Why Be a Meaningful User?

As I write, physicians throughout the United States are deciding whether to become meaningful users of electronic health records by 2011 when Medicare and Medicaid start making extra payments to meaningful users.  For some the decision may be pretty simple.  Almost 200,000 doctors already have adopted EHRs and are using them at a basic or sophisticated level.  For these physicians, the journey to meaningful use, and its financial and clinical rewards, may be comparatively short. Many other doctors, however, remain undecided.

I don’t want to minimize the obstacles.  When I started using an  EHR, I found it challenging.  I often longed for a dose of my old prescription pad (confession – I cheated once in a while). I chafed at reconciling medication lists, updating problem lists, scanning through seemingly endless consultant notes. (In the past, many wouldn’t have been available – lost somewhere in the paper world.) It was much easier to use the triplicate x-ray requisition I had used for 30 years than the radiology order entry software required  by my EHR.  My visits were longer and more complicated.  Every time I turned on the computer, it seemed, I had to learn something new.

But I am glad I did it, as are 90 percent of all physicians who adopt an EHR, according to a scientific survey published in the New England Journal of Medicine. My EHR made me a better doctor.  I really knew what was going on with my patients.  I could answer their questions better and more accurately.  I made better decisions.  I felt more in control.

Physicians don’t go into medicine because it’s easy.  They go through grueling training – spending endless days and nights at the bedside or in the OR.  They face tough personal and clinical decisions throughout their professional lives. They constantly have to grow and learn to keep up with the science and practice of medicine. That’s what makes them the professionals they are.  That’s what earns their patients’ and colleagues’ respect and admiration.  That’s what gets them up in the morning knowing there’s nothing else they would rather be doing.

The EHR is just another of the transitions that physicians are constantly called upon to make in the interest of their patients, their professional competence, and their professional self-esteem.  Its advent is inevitable – no more avoidable than the arrival of the stethoscope in the early 1800s or anti-sepsis in the mid 1800s ( both of which some physicians furiously resisted) or the ICU in the mid-1900s.  Positive change is often disruptive, but it is irresistible nevertheless. In 10 years, paper records will be the exception.  Lagging physicians will be seen as quaint throwbacks, no longer at the top of their game,  nostalgic reminders of a bygone age when offices brimmed with manila folders and piles of forms, or when nurses and doctors searched endlessly on hospital rounds for that one essential patient chart that always seemed missing from the nursing station.  (How many millions of hours have clinicians spent wandering hospital floors looking for those elusive missing paper records?).

Still, some physicians may be tempted to put off the inevitable, trying to postpone the disruption and expense.  Why not wait five or six years?  Maybe it will get easier?  Less expensive?

For several reasons.  First, the sooner physicians start using an EHR, the sooner they and their patients will realize its benefits – the ability to share patient data with colleagues and patients, the ability to retrieve old data effortlessly, the ability to access patient records remotely, so they answer patient questions intelligently from home, or even from a medical meeting.

Second, right now, the federal government is making a once in a lifetime, never to be repeated, offer: it will help physicians pay for the transition with up to $44,000 in extra fees from Medicare, or $63,750 from Medicaid.  Physicians can take the leap now with financial and technical help from the government.  Or they can do it on their own (or facing a financial penalty) in five years.

Third, anyone who is building a practice, and wanting to recruit young, talented physicians needs to confront the reality that the next generation will expect and demand that their own medical home have a modern information system. I know this from personal experience.  With two children in medical school, and a daughter in law who is an intern, I know young physicians will never settle for paper records.  Wait, and the cream of the recruiting crop will pass you by.

To me the choice is clear.  Physicians’ professional, clinical and financial interests all point in the same direction.  Become part of the future.  Become a meaningful user of an electronic health record.

–David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology

100 Comments

  1. While the incentives do make now a good time for transition to electronic health records, the adoption of EHR means that doctors running their own practices will now need to set themselves up with technical support to ensure continued operation of their records systems. In many cases, this adds to the complexities of running a primary care practice so many physicians may defer on these grounds. To expedite EHR adoption, providers of EHR system will need to make doctors comfortable regarding the usability and stability of these systems and this could take some time.

    • Thank you, Dr. Blumenthal, for the personal insight into the EHR journey; I appreciate your candor on both your challenges and the work that providers must put in to successfuly adopt this new technology. I think many providers would like to hear more about when the Stage 1 requirements will be final and when EHRs will be able to start the certification process. With May fast approaching, we’re getting to a crunch time when the expectation that EPs will be able to complete a perfect 90-day Stage 1 cycle in only eight months begins to look not just difficult, but overwhelming and near impossible. The sooner we can specific, “final” final rules, the better.

  2. The technology issue does not have to be as complex if you adopt a system based on cloud technology and rely on browser technology. The difficulty and challenge is there are 250 EMR companies who may not be up to date on technology. The easiest technology is Apple and now IPad. There is a low cost support system for repair and developing skill of use. The problem is that corporations buy Windows machines that have a high rate of maintenance.

    The second challenge is not knowing what may come out of hidden cost of Cloud Technology from browser base.

