my primary care doctor. While this is explicitly allowed under HIPPA, some lawyer advised them to do this release anyway.

waldo21a
waldo21a

This is my field, and I'm not even going to vote on the poll, because none of the listed options are the true major barriers. The #1 barrier is cost (especially for small practices). These systems are expensive in cost, labor, and organizational disruption.

Al O
Al O

I believe the main reasons are that it is a big change from the way they have practiced for years. An EMR will definitely slow them down until they are familiar with the system, and they must be willing to change work habits in many cases.

Jack-M
Jack-M

After dealing with both sides of this issue, first, I'm convinced that the Doctors use paper records so they have an excuse not to have the patients records complete and at the touch of s finger to answer a question he/she might have.Second, it is expensive to convert to e-records and like any good small businessman they tend to pinch pennies and keep their bottom line as high as possible........Jack

MumpsGuy
MumpsGuy

When I first starte work in the commerical lab environment, the systems we had were based on old equipment like the DEC pdp 11/44. It was simply a cost thing as the labs didn't put a lot of money into IT. Yet as times changed, new ideas came to resolve health care related issues and get everyone going in the same direction. For example you have the national standards for submitting claims like 835/837s, but if these are national standards, how come the insurance companies all have different rules on what the want/need as data within this standard? Is this yet another example of the government running something that isn't working as planned. Currently we have a massive project to convert to a new EMR. The costs of the project is staggering in both time and money. That may be part of the problem getting practices to install a system. It is a big committment to the project. But in the long run, it will allow the docs to have better information when treating the patient.

ruchirs
ruchirs

Only to stay away to Comply with regulations, Less headaches and change of mindset..

helen
helen

There are outstanding differences between cloud-based systems compared to legacy client/server software, which generally requires the need to hire an IT consultant, and adds "hidden" cost to the whole EHR installation. However, Practice Fusion is entirely free and web-based. There is no cost for hosting, licensing, training or support, even though the product handles all aspects of a practice's operations. By definition, we have eliminated the main barrier to adoption for physicians - cost.

rjluvkc
rjluvkc

Change! Change can be scary...Physicians that have worked with paper most of their careers are not ready to go electronic. Young physicians will be more willing to utilize technology because they are familiar with it. Soon, physicians will not have a choice, they will have to utilize an EHR. That or they will retire!

GSG
GSG

The cost is tremendously high. The independent providers that have privileges at our hospital are running into issues with the cost, not just of the purchase of the system and hardware, but the professional services. For example, Product A may only cost $25,000 after stimulous money is received, and the hardware only $50,000, which ends up being reasonably affordable. The cost comes in to play because the independent providers don't run IT departments. In the past, if they had issues, more often than not, the Geek Squad came out and fixed their equipment. With the HIPAA regulations and the new HITECH regulations that were in ARRA, the Geek Squad isn't qualified to even walk through the doors. So, the independents usually end up contracting the professional services through the vendor at astronomical prices. We've even had independents calling us for help, which we can't provide without running the risk of violating the Stark Laws. So, some of our people will contract work out after hours at about 4 times their hourly rate at the hospital. The providers that are employees of the hospital are provided with an EMR that is part of our whole clinic system, so a patient seen in Dr. A's office, who is referred to Dr. B's office is assured that Dr. B has access to Dr. A's labs and documentation. The hospital IT department does all of the technical support, builds their forms, pays for the system, and is a liason with the vendor, which costs the provider absolutely nothing.

Deadly Ernest
Deadly Ernest

hardware and software and the maintenance. But, I think a real big problem is the inability to access if there is any technical problem. A nearby local doctor is part of a practice with several doctors and they use electronic files. Not so long ago, there was a bad storm and the server went down. It took the approved contractor two days to fix it and the doctors could only perform urgent or emergency services for those two days as they could NOT access any of the patient files until the server was back up, and they were not allowed, by their insurance company, to treat anything but emergencies unless they had the file available to check against and update.

