Gingrich's EMR vision raises questions of price, standardization and cost

Regarding "Gingrich's grand vision" (Article, Aug. 9): I am a pediatrician in practice for one year and consider myself to be one of the younger doctors who think electronic medical records are doable.

However, I had several questions I would have liked to ask the former House speaker.

First of all, thank you for pressing Newt Gingrich on the upfront costs estimated for current e-medical records systems. I have heard minimum $50,000 for these systems. That is a major hurdle that needs to be addressed. Some other hurdles include standardization and privacy.

I believe Mr. Gingrich wants to implement a Web-based system, which may dramatically lower the cost of start-up.

First of all, we need to choose one system that every doctor, hospital and insurance company will be able to use and access. Either one program, or standardization, is needed to allow universal communication. (This is currently lacking in the private e-medical records system industry.) We also need to have a flexible program with the capacity to change readily when new technology becomes available.

Next, we need to consider how the newly implemented Health Insurance Portability and Accountability Act will affect electronic medical records if our goal is to have them accessible from a Web-based system by different hospitals, doctors, and even pharmacists and insurance companies. The bureaucracy has put up a wall of red tape preventing easy communication.

Finally, we have to deal with the cost. Doctors are wary about the high costs of private company systems to start an electronic medical record. What would happen if a better system comes out in two to three years? As will likely happen, if the U.S. government mandates electronic medical records or creates the standardization necessary, what will doctors do if their systems aren't compliant?

In an environment when reimbursement is decreasing and insurance costs are increasing, electronic medical records systems are a gamble most physicians aren't willing to consider.

Lawrence E. Daykin, MD, Springfield, Ohio

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/09/13/edlt0913.htm.