    I believe that the right role for CHIN’s are to be intermediaries for building the information and evidence based practices and insuring the search and data aggregating features associated with cloud technology are kept at a reasonable per physician/practice cost. I also believe that the view of CHIN and the expertise needs to move to a format of facilitation that is community based and driven and not top down and bureaucratic. I know how to empower and lead this kind of change and I am not heard by the early adopters protecting the old methods of success. Please call on me for advice as a physician and I can coach you. For CHIN communities I have developed a method of identifying a formation of learning and application using social media and building inquiry that has received excellent review in Australia. My dream is to test it here in my own country that is too critical and not taking the time and thought to really come up to speed in what is humanly possible for everyone in network (not hierarchy).

    • Lavinia:

      I agree that cloud technology simplifies the adoption of a EMR. Software-as-a-Service models allow you to see all the fees upfront and turn your EMR service into a fixed expense. Using a cloud-based technology should negate hidden costs as hardware investments are limited (and often, training and support are free). In theory, if you have a computer that can access the internet and watch movies on YouTube, you will be able to access all your patient data from any location with internet access.

      Of course this is easier said then done, but there are several vendors who provide quality products with a limited learning curve. The toughest issues are typically not installation of the product, or even training; rather, they are struggles with workflow changes. Your practice has to WANT to streamline its workflow before efficiencies can be recognized.

      • Peter:

        100 % accurate that the pre-cursor to efficient use of an EHR/EMR is documentation of ‘as-is’ workflows and re-structuring of this to ‘should be’. And, the job is only 50% done when you have conceptual workflows mapped to paper. The technology available today allows organizations move beyond paper maps to put organizational ‘best practices’ (administrative and clinical) ‘in-line’ such that workflows guide patient processing. “Workflows that work” by providing advice and assistance at the individual transaction level are what gives increased staff efficiency, increased patient throughput, decreased admin and clinical errors and increased compliance with internal and external rules and regulations.

  3. Dr Blumenthal, our solo practice received NCQA PCMH level III certification last year. We had had an EHR in place for about two years when we applied. Our practice definitely took a financial hit initially. After one year, we had significant savings related to supplies, staffing and productivity. Unfortunately, we have not seen significant “buy in” by managed care. I believe the Federal government Meaningful Use monies will help get practices started. Level III practices, however, will need significant changes in reimbursement to be financially viable. Fortunately, most studies show that Patient Centered Medical Homes not only improve the quality of care but can do so without raising costs and often introduces savings to the local system as a whole.

  4. As the owner of a Health IT company that focuses on small-medium medical practices, I have found my customers and prospects in a “wait and see” attitude about EHR’s. This attitude is a result of the uncertainty in the marketplace and a hesitancy to change their existing methods. The uncertainty has been created by 3 separate issues: First, the maelstrom surrounding healthcare reform. Second, the ongoing saga of the potential 21% decrease in Medicare reimbursements (AKA “Doc Fix”). Third the lack of an official definition of “meaningful use”.

    I would urge the ONC to remedy the issue they control, “meaningful use” as quickly as possible. This would accelerate the currently stalled market and allow the benefits of EHR to be reaped both by the practices and the patients.

  5. Michelle W says:

    Thank you, Dr. Blumenthal, for the personal insight into the EHR journey; I appreciate your candor on both your challenges and the work that providers must put in to successfuly adopt this new technology. I think many providers would like to hear more about when the Stage 1 requirements will be final and when EHRs will be able to start the certification process. With May fast approaching, we’re getting to a crunch time when the expectation that EPs will be able to complete a perfect 90-day Stage 1 cycle in only eight months begins to look not just difficult, but overwhelming and near impossible. The sooner we can specific, “final” final rules, the better.

  6. Federal funding may be encouraging a move toward EHR, but there’s more to it than just installing systems. How can healthcare data pooling lead to a better system? More at http://www.healthcaretownhall.com/?p=2193

  7. Technical support is 3-fold.

    1. Selecting, maintaining and learning optimal use of hardware/software

    2. Building the operation a person to communicate with EMR company and stay abreast of changes, updates and ongoing opportunity for practice support learning.

    3. Examinations of work patterns and communication patterns with patients- adopting use of social media and web based tools for education and communiication.

    I approach this with physicians and practice owner’s on a budget cycle and respect for continuous improvement.

    I learned to do this introducing the first EMR into practice and combine this with my capacity for training, instructional design, and practice management, which grew out of my firs career in health care.

  8. This may not mean much, but this is absolutely the most superb argument for HIT I have ever read.

    Sitting on the sidelines, waiting for a miracle and an elusive perfection, has never been proven a winning strategy. Participating in the rough & tumble of the game and actively contributing to a better future carries the day every single time. To be sure, there will be cuts and bruises, and paradoxically, the smaller your practice the more important it is that you participate and move forward. This is about basic survival in a fast changing environment.

  9. Evy says:

    I absolutely agree with Margalit. I have to admit…from a patient’s perspective, I’m a little hesitant to embrace EHR. But after reading Dr. Blumenthal’s point of view, I’m coming around.

    I can see how having EHR available will allow docs to have all the info they need all the time.

