EMRs a risky investment, say some small practices

Washington -- Problems with the reliability and utility of electronic medical record systems has caused hardships for some small physician practices -- costing them tens of thousands of dollars and limiting access to patient care.

The House Small Business healthcare and technology subcommittee gathered testimony from some of these physicians at a June 2 hearing. Financial, legal and technological barriers have prevented smaller physician practices from investing in EMR technology, said Rep. Renee Ellmers (R, N.C.), the subcommittee's chair. Nearly 25% of office-based physicians have fully functioning EMRs, according to a 2010 Centers for Disease Control and Prevention study.

Witnesses told the House panel they were concerned that barriers to adopting EMRs are so great that federal Medicare and Medicaid incentives, which can go as high as $63,750, would not be enough to offset costs and entice the remaining physicians to abandon paper records.

Sasha Kramer, MD, a dermatologist, purchased an EMR system for nearly $42,000 two years ago for her solo practice in Olympia, Wash. She had received a $20,000 grant from the Washington Health Information Collaborative and covered the rest from her cash reserves.

Initially, the practice only scheduled one patient per hour from the typical four to six patients so Dr. Kramer and her staff could learn how to use the system. A total of 80 hours was dedicated to training.

"It took about four weeks before I was able to return to my normal patient schedule," she said.

But Dr. Kramer said she will need to scrap her investment and start over if she wants to earn an EMR bonus from Medicare or Medicaid. Her software vendor recently was acquired by another company that decided not to continue support for her software's platform.

"Currently, I am looking at a new system that will cost in excess of $27,000 with $6,000 in annual charges," Dr. Kramer said.

The American Medical Association has lodged concerns regarding the implementation ease and usability of EMR systems. Difficulties experienced during implementation have discouraged some doctors from using new technologies.

The cost and time required to implement EMRs are big obstacles for small practices, said Andy Slavitt, CEO of the health information technology company OptumInsight, formerly Ingenix. Some may point to the meaningful use criteria for EMR incentives established by the Dept. of Health and Human Services as being part of the problem. However, questions regarding implementation aren't so much about whether these standards are right or wrong, but about what should be the focus when EMR vendors design systems, Slavitt said.

"What is important is that today the end users, doctors and patients, are further away than ever from system design, because new product development is focused on satisfying those regulatory hurdles, rather than on simple innovations that improve productivity," he said.

Slavitt favors shifting that focus by simplifying legal and regulatory requirements so vendors can develop better products at a lower cost to doctors.

"As long as [EMRs] are designed principally around a set of needs in Washington and at [CMS], it is a long shot that the technology will provide the simplicity and productivity benefits at the heart of driving real adoption," Slavitt said.