Public clinics: EMRs good for quality, not wallet

A recent study finds that electronic medical records can help provide better care but not cost savings in community health clinics.

By Pamela Lewis Dolan — Posted Feb. 19, 2007

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More safety-net facilities are looking to electronic medical record systems as a way to provide better care for the uninsured and help save money.

But a study published in the January-February issue of Health Affairs indicates that the savings part of that goal could be a pipe dream.

The authors of the study, "The Value of Electronic Health Records in Community Health Centers: Policy Implication," interviewed six community health clinics and evaluated the benefits of each facility's EMR.

While the quality improvement benefits of an EMR are promising, the study suggests little hope for EMRs to have any financial benefit for community clinics. Revenue enhancements are nearly impossible because of Medicaid's flat-rate-per-patient payment system and the Bureau of Primary Health Care's lump-sum payment system. And while EMRs can benefit private health centers through pay-for-performance incentives, few of these incentives are offered to community clinics, the study said.

And even though the clinics might not be focused on the financial return on investment, instead focusing on improved patient care, just getting financing to start the project is a burden too great for many community clinics to bear, the study found.

Carolina Lucero, senior vice president of Sea Mar Community Health Centers, a nonprofit clinic that serves the poor and uninsured in the Seattle area, didn't have to read the study to know about the difficulties a safety-net facility faces in getting an EMR.

"There's places that have had EMR for quite a while, but because we don't have extra funding, it's harder for us to get it," Lucero said. Sea Mar is hoping to launch an EMR system in April that was made possible through government grants.

The study suggests that more grants and financial help are needed for more safety-net facilities to get EMRs and pay for their continued use. It calls the community clinics' inability to get EMRs an "equity issue" and calls for more funding from both private and federal sources because the EMR offers more "social good" compared with systems in the private setting.

That has motivated some facilities to purchase EMR systems.

The Primary Care Coalition of Montgomery County, Md., a nonprofit group that was established in 1993 to help increase access to health care for low-income and uninsured patients, launched a Web-based EMR system in 2003.

Erin Grace, senior vice president of the coalition, which was not part of the Health Affairs study, said the EMR started as a way simply to track the demographics of the patients the clinics served.

Once the clinics saw the potential the system had for improving patient services, the system continually evolved into what is now a network linking the files and records of 10 clinics. An uninsured patient now can visit any of the 10 clinics and have access to all of his or her records.

Southern Illinois Healthcare, a large health care network serving underserved rural residents, recognized a disparity that it thought an EMR could help eliminate.

Bolstered by a $42,000 grant from the Verizon Foundation, SIH, also not part of the Health Affairs study, announced plans in December 2006 to launch a pilot EMR program within the next six months. The program will consist of a database of about 100 low-income or uninsured patients.

According to SIH spokesman Grant Walker, the system will help caseworkers track their health care to help prevent those with chronic illnesses from entering a "crisis situation." The network plans to expand the program once the kinks have been worked out during the pilot phase and when more financing is secured, Walker said.

A few federal EMR grants, such as one offered from the Health Resources and Service Administration, are available for clinics serving mostly uninsured. But the study recommends that Medicaid providers contribute by offering pay-for-performance incentives that would reward "downstream" financial benefits.

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