Screen Gems
Screen Gems

and more importantly, just what are they going to do with the electronic health records? Make them available to paitents via the Internet ? what for? and if they do, the privacy/confidentiality laws come into play with legal ramifications. What if the database is hacked or if someone other than the patient accesses the records using the patient's user name and password such as relatives, husband/wives/kids? The risks of lawsuits outweight the benefits monetarily.

pshore73
pshore73

I think two answers you are missing from the poll are: 'Doctors fear technology due to lack of understanding' and/or 'Doctors simply don't want to change'

hwpratt
hwpratt

I hope you jest, sir: "her response was that it cost too much, she was happy with her paper as it never had a power failure and she didn't want to hire someone to look after all that stuff. I put her down as a Luddite." * A well structured and maintained paper record can be a perfectly acceptable way of maintaining patient records in a small office/clinic--the problem is that too many clinics' record management is in shambles. * The acquisition cost is significant, of course, and the on-going support cost is frequently understated by vendors. "Tablets...an enabling technology..." Perhaps, but first you must have software than is congruent with the practitioner's mental model of patient care and clinic workflow. There is no hardware solution without an appropriate software model. I worked in medicine with an IT special interest for 32 years and came to understand that the mental model of health care used by primary care doctors is vastly different than that used by nurses, pharmacists and laboratorians. A topic for a separate discussion should be: "How do the differing thought processes of various health care providers differ, and how should that impact design of the EMR?"

hwpratt
hwpratt

Computerized records take longer for the physician to complete -- if a system adds "only" 3 minutes per patient encounter time and a doc sees 40 patients in a day in the office, he/she has to work an additional 120 minutes to see the same number of patients!

okarthritis
okarthritis

This is exactly the reason. After working in the Healthcare IT for almost a decade now, I can safely say it is the fear of change. Most of the physicians are still older, and have a fear of computers and change. The next generation will be more likely to change easily, living (and going to school in) the digital age.

tmdowling
tmdowling

(Most, older) doctors are still accustomed to being gods. Having to follow the 'rules' inherent in having a functional EHR system will mean being knocked off of Olympus. Anyone who's spent time as a patient or family of a patient needing more than a quick, in-and-out treatment will tell you how critical this is measure is. Without it, offices within the same hospital often fail to communicate quickly or efficiently -- offices between facilities are sometimes simply unable to extend data at all.

misceng
misceng

As you will know there are extra costs of backup. This does not mean that electronic records are too expensive. All too often the costs are listed but the benefits are not. The ability to access complete records instantly reduces waste of doctor's time which is very expensive. If that was taken into account the cost of electronic records even with a backup server would be seen as a bargain. Here in UK my doctor is in a group practice which means that any doctor in the group will be instantly up to speed when I need him because the doctor I normally see is not available. The practice nurse knows what blood tests I should get when I go for them and the doctor has the results on the screen when I visit him a few days later. The efficiency that these records enable reduces the overall costs of the doctor.

GSG
GSG

The confidentiality aspect is handled through HIPAA. The EMR is not for sharing on the internet, but to replace the paper records in the office. The electronic record is far safer than the paper record. Plus, the doctors don't have a choice anymore. It's now a regulatory compliance issue and doctors' reimbursements are based on whether or not they have EMRs. Right now, they get paid a little extra, maybe they get back 25 cents on the dollar with an EMR instead of the 15 cents on the dollar that's the norm for Medicaid and Medicare patients. I forget the exact date, but there is a deadline for EMR adoption where their Medicaid and Medicare reimbursements will be dropped even more if they haven't implemented an EMR. So, they really have no choice in the long run unless they refuse to accept Medicare or Medicaid patients, which the independent providers do have the right to do.

prpetty
prpetty

I don't mind people knowing I have high BP, or my Cholesterol numbers aren't as good as they should be, but I'm dammed if I want everyone knowing I had syphilis (oh shit)...anyway you get my drift. Long term problems, sure, medications I take as maintenance, sure, but little things that have no impact on my future health or a doctors decision on how to treat me, nope. Not his/her business and I'm not willing to let every government IT professional or every doctor in the new medical bureaucracies being created have that information. That is the biggest problem I fear, fun reading for the masses?oooh look at this one, he got his penis stuck in a milk jar?look the piercing in her nipple got infected.

nicknic44
nicknic44

I am a GP in Australia, and here, most GP's use electronic health records. We try to run a paperless office, with results of all tests, all correspondence, emails, xrays all available electronically within a few mouse clicks. It works well, is much more efficient and time saving, which makes up for any down time the system experiences. One of the most basic advantages is being able to read the previous doctor's notes which previously may have required high level decription to decipher when handwritten. I advise switching to computer records yesterday!