    It’ll be interesting to see how this pans out.

  10. A Cavale says:

    Being a solo practice that has been fully electronic since 2002, without any financial or other support from government or private payers, I can understand exactly why established practices are hesitant to jump on the EHR bandwagon now. Apart from Michael Duffy’s points there are several other practical aspects that physicians just simply hate doing. I for one find the task of using claims-based submission of data to be very cumbersome and inconvenient. So I have decided not to submit data even though we are probably 5-7 years ahead of most other practices. So if the govt forces me to decide between proving my use of IT via claims process and opting out of Medicare, I will choose the latter. Second, most physicians are concerned about how electronically submitted clinical data will be handled – we all know the saga of lost data from the VA, etc. We are worried that this data will be used against us – there has been demonization of physicians from many in the govt, including the President. So, Dr. Blumenthal, if you really want physicians to follow your lead, the govt must come out with a clear promise that they will not continue the policy of “guilty unless proven otherwise” that has been pervasive with the institution of RACs (bounty hunters) and provide a method to provide financial help to small practices without resorting to claims-based reporting requirements.

  11. Curtain Rails says:

    I am agree whatever you mentioned in the article. No one can say that IT is only for some particular services like accounting, finance etc. Now, it can be sync with health services and we can a great example of it which is called medical transcription. it is purely it terms.

    Health and IT have become two sides of a coin. why? because in earlier days, all things was recorded into a small piece of paper but now we have a great computer system where we can copy all the records to one place.

  12. Force Factor says:

    I can certainly see why some medical practitioners are hesitant to embrace new technology. It is not always the easiest thing to do. If going to this system will allow physicians to provide better medical care to their patients, then there is really no reason to try to put it off. This is especially so when they can have the government help them pay for the transition to a more modern system.

  13. Interesting – we in the UK have already adopted the EHR process and it certainly is starting to become a legitimate way of physicians obtaining medical information quickly and effectively. I am in no doubt that the speed in which past medical histories can be obtained have saved lives.

  14. Could maybe lobbying for tax breaks for physicians who adopt the technology help instead of subsidizing the cost with federal funds? Or perhaps a mix of the two?

  15. Frank MD says:

    Dr. Blumenthal -

    I agree with your assessment that electronic health records represent the future of medicine and I have been using electronic medical records for over a decade. While you may have been simply trying to inspire physicians with your post to move forward with EHR, I worry that this approach appears to “simplify” the adaptation process and does not do due diligence to the important decisions that need to be made. While the first decision may be to commit to moving to EHR, the more significant decisions involve system selection and the financial costs.

    Your description of the EHR as just another transition in the ongoing evolution of medicine does not capture the full scope of what electronic health records represent. The EHR is not simply another tool or process that the physician can incorporate into the practice of medicine. Electronic health records represent an entire industry that is transforming the practice of medicine. It is an industry that is primarily shaped and managed by IT departments and software developers, not physicians. Unlike other tools that the physician may use in practice, the physician is not the expert in this field and therefore needs to approach this venture from this standpoint when selecting an EHR system, as it is an extremely costly business venture for any medical practice.

    I am also concerned regarding your presentation of the government incentives as a “once-in-a-lifetime, never to be repeated offer”. The presentation of the incentives in this way makes obtaining an EHR sound more like buying a used car or “easy money”, and dramatically downplays the cost of an EHR system. While $44,000 represents a lot of money, this is a cap payment that is realized over a five-year period. By the government’s own estimates per the Federal Register, the capital costs for an EHR in the first year is $54,000, with an additional yearly cost of $10,000 per year in maintenance and training. While the incentive is helpful, the adaptation of an EHR system still represents a major cost to a medical practice. And if you are dissatisfied with your EHR selection and need to change companies, or your EHR company goes out of business, then the government incentives may mean nothing.

    As I initially stated, I am a firm believer in the importance and utility of electronic health records for the practice of medicine. I am just concerned that in the haste to promote this initiative that the actual costs and impact that this transition will have on small medical practices (solo or two-three physicians in size) are not being fully explained to my colleagues.

  16. Karen LeComte, MD says:

    I adopted an EMR right out of residency and have been e-rxing since its inception, I was fortunate enough to find an internal server-based EMR that allowed me to work through a static or remote system. I could be anywhere in the world and have access to my over 3000 patients through my laptop. I am in solo practice and found a company that catered to smaller practices. It was a couple of thousand dollars and I could lease to own the software. Over all, much cheaper than having someone transcribe each note but really no less labor intensive on my part but less office staff needed to maintain paper charts. Now I am closing my solo practice and moving because I can’t make a living as a neurologist (no procedures). I no longer get paid a consultant fee by Medicare because “consultants don’t send notes” . I built my practice on well done comprehensive (and I don’t mean full of check lists) notes. They have meaningful history, exam, analysis and recommendations. That takes time. The EMR keeps it neat and legible but the formulation is my own and takes effort, research and lots of patient interaction. That’s not reimbursed in this present system. In other words, let’s make sure that we don’t throw out the reason why we had medical records in the first place: to allow continuity and accuracy between internal visits and amongst patient visits with colleagues. It should never have been meant as a “watch dog” and way of penalizing doctors. I also have never seen a penny of reimbursement for E-Rx even though I have done my “g-codes” not even an acknowledgement! Additionally, for feedback Dr. Blumenthal, I am joining a small group practice without an EMR and need information about what is being done in their area (NH), so far after searching on the internet, I found nothing more than this page and a subcontractor’s page saying who has been awarded HITECH and REC funds but no way to contact these agencies for info. I hope that this doesn’t mean that alot of this stimulus money will get eaten up in “administrative” costs while little trickles down to the people who are going to actually establish and use these records. Make sure that this doesn’t become a program for program’s sake. By the way, great essay, I am going to copy the link to your essay to SERMO, a physician only private website so my “resistant to EMR” colleagues can read it. Now just stand up on your colleagues’ behalf and don’t let the status quo of Washington business as usual, sell us out.

