PHRs, sure, but to cut care costs, target exorbitant plan profits

Regarding "Electronic records push: Big companies tell physicians they better go tech" (Article, Dec. 18, 2006): I read your article on personal health records with interest. As a family physician, I think it would be a great benefit for patients to be able to "carry" their charts with them. To work efficiently, a PHR would have to be able to be synced easily with an electronic medical record.

The problem with EMRs (as you alluded to) is that there is no standard, and there are a lot of them out there. The good ones can be cost-prohibitive for smaller clinics. If we are going to be mandated to utilize technology, a lot of docs are going to need help.

One point of contention that your article raised is that medical costs are rising, or that we have a health care crisis. I think it is more aptly called an insurance crisis. When one hears of talk about health care, the complaint is of rising insurance premiums. This really does not have much to do with the cost of health care. Take a look around at the insurance industry. They are posting record profits and holding huge cash reserves.

On my end, I constantly have to fight for payment and am dictated what I can and can't do. Then, with the advent of health savings accounts, we have seen patients paying more out of pocket initially for their care, and buying higher deductible plans. Yet these plans really have not led to reduced premiums. So we're still paying high premiums, and then paying all of the first dollars out of pocket.

And when a patient asks if they have to come in to have me answer a simple question, the answer is "you're darn right." If the question is so simple, then they shouldn't need my advice. But I'd be crazy to treat a patient over the phone, take the liability and otherwise not evaluate them -- no matter how simple it may seem.

I am completely for electronic records, evidence-based medicine, best practices and preventive care. I am completely against the insurance industry controlling the definitions of best practice or the best evidence -- their interest is in profits, not health. Health care is extremely complex. People are extremely complex. We have not arrived at a point where we can agree on a consensus of what is the best practice for many things because people are still individuals. The truly best and most efficient care of disease probably should be made on an individual basis, based on an individual genetic makeup, using large studies as a guide.

But the best and cheapest health care overall is prevention. Yet we continue to feed our kids processed food, sugar, soda and other nutritionally void, calorie-rich foods. We are seeing kids develop disease we only used to see in adults. We are creating disease that is creating expense. We have a health care system run by third-party payers who are profit-driven (and good at it). I just don't see a reprieve from the high cost of insurance by continuing on our current path.

Mark Halstrom, MD, medical director, Williams Integracare Clinic, Sartell, Minn.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/01/29/edlt0129.htm.