Ron_007
Ron_007

It is still too early in the development of computer hardware and software. There is still too much complexity that has to be mangled (sic) manually. Old system: paper (blank or preprinted form), pencil/pen, folders, filing cabinets and people who learned to read in grade school (maybe with additional medical training later) to do the filing and retrieval. New System: Computer (very complex), Operating system (unbelievably complex), Application Software, Network, Storage, Disaster Recovery (mandatory when you have an e-system, not required for paper), training for all users (Dr and Nurses), ongoing upgrade training, trained technicians paid as much as Dr's charge to constantly maintain the technology. Many years down the line, when computing and network infrastructure has become a utility and is as transparent and pervasive as paper and pen or electrical system or water system, only then will electronic medical records become common. Because the underlying technology will be mature and will actually be a utility that even a 3 year old can use. And when all of the legal (HIPA etc) implications have been smoothed out and general knowledge (like the automotive rules of the road). For now the same people who buy new technologies as soon as they are available, paying the high bleeding-edge price premium, will try to go electronic. You know the guys who have quadraphonic LP, 8 tracks, Cassettes, 8" laser disk platter, CD, DVD, Blu-ray systems the size of suit-cases in their attics and basements. Sure they will see some advantages, but they will also pay the bleeding-edge adopter premium.

Lazarus439
Lazarus439

Too expensive to convert with on clear payback No well-defined standards (VHS vs. Beta or Blue Ray vs. whatever-it-was)

Hal1000
Hal1000

The typical physican is in a small business. He has to be the professional and still run a profitable office. Keeping up with the new drugs and treatment is difficult enough. Add all the insurance red tape and regulations to it an he won't have time for golf. His office manager must direct the office system. He has to trust that person. That manager must implement the system and train the doctor to use it.

rclark
rclark

Because they are decision makers and they dont see a ROI. We are installing Focus 6.0. About two years in and lots of change from an inhouse developed HIM. The long term benefits will be lowered cost of healthcare, but the short term capital investment is crippling to expansion and to enhanced services. Tech is tech, but EHR is more than the sum of its parts. As we have gotten more information available instantly, protocols can spot an anomaly much faster, sometimes on entry. Warnings that would have taken an FTE pharmacist, dietitian, lab supervisor are getting automated. Watchdog systems are being implemented to determine outcomes prior to sentinel events. Add to this computerized physician order entry and bedside administration and verification of medications and you have a good chance of reducing one of the highest costs of not having an EHR which is medical mistakes and adverse outcomes. Doctors are people too. They desperately want all the help they can get to do the right thing for their patients. What they will not do is waste time doing grunt paperwork just to satisfy a regulation they see no value in. If it helps them to provide solutions to patients, they will adopt it, much quicker than anyone expects. So the major problem I see in the adoption process, is there is no standard solution package that works and provides what they need in their practices. This stuff is not easy to implement, and the results are mixed when not done correctly. So from their point of view, why should they adopt an expensive, complex system that will reduce the kind and number of services they can provide and will not materially affect their ability to deliver care? Just because the government is going to cut their reimbursement 10% in 5 years? 10% of nothing is still nothing. When they don?t make any money on Medicare/Medicaid patients now, and the Doctors are going to receive even less in the future, how long do you think it will be before the elderly and poor can not get healthcare anywhere? So if you want to truly impact the adoption process, there are two major steps you can take to speed the change. First, totally exempt IT from Stark provisions. Second, up the percentage on all IT costs and investments to 100% on the cost report for the next 10 years. The first provision will allow the creation of meaningful sharing of resources between regional health systems and physician practices. The second will allow the health systems to partially defray the costs of providing help to physician practices in the form of support and implementation. Together, they will broaden the adoption of more sophisticated EHR systems into smaller practices. Anything that will lessen the cost of implementation, increase the support available, and reduce the training needed to succeed. When you talk EHR it is not about competition, it is about cooperation.

