Obamacare

Are Government-Mandated Electronic Records Making Health Care More Expensive?

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Photo credit: The Doctr / Foter.com / CC BY-NC-ND

In today's Wall Street Journal, surgeon and Reason contributor Dr. Jeffrey Singer makes the case against the federal government's electronic health records program. Electronic systems distract doctors by requiring them to face screens rather than patients, he argues, resulting in worse bedside manner and more time spent futzing with electronic systems than real human beings. Singer also points to some evidence that they drive up the cost of care: 

[A] Deloitte survey also found that three of four physicians think electronic health records "increase costs." There are three reasons. First, physicians can no longer see as many patients as they once did. Doctors must then charge higher prices for the fewer patients they see. This is also true for EHRs' high implementation costs—the second culprit. A November report from the Agency for Healthcare Research and Quality found that the average five-physician primary-care practice would spend $162,000 to implement the system, followed by $85,000 in first-year maintenance costs. Like any business, physicians pass these costs along to their customers—patients.

Then there's the third cause: Small private practices often find it difficult to pay such sums, so they increasingly turn to hospitals for relief. In recent years, hospitals have purchased swaths of independent and physician-owned practices, which accounted for two-thirds of medical practices a decade ago but only half today. Two studies in the Journal of the American Medical Association and one in Health Affairs published in 2014 found that, in the words of the latter, this "vertical integration" leads to "higher hospital prices and spending."

Here's another problem: The systems don't work. Not like they were supposed to, anyway. Electronic health records were supposed to make it easy to transfer records from one provider to another, increasing integration and coordination between providers. In the relatively small, self-contained health systems that have long used these sorts of records, that's how it works. 

But not in the systems spurred on by the federal government. 

Most current health IT systems are "quite clearly" not interconnected or interoperable, according to a 2013 RAND study looking at the adoption of health IT. "The health IT systems that currently dominate the market are not designed to talk to each other," the study reported. Rather than enable and encourage broad access across multiple provider networks, they end up creating a kind of lock-in to individual provider organizations. Or, as the RAND study puts it, they effectively serve as "'frequent flier cards' intended to enforce brand loyalty to a particular health care system." 

Imagine that: The federal government set up rules intended to encourage provider openness and sharing. Instead, those rules make health care more closed and opaque than ever. 

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  1. Any sufficiently advanced incompetence is indistinguishable from malevolence. (with a nod to A. C. Clarke)

    1. I don’t even get 2 guesses?

      1. You get one. Everyone gets one.

        1. you aren’t the boss of me, Oprah!

            1. Whoa!

            2. so THAT’S what happened to the bees…

  2. Look, do you want all your intimate medical information easily leakable or not?

  3. The wrong answer is “no”, right?

  4. Electronic health records were supposed to make it easy to transfer records from one provider to another, increasing integration and coordination between providers. In the relatively small, self-contained health systems that have long used these sorts of records, that’s how it works.

    I think we’re forgetting the most important thing here: Electronic health records makes it easier for the government’s bureaucrats to seize and search your records for any wrongdoing you’ve probably engaged in.

    1. Exactly. How else will they find out if you’re doctor shopping for oxycodone scripts?

  5. Fewer doctors and poorer quality medical service for all!

    1. the perfect endgame for the alien invasion!

      1. I, for one, look forward to our future, inter-galactic overlords.

  6. “Doctors must then charge higher prices for the fewer patients they see.”

    Or, we could just tell them how much they are allowed to charge. Problem solved.

    1. that’s TOP MEN thinking right there!

    2. You sure you ain’t the smartest man in the world?

      /Idiocracy

  7. I predict the health record database would overflow with all that is in Warty.

  8. You know, my general practitioner, the gal I see first and most often, knows me, my medicial background and needs. These EMRs are as unnecessary as they are expensive.

  9. What doesn’t government make more expensive? It’s one of the truly mind-boggling things about the net neutrality nonsense–more government is supposed to improve and cheapen service? When has that ever happened?

    1. well, hmmm….

      I’m sure… what about?…

      space exploration? I mean, we have no way to PROVE it, but surely government studies show it’s a cost savings.

      1. Nope. They don’t even kill, their best thing, in a cost-effective manner

  10. Then there’s the third cause: Small private practices often find it difficult to pay such sums, so they increasingly turn to hospitals for relief. In recent years, hospitals have purchased swaths of independent and physician-owned practices, which accounted for two-thirds of medical practices a decade ago but only half today.

    It’s almost like regulations create barriers to entry and benefit larger entrenched firms…

    1. Nope, never happens. Regulations never adversely affect businesses, except when applied to abortion providers.

  11. “The doctor is in.”

    1. Are you captioning the Suderman’s photo above?

      1. Yup.

        1. Nice.

  12. But computers are so useful and electronic records sounds like a common sense improvement, so it must be good. And since it is good, a government mandate will only make things better quicker.

    How could any of this be wrong?

    1. with that level of sciencey thinking behind it it must be true!

    2. Just like business people, computer people are capable of anything as long as you tell them to do it and give them enough pressure.

  13. The premise was that EHRs would allow for better quality of care, thus reducing the global cost of health care in the long run. So far, there is very little reason to believe that this is, or will, happen.