  17. Hello Dr Blumenthal,
    I am pleased to read this blog about EHRs and the future of health and care delivery system in the United States. I am a 27 year old new grad RN and a baccalaureate student in Health Informatics. It is indeed good to know that there is a bright future in the field of electronic health records and management. I am happy I chose a good area to study in. Thank you.

  18. David McSparron says:

    The other side of EHR, apart from its usefulness within and between individual medical practices, is the possibility that aggregate data can be used for statistical purposes. Outcomes based on different treatments can be measured and compared, medication side-effects can be enumerated. A whole host of useful information will be available that is simply impossible to obtain when data is hidden in indivdual medical practices. This information bonanza can lead to greater efficiences of treatment and significantly reduce costs . Of course, the EHR system to be used has to be designed from the outset to support such statistical information gathering and dissemination.

  19. I think it’s great idea to get the health care professionals on board with this initiative. However, at the same time, I wish that such data was more easily accessible by the patients themselves. There have been so many occurrences where I’ve gotten blood tests but my results never made their way to the doctor’s office (and since the Doctor’s office has a terrible policy of no call, no problem…I naturally assume I have a clean bill of health when it could be quite the opposite).

    I strongly believe that patients should get access to their own test results (after all, you are your own best doctor whom follows you around day to day and understands your living circumstances). Of course there would be a need to acquire some medical knowledge, but with useful resources such as the internet, patients can become meaningful users in no time!

  20. One thing that can make you safer if you do have a medical condition is using a medical alert bracelet. Your medical history and info such as allergies are always with you in case you’re in an emergency situation, it helps first responders and attending doctors know how to treat you and avoid any possible allergic reactions.

  21. Sharlet says:

    It Is great to see the USA and the UK adapting this method. Although in the UK this this has already started. I also think it is a great idea for physicians to be able to get access to medical records quickly and easily to ensure patients health is not at risk.

    some people may argue differently buy it is far easier to be able to get hold of your records in times of emergency. The only problem i can see with this is that the infrastructure has to be in place to cope with the paperwork other wise patients records can get mix up and that would be a disaster.

  22. Anthony says:

    I think electronic records are extremely important regarding a patients overall health care and quality. More innovative non-cloud computing needs to be adapted, therefore I disagree with the previous comment that state more cloud computing needs to be adapted. For those engineers who understand the importance of security and privacy issues, cloud computing your health care records would be a huge mistake.

    Perhaps designing microsystems (soft apps) that are geared towards medical records that are downloadable for offline usage into Macs, PCs, or Mobile phones, would be a better solution regarding privacy & security risks.

    Anthony

  23. Bill Bertham says:

    I see the use of EHR as a two tier system. The older generation of doctors were brought up on hand written records and find it hard to let go. The up and coming younger doctors embrace new technology and realise the benefits of having EHR. It will take some time before we can convince a doctor living in the backwoods to see the full potential, and yet these are the ones that would really benefit from it. We have a transient population and to have all on a EHR system would be fantastic but I believe we have a little way to go to get everyone to agree.

  24. At our state medical facility we have been using Electronic Health Records for some time now and I cannot think how we managed without them in years gone past. It does take a while to get used to them but once Doctor and Nursing staff are trained and conversant I can assure all that this tool is truely a blessing.

  25. Setting up a system on this scale is a daunting task, and data security is a huge issue, but really its the only way forward. Imagine how complicated the system would be in years to come if it were still paper based, incredible amounts of paper that needs to be stored and accessed easily somehow. The right system with training and support and ongoing maintenance will make the entire process smoother and more accountable.

  26. Bill says:

    Electronic records certainly give us the ability to store, retrieve and perform analysis and they are definitely here to stay. They also give very fast access to the information, yet they are not without their problems.

    Here in the UK, there is a groundswell of objection to the collection of medical records and placing them on a large database somewhere. The reason is because there have been a number of occasions where government-controlled personal and private data, including names, addresses, medical and financial details and so on, have been lost – for example on a stolen or lost laptop computer.

    Thus for EHR, security becomes a major issue. It is much more difficult to lose several hundred thousand paper records than it is to unintentionally give access to several million electronic records. Equally, you can copy a large number of electronic records without leaving any evidence, but photocopying their paper counterparts would take far too long.