peter
peter

In the UK, the National Health Service has been providing health care free at the point of use since 1948. Only about 8% of the UK population use private health care, mostly paid for by insurance, and generally as an adjunct to the NHS. In the UK all medical records are held electronically. The major advantages are: 1. Wherever you fall ill, your records are immediately available, anywhere, so medical history and current medication can be taken into account when considering a diagnosis. 2. Go for a blood test, x-ray, etc. and your physician can access the results on-screen, without postal delays. 3. The physician may consult, online, with a specialist anywhere in the country, making a wider knowledge base available to the general practitioner. The US spends more on health care, per capita, than any other country; two to three times as much as the UK. This is largely due to fragmentation and duplication of resources, e.g. IT, and the insurance-based system which inevitably results in higher costs.

eternal_life
eternal_life

A M.D. has no use for collecting data sheets as the heart is always situated hidden under the thorax, the liver and other organ is also wellknown, therefore there is no need to update this verified data, as it always is the same. Beyond that lies a common supspisciosness among Doctors to get to know the computer as the computer currently disobey and not is 'bow' and celebrates the Doctors typing on the machine, and a Doctor is used to be view as GOD, and as the computer does not care about this fact, in fact the computer give a [censored] about WHO is trying to access the machine, the Doctors therefore condemn and judge the usage of Computer sciene as 'false' 'none-validated' unreliable and set the diagnosis that the data the computer products/present as useless. Better thrust the stethoscope. Once and for all. FYI. IF some Doctors are gathering around a client/patient who is dieng, about to die and struggle for his/hers life, the exclusive right to set the state as "the death apperad at timestamp, that privelege is mandated to Anesthesians. No other, no matter brainsurgeon, cardiologyist, or any other spec. To set timestamp an verify the Ad Mortem and not to proceed with more lifesaving methods is and will alwasy be the exclusive rights of the Anesthsian Doctor. That one is the Uber-God. Sort of.

srlevine1
srlevine1

The major assumption that comprehensive health records are useful is somewhat in error. Test results immediately after a test or when the patient is being referred have value. And in emergent situation, only gross findings may be relevant as tests to rule out conditions based on presenting symptoms are going to be ordered. Add to that the time, effort and trouble of adding crappy data with handwritten physician impressions and you have a nightmare of potential problems. The inaccuracies of diagnosis codes for billing complicates the matter. (Was it a cosmetic rhinoplasty or a response to a deviated septum that resulted in a nose job? Was an appendix removed just because we were there and we didn't know what caused the general inflamation?) Just because we can write something down does not make it true or accurate. How many people receive antibiotics for an general infection rather the STDs? Few doctors have the time and patience to do their own data minining and fewer still really trust lab results and impressions that are not confirmed with their own lab tests. So what is the utility of having tons of data online? A paperless hospital sounds great -- but the true benefits are achieved with the transmission of contemporaneous test results between facilities and physicians at the time of the consult. Not in the archiving of data which becomes more out of date and useless as the patient ages. The best answer is a secure patient data respository with a log of only major events and findings (an index if you will) and an ability to reference further data if necessary.

Deadly Ernest
Deadly Ernest

costs - in this case, things like: Hardware, computers and network, Software, Time taken, and teachers, to train doctors and staff, Staff hours to convert the records over, Hiring technical staff to maintain the equipment and software, Replacements and upgrades as required. the old paper system, once set up, required next to nothing in the way of maintenance, just some extra sheets of paper for the doctors to write, every now and then. The new IT systems require preventative maintenance, fault fixing, replacement every four or five years, software and hardware upgrades - yes, extra costs.

Screen Gems
Screen Gems

While most medical [and dental] offices bill electronically they don't send PHI [protected health information] as part of their billing. There's a whole process for determining whether a medical facility must comply and often it's hospitals that end up having to comply. From the NAHU web site: ..Covered entities: " These are health plans, healthcare clearinghouses and most healthcare providers. (A provider is a covered entity only if it transmits health information electronically in connection with certain standard transactions, such as claims submission). If a covered entity doesn't transmit health information electronically, that is meaning personally identifiable health information, they don't have to comply.

