The best future for EMRs would be single, national system

Regarding "Fear of commitment: Weighing costs and benefits of information technology" (Article, June 27): This article discussed the fear that most physicians have about the cost of implementing electronic medical records into their practices.

The concept is not the problem; it is almost universally accepted. The problem lies in the prohibitive cost of implementing and maintaining such a system privately at a time when liability premiums are very high, along with increasing overhead costs and decreasing remuneration by all payers. Unlike other areas of our society, there is no "big daddy" that will come and offer any financial help to physicians to be able to afford this very costly improvement.

There has been some speculation that the Dept. of Veterans Affairs might be able to supply their system to physicians and hospitals at no or very little cost to them. The VA system is considered one of the best EMR systems out there at present, being upgraded constantly in a similar fashion across several hundred facilities nationwide. Everyone knowledgeable in medical IT agrees that the best possible situation would be for every medical facility to have the same system. Communication between systems would thus not be a problem, and upgrades could be implemented rapidly and uniformly across the country (as is already being done now in the VA's system).

I realize that private vendors are salivating at what they can make outfitting physicians and hospitals with their often different proprietary systems. But wouldn't it be much better and much cheaper to have the same system nationwide and being upgraded for everyone at the same time? And wouldn't it be better to have a system that would be the most inexpensive for the country and its physicians and the best way to make sure every medical facility and doctor would be in sync with health care delivery? I think the Congress might look into facilitating such an implementation, since they are already gung ho about all physicians implementing EMR into their practices.

David R. Jackson, MD, Florence, Mass.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/10/03/edlt1003.htm.