    There is also the issue of readability; paper is inherently easier to read than an electronic record and most people prefer paper if they can get it – which is why paper records endure. Reading a document on a computer screen is like looking at it through a letter box and so you have to scroll up and down to appreciate the whole thing.

    It is also a lot easier to make notes on paper and although word processors have made editing much more powerful, I can make edits and notes on paper at any time and anywhere.

    Not only do we need to consider the self-esteem of the doctors, but also that of the patients. Patients need the right to see their records, so long as there is no good reason to withhold it, simply knowing that they can access them will often make them feel better. Yet it remains paramount that the security of their data remains intact.

  27. Proxy says:

    I would think that this would be a no-brainer for physicians. To have everything cataloged electronically seems to me to be a big time saver once you get past the learning curve. I understand the resistance to new technology, but this seems like a good move.

  28. I think that the innovation of electronic records is well past it’s time but a key issue is gaining public confidence in the systems. Here in the UK, where we have a fairly extensive use of EHR already, apart from IT teething troubles the biggest issue by far was public concern over data protection.
    Fortunately the system has held up well so far so it is to be hoped this system fares as well.

  29. EHR says:

    I am from the netherlands and we have a similar electronic health system since a few years.I must say that it has a lot of benefits.Ofcourse in the beginning a lot of complaints but that is always the case when changes are made.People do not like changes, but a few years later and no complaints about the dutch EHR.

  30. As a patient I strongly believe we should have access to our own test results. I can’t count the number of times I’ve sat around in waiting rooms just to have my Doctor read out my blood test results. I often don’t even go get them as it’s an inconvenience to book the appointment for a 3 min discussion. With useful resources such as the internet, we as patients can become important users in no time!

  31. zsolutionz says:

    A transition of any kind takes time to both implement and to become familiar with, but over time the benefits of computerized records greatly overshadows its paper counterparts, in both storage and time to access records. Filing and manpower are heavily reduced and time and resources can be better applied to patient care.

  32. As you’ve put it, positive change can often be disruptive but prove to be beneficial for all health care providers and patients alike. It is also important to stress the continuity in patient management and that waiting for 3-5 years before other collegues adopt to the new system, would jeopardise that continuity. The sooner we become willing to go through these transition, the better for the whole health system as a whole.

  33. Ben says:

    @ Peter,

    I have run into the same problem with my software business. Software tends to do work the people do. I have found that potential customers will sometimes choose inefficiency because they don’t want to change their workflow processes, as you say.

  34. The doctor I go to has just recently implemented a new record keeping information system that allows me to view certain records online whenever I want to login and see them. I really appreciate this, and hopefully in the future everyone will have access to their own records when they need to see them.

  35. As technologies improve it is inevitable it has to be used. Sounds like you guys are already way ahead of us in the UK – though you do pay for it. The NHS spent millions on bringing in centralised systems but I am not sure they ever got it to work properly.

  36. I know in our practice, anything to help simplify record keeping is great. This allows us to concentrate more attention to the treatment of patients rather than the mundane paper trail. What do you think is more important?

  37. Larry says:

    Whatever decision is finally made it must be the interest of both parties. Medical records and transcripts by their very nature are sensitive documents that must be handle with care. Security where this is concern must be given priority; and even if the desire might be to have them easily accessible to patients, one must consider that doing so increase the possibility of some of the documents falling into the wrong hands. However I will agree that pooling the health care data will eventually make the system more efficient. EHR is the future of Health Care in America!!!

  38. Jill Moore says:

    I think electronic health records are great, I live in Thailand and the hospital we use in Bangkok are all electronic – everything is there at the push of a button going back years. I am sure it will lead to a fewer errors being made because of indecipherable handwritten notes made by doctors!

  39. JamesZachery says:

    Implementing an Electronic Health Records system is a no brainer. It is something that must be done eventually, so why not do it now and get the financial and technical help that the government is now offering. The medical industry needs to be progressive in their record keeping practices.

    As Dr. Blumenthal notes in his third paragraph, over 90 percent of the physicians who adopted the system are happy that they did. He also said that it has made him a better doctor by giving him quicker access to information and conveying it to his patients. The thing that impressed me the most is that he said it helped him to make better decisions. Isn’t that what it’s all about?

    For small practices, economies of scale could be a deciding factor in adopting the system. On the other hand, not adopting an EHR system could limit their growth in the long run.

  40. ‘Meaningful Use’ of EHR should be define further so as the extend of EHR in not manipulated. The system that control the input and databases are critical because confidentiality is the up most important in this era.

    Take for example on how the military information are being exposed by wikileak? Will there be another instance where our health information are exposed as well?

  41. Den says:

    Why not use EHR if it helps improve lives? I know there are people that are quite hesitant about it. We always need to adjust when there’s a change, it has always been like that and it has never been easy.

  42. Abby says:

    I can understand the hesitation to adopt a new system, especially when the current one you’re using seems to work just fine. Getting over the learning curve requires extra effort (and a little humility) which many doctors may not feel is worth the leap. Dr. Blumenthal made the ultimate case with this statement: “My EHR made me a better doctor. I really knew what was going on with my patients. I could answer their questions better and more accurately. I made better decisions. I felt more in control.” What a big challenge and encouragement that is to those doctors who have yet to make the move. Isn’t improving care worth the initial complexity?