Excelmann
Excelmann

A specialist has his own practice, has hospital privileges, and consults as part of a group. Each entity has purchased a different system which unless it is 100% compatible with the other two, errors with irreparable consequences may occur. Additionally, the doc has to learn how to operate three different systems/devices. Don't forget security issues (PHI and HIPAA). Are you going to allow the doc to use the same userID and password on multiple systems and how often will he have to change passwords? And as soon as the group or hospital is bought or merged with another, it is time to learn a new system and ditch the old. I have seen organ transplant billing where 48 (four dozen) different doctors had consulted, treated, diagnosed, confirmed, etc on one patient's transplant. So with a mandatory EHR requirement, you have a choice between a monopolistic (read prohibitively expensive with little useful functionality), single choice decision with no chance of entrepreneurial improvement and innovation (AKA government/GE) or anarchy of many partially compatible & generally reliable systems (possibly affordable, efficient, easy to use, but questionable accuracy, interoperability, and completeness with other systems). I'll go with our private system over a govt system any day. Five Year Survival Rates: Breast Cancer: UK, 70%; US, 84% Prostate Cancer: UK, 51%; US, 92% My neighbor is a former Brit, now naturalized American. Before he immigrated, he was involved in a car accident with cerebral skeletal injuries requiring surgery. Fortunately, his employer had private insurance which allowed the surgeon to operate the next day. NHS provided care would have put him at the end of an 18-month waiting line with the same surgeon. Source: Lancet Oncology, 2008

svilla8874
svilla8874

When you compare a provider in a system with electronic records to one without, the benefits are clear, especially if you see multiple providers within the system. Information is readily shared and available to all concerned. My husband had a heart attack and was taken to a hospital outside our system where I watched them labor with cumbersome paper charts. Just locating pertinent information must have become very difficult in what became a 5 inch thick binder of his information. When he was transferred to a hospital in our insurance system, they immediately input his records so that any health care professional helping him could easily review his history and information. What could be better than that? I've watched Doctors in our system adapt to using the online system and have to say it must be better for them as well, once they get over the hurdle. Writing is writing, whether you use a typewriter or longhand - the content is what matters and that's the part that hasn't changed. I think a doctor can make crappy, unclear and incomplete notes as easily in longhand as they can typing.

Dr Dij
Dr Dij

thieves - backup tape was stolen if I recall, with health records of huge# of brits.

Deadly Ernest
Deadly Ernest

specific conditions that require notification at time of emergency treatment. I know of a few like that, where the key information is carried by the person and they also have a membership number on a bracelet or necklace they wear at all times. The few I know of are all pay for system where you pay an up front fee to be a member, but it pays off in an emergency.

Deadly Ernest
Deadly Ernest

another doctor, or just sharing information when I ask them to. I wonder what doctors are like in your area - or if the laws are different. I've lived in a couple of states now, and I do know the state laws on privacy and control of the medical profession are different between the states. In one, I asked for the file, the doctor made a copy for their records (legal reasons) and gave it to me to hand to the new doctor when I get settled in the new location. In another state, they weren't allowed to do that by the state law, and had to fax it over when the new doctor sent them a written request for it over my signature. The docs had no trouble with sending it on. Mind you, the same issues will apply with an electronic file, too.

harryolden
harryolden

What I have found that the Doctor does not want to share your file with another doctor or thy dont want to release it Thy treat it like it is thier property and not yours My self I think you should be able to take your file to another Doctor and be treated by whom you would to be treated.

Deadly Ernest
Deadly Ernest

except in an ER and the patient has just arrived. In a normal surgery, using a paper system, the receptionist / nurse gets the file out and checks it's current, then puts it out for the doctor to grab when they call the patient forward. As to the paperwork, under the laws here, they still need a paper file as the first visit requires certain forms to be completed by the patient and signed, and other documents also need to be kept in print format for legal reasons. So there is NO space saving at this time. However, in an existing practice looking to go from paper to electronic, they already have the paperwork system in place and working, so no cost saving is generated at all. There may be, if the laws permit it, a saving later when the space for those files is emptied - but that won't happen for a long time after the change.

jruby
jruby

The floor space cost for all the paperwork, the effort required to correctly file paperwork, the time required to retrieve a paper record. I work with doctors who have been using EMR for several years and they fret when it takes 8 to 10 seconds to pull up a patient chart on the screen, but some do appreciate the fact that it no longer takes 8 to 10 minutes to get that same chart out of a file room down the hall.

