re: EHR Savings Debate Grows
Deja vu all over again...this is a mirror of the discussion of the value of ERP systems in the 1990's, the Internet in the early 2000's and others too numerous to mention. Early in the adoption lifecycle there are always naysayers who latch onto any negative data to make their point that the change is a bad thing. Take the HHS letter to the hospitals about upcoding which sounds political to its core.
Does an electronic system allow for upcoding? Sure. No more nor less than the old systems ever did...but committing it to an EMR can improve compliance and the ability to investigate fraudulent behavior such as upcoding. Is an equally plausible explanation be that the accurate capture of encounter data allows for the [more] accurate coding for billing purposes and that this accuracy could contribute to increased charges? Sure it could. The problem is nobody has reduced this debate to fact...so the politics continue.
Having spent significant time in my past at Kaiser Permanente helping to implement their EMR, there are a lot of good reasons for doing so. Capturing clinical data so that it is computable (which it emphatically is not in a paper chart!) is extraordinarily valuable...and takes time and new, innovative efforts to capitalize upon. Achieving integration among the dog's breakfast of legacy clinicial systems is equally time consuming but the aggregation of the data into usable information can (and in some places, does) have a measurable impact on performance (both cost and clinical quality).
How many of the health systems implemented EMRs because they wanted the HHS money or because the were "compelled to" by the APA/HITECH provisions? That is no reason to undertake such a large ORGANIZATIONAL CHANGE initiative (it isn't an IT project!). Those organizations that invested in EMRs for all the right reasons - Kaiser, Group Health, Intermountain, UPMC, and others - are getting their benefits and are not looking back. Others, not so much...
I will close with a thought and a quote. The thought is that if you understand that the EMR is a foundational investment required to deliver the value of population health, patient-centered care, and other interesting delivery models that are impossible without access to computable healthcare information, you have the ability to manage the changes that it will require in your health system to deliver the benefits that the lucky few have achieved. The quote is from Churchill: "This is not the end; it is not even the beginning of the end. It is, perhaps, the end of the beginning..."