  43. Alex says:

    I’m against a centralized system and would prefer individual systems for doctors/hospitals where interfaces are standardized. Don’t give too much power of knowledge to a centralized organisation.

  44. Quite frankly, I’ve been waiting a long time to have all my medical and other records readily available that I could just swipe my card and have all the information automatically transferred. I can’t stand filling out the forms when you go to a new physician and am even somewhat annoyed at having to fill out the same forms every year… you know, if something changes then it would be in my automated records. Please don’t give me busy-work to keep me occupied while I am waiting my turn for my appointment.

  45. Electronic health records are not only convenient but cost effective. Like many have already mentioned, might as well make the shift now as there are incentives.

    I do realize that this is a 2 sided argument with pros and cons to each. One can only hope that the higher ups are viewing this discussion and taking some notes.

  46. This does seem like a great concept. It will make records more available to providers but the learning curve I feel will discourage many practitioners from implementing sooner than later.

  47. alexwfix says:

    According to me, EHR or Electronic Health Record, is beneficial for today world because it is s a computerized system where patient records are created, used, exchanged, stored and take back, when its requirement. Most EHR programs support multiple users accessing a chart at the same time. Many even allow multiple people to chart notes at the same time also.

  48. John says:

    I have mixed emotions, as many do, about this system (EHR). I can certainly see the positive points as stated. However, there are problems with security as with any other centralized data center.

    I think more has to be done to educate the general public, and this blog is a part of that education.

  49. kazanganti says:

    Thus for EHR, security becomes a major issue. It is much more difficult to lose several hundred thousand paper records than it is to unintentionally give access to several million electronic records. Equally, you can copy a large number of electronic records without leaving any evidence, but photocopying their paper counterparts would take far too long.

  50. Transition to electronic health records is a must! Why wouldn’t you want to streamline the tedious process of health record management?

  51. Seriously , this would be fantastic. I know I personally can’t stand going to a new doctor and of course they want you to feel out what feels like hundreds of different forms. Now what could have been a in and out visit becomes an even longer process because your to busy feeling out forms. What makes it even worse is you could be in some serious pain but now you have to wait to be seen because your to busy feeling out paper after paper. Please stop the insanity.

  52. Dwayne says:

    This will be extremely expensive and a large learning curve for the health community, but it’s way easier to manage a 1000 pages of data that 1000 physical pages…

  53. Ford Michael says:

    Electronic health records, is best for today world because it’s a computerized system where patient records one time created, then they use card for scratch and exchanged all data, stored and take back, when its requirement. And its support multiple users accessing program at the same time. I know there are few people that are quite hesitant about it but We always need to adjust when there is a change. EHR system is very cost effective.

  54. Ray Roman says:

    I have always been hesitant to see anything personal of mine in an electronic formant, however after reading Dr. Blumethals article I find that the arguments in favor do have some significant value. Though I am not yet totally convinced of the benefits of EHR I am coming around just a bit.

  55. Rick Redman says:

    I think electronic record are costly but it is useful to give the right information about our health.

  56. This is the future, I think it is inevitable. Keeping health records on electronic files, having it on your computer will definitely make it easier for both doctors and patients. But having your files stored on a computer also means it can be hacked. It is more likely that someone would and could hack in a computer and download the files than it is trying to steal files on paper. None the less, EHR will make it easier to store all data to be used for all kinds of researches in the future. The days of paper will probably one day be obsolete.

  57. brenton says:

    Its a good start but when will the records be integrated accross all heath professionals. I deal with my healh in a holistic way. I see a medical doctor, physiotherapist, osteopath and have seen a dietician all with seperate records with no complete view.

    Regards
    Brenton

  58. Mike says:

    Our physician uses this system and its great! It’s just part of the overall development of computerized systems in the doctor’s office. When we have an appointment our Dr always has his notebook computer on, and will refer to it as needed during the visit. Way more efficient than before…

  59. Tulsa Awards says:

    If you have your files stored on a computer that also means it can be hacked and stolen that way… I think it is more likey that someone would hack into a computer and download the files than it is trying to steal files on paper.

    • brenton says:

      Hello Tulsa Awards,
      Like all things in life we need to keep this in perspective rather than dealing with life on the basis of fear and uncertanty. They will hack my records! So they will know I had chicken pox and measels as a kid! Got a cold a few times. How will this be used to my detriment or to the detriment of society as a whole? The fears dont outway the advantages. Lets go with the advantages and live up to a level rather than go with the fears and live down to a level.

      Regards
      Brenton

  60. MD Tech Pro says:

    It’s all about selecting the right EMR. The physicians I’ve seen that are not happy with being on an EHR system typically have selected a system that doesn’t fit their practice. Secondary to that is they weren’t receiving the right support form the EMR vendor or an IT professional.

