Q: Given that digital medical records have been proven to improve care, what's the real reason doctors aren't rushing to use them?
| posted by Fast Company staff
It will probably cost them extra money for integrating the technology and data entry of all the records. And considering the way the healthcare system in this country is set up, doctors keep as much money as they possibly can.
cost of maintaining data effectively and safely may be another reason. I believe that a signicant percentage of registered doctors work at small sized, budget-tight hospitals.
According to the New York Times, most doctors lack the financial incentives to move to computerized health care records. Some have estimated that the cost upgrading software, providing technical support, etc. could cost around $20,000 per doctor...
In addition to the financial and data security issues, could it be that some doctors are worried about the transfer of knowledge and patient visits to another medical provider?
Something akin to what number portability may have done to the telcos
My guess is, they don't trust them. They are doctors, not computer whiz's. Their thoughts run to things like: If the computer goes down, where are the records, then? Paper is heavy & bulky, but paper copies have stayed around a long time.. I personally collect really old cookbooks - I have a copy of one from 1789.. Have we any confidence that a digital record will still be around in 319 years (2327)?
Given the structure of the billing process in our "public" health care system Medical professionals do not have the time, trained staff or client acceptance of the security of the product to implement thier use.
Digital medical records may provide a better recorded history of the patient but I seriously disagree that they improve the delivery of care. The real reason physicians are not rushing to use them are the hassel and inconvenience of moving from dictating their medical intervention to taking the time to learn how to use the electronic chart, who owns it (as in healthcare facility or practice) and the challenge of accessing and exchanging protected health information electronically. HIPAA (the Health Insurance Portability and Accountability Act of 1996) has also contributed to the challenge in moving and recording the PHI.
Healthcare professionals rely on their old habits as well as the word of conventions and symposiums to keep up--but the education and manufacturers that present their new products are not keeping up as well!
I believe they are also wary of any electronics that could produce static or interfere with live-saving devices. Cell phones and laptops are not allowed in patient care areas fo this reason. A hospital would either find new ways to wirelessly transmit information or install a cluttering computer network to make digital records work.
I do see, though, that this could work in small, private care offices.
Doctors don't want people to second guess them. And, digital medical makes medicine a commodity, not a service...so each medical procedure, medication, etc. would scrutinized and the price to perform each would ultimate go down.
Not many people in any profession embrace change. Doctors are generally on the latter part of the adoption curve. eRecords are new, different, expensive, and "get in the way" of care during the adoption phase.
The benefit is less for the doctor herself than for the insurance company and the patient who may want to take her records to another physician.
Speaking as a family doctor who is also very tech savy, and having used electronic medical records (EMR) in several practices... i can say that i have not found a single EMR that can be called usable. They have been very clunky, poorly designed and very cumbersome. This is coming from someone who is very comfortable with computers. Many doctors that i know are very slow to embrace technology. Having poorly designed interfaces makes it much more complicated to get them to use an EMR.
Also, patients shouldnt get the idea that because a doctor uses an EMR he/she is a better clinician. A great deal of information can be HIDDEN in an EMR, never to be seen again. Rely more on a physician's intelligence and insight. Of course, interpersonal skills would be a HUGE bonus, as would the ability to actually listen to a patient.
Michael R. Springer, MD
family medicine,
bloomington, IL
As a healthcare program manager in the Silicon Valley, I'm SHOCKED at the delay in adopting electronic medical records. My own nonprofit agency has delayed in part due to lack of money and expertise. I champion the cause at every turn, but have found few sources of support, either inside or outside the agency. What are you doing to champion the cause in your own practices?
First, I think we really overestimate the technical acumen of doctors. You may need to be brilliant(ish) to get out of med school, but that doesn't mean you know how to navigate the latest technology. I've seen that in every field - brilliant people who can't fax and scan, much less upload. So, there's a learning curve combined with egos not very well-suited for admitting there is a learning curve.
Then, there is the fear - irrational or no - of jobs being displaced and patients thinking the "man" will use their health against them.
INSURANCE COMPANIES
DENIAL OF COVERAGE TO PATIENTS & THEMSELVES.
RECORDS BEING USED TO DENY CARE FOR PEOPLE/COVERAGE/INCREASE RATES FOR COMPANIES/MORE UNINSURED PEOPLE.
1)startup costs
2)unwillingness to adapt to change
3)Also 'proven' is a strong word, pros and cons are both present as with any new technological advance.
It will take some time before the pros dominate the other reasons preventing adoption.
They are not rushing to digital records because security is in-effective, the risks of "leakages" are astronomical and in the end, read the fine print "exclusions" in their insurance policies regarding general liabilities.
