Money is what everything comes down to in the business environment. But sometimes bottom-line decisions can be short-sighted. It's my considered opinion that that's been the case in health care for at least the past 20 years. And the result has been less-than-optimum patient care.
I'm not talking about DRGs, or the move to managed care, or hospital buyouts of medical practices, or the often byzantine government regulations and payment schedules. I'm talking about technology and the infinitely slow progress of it in the medical field.
Nearly 20 years ago, I reported in the pages of a Medical Economics special issue on computers that one doctor in five had a computer in the office and that it was "possible that computers will be taken for granted in most medical offices by the end of the decade." If that prediction came true, I suspect that most practice computers were not used for clinical applications. One reason: money.
Another article in that issue cautioned that before "rushing out to the computer stores," doctors be sure that the costs were justified. Doctors were also warned that clinical applications would "require more storage capacity than a basic financial package." Read that: Will add to the cost. An investment in a computer system that handled billing could add directly to the bottom line and improvements in collections could be easily documented.
Not so easily documented or quantifiable are the benefits of clinical applications. So, despite the fact that that special issue 20 years ago also carried an article about some very successful early-adopters of electronic medical records, medicine is still in a position that prompts us to run two articles this month proving that EMRs can do great things for a practice. (See "EMRs cost too much? This group says No Way!" and "EMRs boost efficiency, too" in this issue.)
We highlighted cost and efficiency in the titles of those articles because, again, that's what drives purchasing decisions. What ought to be driving them is the better patient care that electronic medical records can facilitate. I'll bet you anything that the foot-thick records some of you have on patients with chronic conditions have lots of gems buried in them that you'll never findinformation about an adverse reaction to a drug you prescribed years ago, for instance, that might stop you from prescribing it today.
Easily keeping track of all a patient's medical history is just one example of what a good electronic medical record system can do for you. Better documentation, ready drug data, more accurate charge capture, and access to office records from remote locations are others.
Remote access will be one of the best features if hospitals ever get their acts together, too, and move to EMRs. How great would it be for clinical outcomes if you could access a patient's complete medical recordoutpatient and inpatient, plus labs and prescription data from wherever you were? The benefits would be enormous.
But hospitals are no further along than doctors in adopting the EMR as standard. A recent issue of Hospitals and Health Networks had this to say on the subject: "In short, evidence abounds that EMRs can significantly improve care and reduce costs in the long run. So why the continuing reliance on paper-based medical records? . . . The obvious reason is money."
To diminish that harsh reality, the article went on to spread some of the blame to doctors' resistance to a move to a computerized system.
I suggest that doctors are far more willing to adopt EMRs than hospitals. I also suggest that if doctors do make the move to EMRs in their own practices, you'll have the clout to move your hospitals into the 21st century whether they want to make the investment or not.
Why? Because if a hospital can't give its physicians the tools they've become used to in their own officespoint-of-care access to all a patient's clinical informationthen those physicians will stop admitting patients to that hospital.
So the way I see it, optimum patient care is up to you. What's stopping you? Money?
Marianne Mattera. Memo from the Editor: Money!. Medical Economics 2002;7:7.