  61. TruNature says:

    You’re quite right Dr. Blumenthal, the medical profession needs to become part of the future and be meaningful users of electronic health records. In reality they have no choice, technology will creep up on them whether they like it or not. Too many professions which have resisted technology have ended up being overtaken by it anyway. The medical profession has been and will be no different. Those doctors which do embrace technology will fly ahead of the old school, who quite frankly don’t want the learning curve and are hoping retirement will save them from having to master something new. Just my two cents worth.

  62. C. Johnson says:

    I’m tired of going to different doctors and having to educate them on my entire medical history, a central database to access all of my information would be helpful. When I moved from Arizona to Wisconsin none of my medical information traveled with me, how is a doctor in Wisconsin to know my history in detail?

  63. Bill Davis says:

    What continues to befuddle me about healthcare professionals is their insistence on my filling out multiple forms with identical information throughout (like phone number).

    I hope this is one of the things that improves with EHR.

  64. David Brown says:

    EHR may be on its way due to federal funding but installing systems is just one part of the story. Do you seriously think that healthcare data pooling can pave way for a more improved system?

  65. jamesndersn says:

    HIE provides the capability to electronically move clinical information among disparate health care information systems while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care. HIE is also useful to Public Health authorities to assist in analyses of the health of the population.

  66. Electronic Health Records are interconnected with other systems of healthcare delivery besides the word processor that many clinicians still consider the heart of a patient record. Hard to publish how well a plan does caring for its diabetics, for example, if nobody’s keeping track of…how well it’s taking care of its diabetics.

    EHRs can do that, down to the last A1c and LDL cholesterol score.

    What’s remarkable isn’t the specific groundwork being laid, it’s the underlying, iterative process.

    1. Gather hard numbers.
    2. Compare and publish those numbers.
    3. Utilize IT technology to facilitate both tasks.
    4. Observe how IT allows advances that would have been impossible to even conceive before.

    I’ve said it before and I’ll say it again: the days of wine and roses are over.

    Data mining and statistical comparisons as things “those pencil-pushing insurance guys” used to deal with? Now, these activities will determine which health plan your mom picks. Publishing of patient satisfaction numbers (on plans as well as doctors) as something to be whispered about (will it ever happen)? It’s already here. “Those guys” aren’t just the insurance suits, and they don’t push pencils anymore. They push IT, and they should include you, if you are directly involved in the delivery of healthcare in America.

    Wakey, wakey. The noises you’re hearing aren’t the movers coming. They’re already here.

  67. Eric Kai-Lewis says:

    With EHR, once doctors have gone through the learning curve, they now can focus more of their time on being the best they can be for their patients. And that’s what should be the most important thing.

    Great post

    Eric

  68. I’m all for EHRs, but I worry about security, specifically intruders being able to access databases from either the Internet or locally. Will Drs be trained on basic Internet/Computer Security such as encryption, firewalls, viruses/malware, or security related to local intrusions?

  69. Really enjoyed reading your views. EHR’s are clearly the way to go. Medicine like most professions need to leverage technology to improve the service they provide. I understand the security concerns, but with due diligence this can be overcome (speaking as someone who works in IT).

    Anything that helps the patient is surely a good idea.

    • Julia says:

      A good physician is a one who can accumulate the patients data, retrieve it from their mind and analyze so that it may be applied to another client to the benefit of the later. Frankly speaking, how many physicians like this do you know? Well i know 2 and i consider myself lucky. For the rest using EHR is the ONLY solution, because some can simply not keep such a data not even talking about analyzing it. My hope it that with EHR they will be able to help the patients better and save more lives, because human health is a complex approach. And ready off the shelves prescriptions help only in 10% of all cases.

      It is good to know more from those who have already an experience of using EHR as it is life for more than 2 years by now.

  70. Thanks for sharing the information. There are many differencing opinions on this matter. As a computer person, I am all for EHR because it is a better system than the traditional tabbed manila folders used by most doctors today. There is improved security with a digital solution instead of a paper one because of the ability to do backups.

  71. Fazli Sabrin says:

    Wow i been looking for some discussion now here it is

  72. Online Games says:

    its really nice article.keep it up

  73. Excellent article, thank you for sharing this with me.

  74. is important to create an awareness of the public health, and is very good the facilities you give to the people to get medicine

  75. danzel says:

    Great article! I found it really great. I’ll be checking back here again soon! Keep up the great work!

  76. Yeah the digital technology is definitely going to reduced some human errors on the organization
    side. Glad to see that this is slowly being adopted.

    - granite Anaheim

  77. Marketing says:

    Thank you, Dr. Blumenthal, for the personal insight into the EHR journey; I appreciate your candor on both your challenges and the work that providers must put in to successfuly adopt this new technology. I think many providers would like to hear more about when the Stage 1 requirements will be final and when EHRs will be able to start the certification process.

  78. Yoli Oliver says:

    I absolutely agree with Margalit. I have to admit…from a patient’s perspective, I’m a little hesitant to embrace EHR. But after reading Dr. Blumenthal’s point of view, I’m coming around.

    I can see how having EHR available will allow docs to have all the info they need all the time.

