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Rapid Responses to:
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Electronic letters published:
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif){kind=icon}
Do electronic medical records compromise patient privacy?
The Electronic Medical Record: Who Pays?
Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care
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Munir E Nassar, M.D., Ph.D. None, None
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mnassar1{at}rochester.rr.com Munir E Nassar, et al.
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It is refreshing to read the progress of addressing efficiency of care and cost containment in the articles of Dr. Chaudry and colleagues(Ann Int Med 2006;144:742-752)and the electronic responses of Dr Stark(17 May 2006),and Steinberg and colleagues(20 April 2006), as well as the Editorial of Dr. HaLmaka. In my opinion further studies are needed to assure the implimentation of ways of patient privacy from prying eyes. Second, it would be informative to all medical institutions and hospitals in this nation of ours, as to what does it cost in dollars to transform paper records into a system of electronic medical records. Third, How to have a smooth efficient system of medical provider alerts and peer review of abnormal or critical lab. results or drug adverse reactions /interactions, that have been reviewed by the provider in a timely fashion and acted upon promptly ? Who will do the peer review besides the provider ? Conflict of Interest:None declared |
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James J. Stark, MD Maryview Medical Center, Portsmouth, VA
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jjstark{at}starkoncology.com James J. Stark
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I read with great interest the article by Chaudhry et al (1) and the accompanying editorial by Halamka (2) on the value of the electronic medical record (EMR) in improving process and outcome in health care. As a Medical Oncologist who has seen his practice crippled economically by changes in Medicare reimbursement, and as someone conversant with the problems of internists in keeping their practices economically viable, I wonder who will pay for all of this. Some hospital chains are offering to their staffs the cost-saving opportunity to piggy-back on to their newly established EMR’s; however, software licenses for free-standing practices not affiliated with hospitals are likely to be very expensive. Taking old paper charts and transforming them into the EMR will be very labor intensive and expensive; unless hospitals develop interfaces with free- standing office practices the need to enter manually lab data and x-ray reports into an EMR will be extraordinarily labor-intensive and expensive. Unless a national EMR is established with links to hospital information and insurance claims systems many small practices will find adapting to this new world difficult to impossible. The specter of the government tying the level of Medicare reimbursement to the implementation of the EMR is particularly difficult for the small practice and arguably an unfunded mandate. Several well- trained and highly-regarded internists in our community have gone to a cash-only prepaid model (patients pay a monthly fee and have unlimited access to the doctor). A huge unfunded mandate will drive more capable physicians out of the mainstream into boutique practices. Only the federal government has the resources to underwrite a conversion to a unified national EMR. In the current climate in Washington it is difficult for me to believe that there is the willingness for Congress to fund such a venture. References 1. Basit Chaudhry, Jerome Wang, Shinyi Wu, Margaret Maglione, Walter Mojica, Elizabeth Roth, Sally C. Morton, and Paul G. Shekelle Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care Ann Intern Med 2006; 144: 742-752 2. John D. Halamka Health Information Technology: Shall We Wait for the Evidence? Ann Intern Med 2006; 144: 775-776 Conflict of Interest:None declared |
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Gregory Steinberg, MD ActiveHealth Management, Lonny Reisman, Daniel Halevy
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greg.steinberg{at}activehealth.net Gregory Steinberg, et al.
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The results of Dr. Chaudhry’s review are sobering. Despite more than 20 years of research and millions of dollars in development, health information technology systems appear disappointingly ineffective. However, the field is rapidly evolving, and systems are currently in use that can aggregate both clinical and administrative data at the patient level and apply evidence-based clinical algorithms to drive alerts and reminders. One such system was studied in a one-year randomized, prospective trial examining the effect of such communications on hospitalizations and costs in a managed care population. Nine hundred eight clinical alerts were issued to the intervention group out of a total population of 39,462 patients, resulting in 9.1% fewer admissions per thousand (p=0.03) and $8.07 lower in paid claims per member per month. Analysis of the subgroup of patients who actually received alerts showed 19.2% fewer admissions per thousand (p<0.001), and $68.08 lower in paid claims per member per month (p=0.003). We agree that several barriers remain, particularly related to changing physician behavior and increasing adoption of the technology. Our hope is that government and industry funded efforts will lead to improved information sharing and better overall health outcomes. References 1. Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC and Shekelle PG. Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care. Ann Intern Med 2006; 0. 2. Javitt JC, Steinberg G, Locke T, Couch JB, Jacques J, Juster I, Reisman L. Using a Claims Data-Based Sentinel System to Improve Compliance With Clinical Guidelines: Results of a Randomized Prospective Study. Am J Manag Care. 2005;11(2):93-102. Conflict of Interest:None declared |
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