    Some fools may have been saying they would reduce costs in the short run, but, hey, fools.

    1. Our hospital spent itself nearly to default on an EHR– until we had to get taken over by a huge mega-corporation which is apparently spending itself into default– but with a much longer tail due to much deeper pockets, and as a result, I and my entire department were outsourced to India to save on IT costs.

  14. But what if my medical records are on a 8 inch floppy? I’m joking around but thirty years from now whatever is currently cutting edge will be just as obsolete and unreadable.

  15. Gov’t IT systems! They are the standard to which all others should be held!:

    “Buried in the fifth paragraph of a Fiscal Times story surrounding Healthcare.gov’s persistent inability to function is the costs that taxpayers are expected to shoulder for this debacle. The construction of the ACA’s federal web portal and the subsequent repairs this site required have to date cost the country? wait for it? $2.2 billion. For a website. As recently as last summer, Healthcare.gov had only cost the government $840 million. Apparently, the costs associated with maintaining this site have nearly tripled.
    By way of context, the tech site Executionists.com estimated in 2014 that the average large-size business’s e-commerce site with all the bells and whistles could cost between $14,7000 and $29,900 to design, construct, and launch.”
    http://hotair.com/archives/201…..extension/

    Didn’t Michelle have some acquaintance with a principal in the bizz that delivered such a wonderful product?

    1. Luring all those FORTRAN and COBOL developers out of retirement doesn’t come cheap.

      1. bingo. the website needed to interface to multiple obsolete government systems that had no commonality and had entrenched bureaucrats demanding conformity to their standards

        1. The guys who change the reel-to-reel tapes all day probably start at around 100K.

  16. when it’s “govt-mandated” whatever, is the result ever less expensive?

    1. FREE INTERNET YOTTABITS/NANOSECOND!!!!!

  17. But, but, everything electronic is awesome and this Prez is cool and hip so hospitals MUST use EMRs!!!

    -progressive millenial

  18. physicians pass these costs along to their customers?patients.

    Uhhhh, wrong, and that’s always been the big fuckup with how things have been done for the last 50 years. The person who pays the bill is the customer. The insurance company is the doctor’s customer. The employer is the customer for the insurance company. The patient doesn’t enter into the equation anywhere.

    1. Unless your self employed then your stuck with all the bills and the screwups

  19. And then there was “I’m from the government and I’m here to help”.

  20. ha, the least they could do is put the computer screen behind the patient so doc could at least pretend to be talking to the patient. The first time a doc turned his back on me and fiddled with the computer I thought it was both rude and weird. My current doc doesn’t have computers in the exam room. I prefer this arrangement but I’m only a patient so my opinion doesn’t really matter, now It’s all about the precious records and the valuable info amassed – makes me not want to visit the doc so much, but that also might be the plan.

  21. Since when has government involvement, particularly of the Federal kind, ever produced a better, less-expensive, solution?

  22. The federal government set up rules intended to encourage provider openness and sharing.

    Funny, the feds also set up rules, via HIPAA, that make it much more difficult share medical records across organizations and platforms.

    While the proprietary nature of EHRs is a big source of the interoperability problem, the feds are also a major barrier.

    Let’s say a hospital wants to share patient data with a big physician group. That’s OK, as long as the patient is an existing patient of the group, meaning population health analysis and continuity of care communication is severely restricted, unless:

    (1) Each patient gives written consent. Since interoperability only really matters for large patient populations, this is a non-starter.

    (2) You hire the group as a “business associate”. This triggers a whole new slew of regulatory headaches limiting what the group can do with the data, prohibiting them from using the data, including (probably) data on their own patients for any purpose other than doing the contract work, etc.

    (3) That’s about it.

  23. I asked my doctor if he would continue to keep paper records for me if I paid him in cash. He laughed. I’m thinking about looking for a new doctor now.

    1. In another country, I take. I can’t imagine any doctor missing out on that Meaningful Use Cheese.

  24. You missed one of the major reasons costs will increase. The more computing power doctors have, the more records the government will require them to keep.

    My GP assured me, with a straight face, that ten years from now whoever took over his practice would be able to instantly tell me what I weighed at this year’s annual exam.

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  26. They missed a big 4th factor driving up costs. It seems that electronic medical systems are actually good at at least one thing — prompting docs and other providers to ‘up-code’ for their services:

    http://www.publicintegrity.org…..ated-bills

  27. “$162,000 to implement the system, followed by $85,000 in first-year maintenance costs.”

    I wish. There are non-government Open Source EMRs that do the job for a lot less. Like under $5,000 for a server and installation and about $1,000 per provider per year for maintenance…

    I install Oscar (oscarcanada.org) in Quebec, Canada. It is used by thousands of physicians across Canada. There are other Open Source solutions in the USA.

    I do agree that they will not save physicians much time. The savings are outside of the physician / patient encounter… in just about every area.

    No charts to find, file and store. All the patient information in one place. No more misread prescriptions. Instant Rx interaction warnings, etc…

    In Canada, these solutions do not have to be connected with the government. In fact, that’s a big advantage for many physicians.

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