    My mum´s doctor has just recently implemented a new record keeping information system that allows her to view certain records online whenever she wants to login and see them,she does not know how to do it but I always help her,you always can print out your records and ask for a second opinion. I really appreciate this, and hopefully in the future everyone will have access to their own records when they need to see them.

  79. From a patient’s perspective (and as the husband of a patient), I think that electronic health records are absolutely vital. It is incredibly frustrating to go to a specialist and then find out that they didn’t receive your health records and have to reschedule next month – or to go to your physician and find out that the specialist never sent over the test results – or to have to fill in a six page form every time we visit a health care facility – or have to remember every one of my wife’s prescriptions and dosages from memory. As it stands, if your doctor happens to be out that week and another doctor has to examine you for some reason, you’re in trouble. The other doctor may not know that you have spinal damage, or that you’re allergic to shellfish, or that you have chronic sinus problems — and that can be very dangerous. Worse, trying to get a copy of your own records from a doctor can be a nightmare and a half, and expensive in some cases. The more paperwork we can cut out, the more lives that can be saved in the long run and the less expensive health care will be.

  80. As a patient I agree it is annoying when I go to the doctor and have not received the results of my tests or worse when they have to repeat my medical history or postpone appointment 2 months. It is vital for patients and physicians have electronic records.

  81. I work as an IT in healthcare. and we are going live with our meaningful use, Nov. 1st. True there are a lot of opposition about this step but we have to be open and embrace the drive for change.

    This will make healthcare service better.

  82. The EHR is not basically another tool or technique that the physician can incorporate in to the practice of medicine. Electronic health records represent a whole industry that is transforming the practice of medicine. It is an industry that is primarily formed and managed by IT departments and application developers, not physicians.

  83. Being a solo practice that has been fully electronic since 2002, without any financial or other support from government or private payers, I can understand exactly why established practices are hesitant to jump on the EHR bandwagon now. Apart from Michael Duffy’s points there are several other practical aspects that physicians just simply hate doing. I for one find the task of using claims-based submission of data to be very cumbersome and inconvenient. So I have decided not to submit data even though we are probably 5-7 years ahead of most other practices. So if the govt forces me to decide between proving my use of IT via claims process and opting out of Medicare, I will choose the latter. Second, most physicians are concerned about how electronically submitted clinical data will be handled – we all know the saga of lost data from the VA, etc.

  84. I work in the medical field and my wife is a physician. The primary reasons doctors and facilities put this needed upgrade off is cost, time, and knowledge. At it’s most basic, it is simply patient throughput. I was at my Dermatologist today at a very modern facility that is just now moving to EHR. They asked me several questions that they already should have had information for. They also explained the transition they were going through. that it had slowed them down, but that they were optimistic about the end results. My wife went through the same thing several months ago at a major University. Every doctor making the move wanted to find a new profession the first week or two. It was costing many of them several hours per day. It has been 4 months now and things have improved. It is a long learning curve to get back to your original patient throughput. The hard part is that the entire staff has to learn and be trained on the new way of doing things. If you have people that are slow to adapt to technology you will have a slow transition. I have no doubt that once completely learned and converted the EHR will be more productive and effective.

  85. IT School says:

    The other doctor may not know that you have spinal damage, or that you’re allergic to shellfish, or that you have chronic sinus problems — and that can be very dangerous. Worse, trying to get a copy of your own records from a doctor can be a nightmare and a half.

    Thanks man!

  86. Cyan says:

    Electronic health records! , i really enjoyed reading this post, now we need them to start communicating via email and we can be happy

  87. Tammy says:

    Meaningful use has improved so much since this article was posted. Medical providers and organizations had no idea how quickly technology would improve healthcare. Federally regulated and maintained systems have greatly improved life for both doctors and patients. Most were concerned about hackers, loss of information or computer crashes but the evolution of cloud computing has definitely made EHR systems even more interoperable.

  88. Blog writer says:

    That is a new piece of information for me. I have had experiences where my health records have actually been of good use. Electronic health records will only simplify the whole process. As Tammy has mention- hackers can be a bit of a problem. If a solution is found wherein there’s a strong firewall built to protect the information along with good back up, and since that is met- it’s gonna create history!

  89. pcy says:

    I work as an IT in healthcare. and we are going live with our meaningful use, Nov. 1st. True there are a lot of opposition about this step but we have to be open and embrace the drive for change.

  90. ppgbio says:

    I think electronic health records are great, I live in Thailand and the hospital we use in Bangkok are all electronic – everything is there at the push of a button going back years. I am sure it will lead to a fewer errors being made because of indecipherable handwritten notes made by doctors!

  91. Lee Latner says:

    I truly believe that setting a standard for the medical profession and streamlining data is the way of the future. I was surprised at how archaic processes still are and would assume that improvements would be welcomed.

  92. I think electronic health records are great, I live in Thailand and the hospital we use in Bangkok are all electronic – everything is there at the push of a button going back years. I am sure it will lead to a fewer errors being made because of indecipherable handwritten notes made by doctors!

  93. Bail Bonds in Buena Park says:

    Yes software is more secure and last longer than the human memory without the need for a laggy or misremembered data. Which is crucial to preventing patient past problems. EHR for the win.

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