Universal Electronic Health Records: Progress or Boondoggle?

For Marc Hamburger, MD, an otolaryngologist at ENTAA Care, a 12-provider group with six offices in Maryland, a five-year, $500,000 investment in hardware, software, and training to implement EHR from Sage was expensive, but worth it. We started from scratch to improve the practice’s business side and then decided to integrate the patient record portion as well, he explained.

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Figure. A busy medical center uses the Open Vista platform for its electronic health records.

Some advantages of the move were obvious: easier billing, better patient care, and management of call from home. There were difficulties as well, however. The switch was painful, especially to the doctors who were 25 years out of school, but we didn’t give people a choice. We all had to jump off the cliff together if this was going to work, he said. Today, all the providers use wireless laptops, which are convenient to carry between exam rooms and offices. The EHR has automated scheduling, notes, test and lab results, and more. Although the group would like to have interoperability between its EHR and electronic records with its two local hospitals, neither hospital has an EHR, so ENTAA Care has to input labs results and radiological studies from the hospitals on its own system.

Regarding the systems’ cost, Dr. Hamburger said that a significant part of the expense was a small number of providers practicing in six offices that had to be connected via high-speed cable. He added that physicians practicing in ones and twos might have an easier time, implementing an EHR, purchasing systems for $20,000 to $40,000 or so. But that doesn’t cover the countless hours and endless patience required to sort through more than 300 EHR vendors. Specialists, including otolaryngologists, have an edge because this is expensive. For primary care docs with less money to invest in IT, it could be a stretch, he added. As for the government’s incentives, its 2% bonus for Medicare may help, but the ongoing maintenance, licensing, and consulting costs far outweigh any existing or proposed government reimbursement.

Hospitals

It is difficult, expensive, and chaotic for hospitals to make the transition from paper to fully electronic health records. Team Obama’s $19 billion carrot to hospitals and physician groups to beef up health care IT may speed things along, but the estimated $20 to $100 million price tag per installation has kept EHR adoption in hospitals below 10%.