Screen Gems
Screen Gems

The Privacy rule is the only set of rules that cover both paper and electronic information. Paper documents have always followed the privacy rule even when there weren't any regulations in place. In the medical industry, there was a standard practice of patient/doctor confidentiality rights. The HIPAA privacy regulations is simply stating what the medical industry already did in protecting the patient/doctor confidentiality rights. But the bulk of HIPPA privacy, security rules deals with the electronic transmission of patient information which ensures confidentiality and upholds the patient/doctor confidentiality laws and the rules really pertain to certain electronic transactions which has information such as payment and payment history, medical conditions, health status that can be linked to an individual person. Given that virtually the entire medical record is that, any disclosure falls under HIPAA in the privacy or security rules. However, ePHI transactions really relate to billing/insurance and clearing houses. If you send in your billing by paper, as long as you adhere to the privacy rules, you comply and the medical industry has done that for decades.

GSG
GSG

I'm the HIPAA security officer for my organizaton and a certified HIPAA professional. Yes, when you bill, you do send ePHI. The patient name is ePHI, and you have to send that, insurance info, etc.. along with diagnosis codes that are all ePHI and are protected information. Doctors offices are Covered Entities. HITECH covers ONLY the electronic transactions, but HIPAA covers paper as well as electronic transactions. So, if a doctor wants to continue in paper, he has to comply with HIPAA regs as he sends his paper to a clearinghouse (who he will have to pay to convert his paper to electronic data). At that point, with the new HITECH regs, the clearinghouse is now a Covered Entity and because they are transmitting and storing electronically, they have to comply with both HIPAA and HITECH. Working in paper does not excuse an entity from following the HIPAA regulations. It just makes it harder for the entity to track the required information. For example, the department of Health and Human services now requires that all breaches be reported yearly with the exception being breaches of 500 or more records. They do not distinguish between paper and electronic breaches. PMC Medicare choice of New York, MMM Healthcare of New York, Care Clinic of Illinois, Brown University of Rhode Island, Kern Medical Center of California, Brooke Army Medical Center of Texas, all reported that they mishandled and lost paper records for more than 500 patients, and that was in only the 1st 3 months of when reporting had to start. The problem with paper is that it's very difficult to figure out just whose privacy was violated.

Deadly Ernest
Deadly Ernest

they call uninsured, and level of insurance. According to the US Census the USA has 307 million people - but there probably is another 13 or more million illegals unaccounted for. But, let's take 307 million and you say only 20 million are uninsured and half are fit young people. What insurance covers the unemployed, the homeless, poor, and elderly without much money? The US government stats puts 12% of the population at below the poverty line - and they wouldn't have insurance to cover expensive operations - that's over 36 million right there. The US government stats puts unemployment at about 9.3% there's another 27 million who are unlikely to have insurance. Then those on the basic insurance that doesn't cover the more expensive operations. And if they do, how much to they pay for the expensive drugs required following the operations for cancer treatments? Then lets go have a look at the stats for the periods the surveys covered.

prpetty
prpetty

But when you look at the un-insured in the US you find about 20 million (if you don't include the illegal aliens). About half of that 20 million are young healthy adults that opt out of getting insrance. Given a country with 320 million people the stats don't seem that far out to me.

Deadly Ernest
Deadly Ernest

make sure you are looking at the EXACT same sets of surgery stats. I'm no advocate of the UK or Aust National Health system, but one point they do have ahead of the US private health system is people are seen, diagnosed and treated - regardless of their economic situation. Another thing I hate worse is people trying to compare stats that are not related to each other. In the UK system you can be sure that the number of people with Breast Cancer or Prostate Cancer included in those stats is better than 95% of those with it, if not actually 100%. On the other hand, you can be just as certain that the number with those illnesses in the US treated for those illnesses is no where near the 90% and likely to be very much lower than that. Why you ask - economics, those who can't afford the treatment or diagnosis won't be treated, so they won't show. And it's those at the low end of the economic scale that are less likely to recover well. Thus, where the UK has more people surviving less than 5 years, in the US, they don't even get the chance at those five years as they don't get treated because they can't afford it.

wendygoerl
wendygoerl

The so-called "health care" reform bill--excuse me, LAW--isn't just mandatory insurance, it's mandatory EHR, too. Viewable by anybody with a government-recognised interest in your health--no consent required, no opt-out allowed.

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