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Noam N. Levey's interesting and well-written article March 15 on the future of electronic medical records made some important points. EMRs have several potential advantages over the current system. But the expectation that they will reduce costs in an outpatient setting like a doctor's office is far-fetched.
Rather than control costs, electronic medical records in an outpatient setting increase them. The systems are expensive to purchase and maintain, and have been shown to reduce productivity for up to a year after they are instituted. The figure of $30,000 per physician is, in my opinion, optimistic. Ignoring the purchase price, the maintenance costs alone for many of these systems can exceed $1,000 per month per physician. Because EMRs can decrease productivity, fewer patients may be seen per hour, and charges would have to rise in response. These costs would be passed on to patients, as any expense would be in any business. The result could be increased insurance premiums, higher co-payments or decreased access to physicians.
Many issues need to be resolved before EMRs become viable in most doctors' offices, including mine. Vendors who sell EMRs have in some cases gone out of business, dropped support for the products they sold, increased the fees they charge to maintain systems, stopped offering technical support in-house, required office-based data to be transferred to the Internet as a condition for continuing service and the like. Nor is there any requirement for one EMR system to interface with another one. As a consequence, whenever patients changed practices, their charts would still have to be printed on paper. As a physician, I can tell you that there are few things as irritating as having a new patient present you with a disc with their medical record on it that my computer cannot open.
Certainly computers have their uses in medicine, and every opportunity should be taken to optimize the benefits of patient management. But for primary-care physicians in an office-based practice to blindly leap off the cliff of an immature and expensive technology based on an irrational hope that electronic medical records will reduce costs and increase efficiency is, at this point, spectacularly unwise. The time for EMR may be coming, but it has not arrived.
Glenn S. Schlundt, MD, MPH, FAAP, is a pediatrician at the Rose City Pediatrics Medical Group in Pasadena.
Rather than control costs, electronic medical records in an outpatient setting increase them. The systems are expensive to purchase and maintain, and have been shown to reduce productivity for up to a year after they are instituted. The figure of $30,000 per physician is, in my opinion, optimistic. Ignoring the purchase price, the maintenance costs alone for many of these systems can exceed $1,000 per month per physician. Because EMRs can decrease productivity, fewer patients may be seen per hour, and charges would have to rise in response. These costs would be passed on to patients, as any expense would be in any business. The result could be increased insurance premiums, higher co-payments or decreased access to physicians.
Many issues need to be resolved before EMRs become viable in most doctors' offices, including mine. Vendors who sell EMRs have in some cases gone out of business, dropped support for the products they sold, increased the fees they charge to maintain systems, stopped offering technical support in-house, required office-based data to be transferred to the Internet as a condition for continuing service and the like. Nor is there any requirement for one EMR system to interface with another one. As a consequence, whenever patients changed practices, their charts would still have to be printed on paper. As a physician, I can tell you that there are few things as irritating as having a new patient present you with a disc with their medical record on it that my computer cannot open.
Certainly computers have their uses in medicine, and every opportunity should be taken to optimize the benefits of patient management. But for primary-care physicians in an office-based practice to blindly leap off the cliff of an immature and expensive technology based on an irrational hope that electronic medical records will reduce costs and increase efficiency is, at this point, spectacularly unwise. The time for EMR may be coming, but it has not arrived.
Glenn S. Schlundt, MD, MPH, FAAP, is a pediatrician at the Rose City Pediatrics Medical Group in Pasadena.
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