Doctors are known to be the professionals who always try to make maximum use of their medical education (spaning more than 5+ yrs.).But when it comes to the task of collaborating the accumulated knowledge with the patients live health profile, they often disparage its siginificance.One of the reasons may be short of time,and another can be their lack of awareness bout such kind of medical records.
One of the major problems with Electronic Medical Records (EMR)is that each physician's practice is run a little differently from the next. An EMR company will sell you their product with the promise that they will customize the software to your individual practice. After you have purchased the software, there is no incentive for the EMR company to follow-up on their promise.
I disagree with the comment that medical records have been proven to improve care, and I speak from experience. While EMR may increase the effectiveness of record storage, with assembly line-type, uncustomizable EMR software, it actually takes physicians more time to see patients and complete notes than it does with paper records. This decreases the number of patients a physician can see per day and increases the amount of time it takes new patients to get in for appointments with physicians as well as increases the amount of time it takes established patients to get in for follow-up appointments. Please explain how this improves patient care.
Having worked for an EMR Software company and having successfully implemented the EMR system in over 50 clinics personally, I believe that the biggest reason for the resistance to move towards an electronic system is "Change". It is not just the doctor who needs to change, but the entire office, including the support staff (Front Office Staff, Receptionists, Nurses, Billing staff) that needs to undergo the "change". It may seem like an expensive proposition to begin with in the short term, but the long term benefits far outweigh the COST factor of the short term.
My Dr. is using digital records. When I filled out all the paperwork at the receptionist and saw the dr for the first time, he quickly review my forms on his labtop and knew my problems. Its a quick way for them to refresh their memory of your past history. When my MRI was completed he was able to show me the results. I believe more dr should use them.
27 Total
June 24, 2008 at 9:26am by Rachel King
It will probably cost them extra money for integrating the technology and data entry of all the records. And considering the way the healthcare system in this country is set up, doctors keep as much money as they possibly can.
June 24, 2008 at 10:05am by ryan ryan
cost of maintaining data effectively and safely may be another reason. I believe that a signicant percentage of registered doctors work at small sized, budget-tight hospitals.
June 24, 2008 at 10:43am by Rip Empson
According to the New York Times, most doctors lack the financial incentives to move to computerized health care records. Some have estimated that the cost upgrading software, providing technical support, etc. could cost around $20,000 per doctor...
June 24, 2008 at 1:58pm by Syamant Sandhir
In addition to the financial and data security issues, could it be that some doctors are worried about the transfer of knowledge and patient visits to another medical provider?
Something akin to what number portability may have done to the telcos
June 24, 2008 at 2:08pm by Carel Two-Eagle
My guess is, they don't trust them. They are doctors, not computer whiz's. Their thoughts run to things like: If the computer goes down, where are the records, then? Paper is heavy & bulky, but paper copies have stayed around a long time.. I personally collect really old cookbooks - I have a copy of one from 1789.. Have we any confidence that a digital record will still be around in 319 years (2327)?
June 24, 2008 at 3:21pm by Brett Reid
A Canadian perspective....
Given the structure of the billing process in our "public" health care system Medical professionals do not have the time, trained staff or client acceptance of the security of the product to implement thier use.
June 24, 2008 at 6:12pm by Jay Tatum
Digital medical records may provide a better recorded history of the patient but I seriously disagree that they improve the delivery of care. The real reason physicians are not rushing to use them are the hassel and inconvenience of moving from dictating their medical intervention to taking the time to learn how to use the electronic chart, who owns it (as in healthcare facility or practice) and the challenge of accessing and exchanging protected health information electronically. HIPAA (the Health Insurance Portability and Accountability Act of 1996) has also contributed to the challenge in moving and recording the PHI.
June 24, 2008 at 6:14pm by Jenn de la Vega
Healthcare professionals rely on their old habits as well as the word of conventions and symposiums to keep up--but the education and manufacturers that present their new products are not keeping up as well!
I believe they are also wary of any electronics that could produce static or interfere with live-saving devices. Cell phones and laptops are not allowed in patient care areas fo this reason. A hospital would either find new ways to wirelessly transmit information or install a cluttering computer network to make digital records work.
I do see, though, that this could work in small, private care offices.
June 24, 2008 at 9:41pm by Ian Miller
Could be the texhnology is not yet stable enough to be widely embraced by the medical community.
June 24, 2008 at 11:47pm by Steven Lockhart
Doctors don't want people to second guess them. And, digital medical makes medicine a commodity, not a service...so each medical procedure, medication, etc. would scrutinized and the price to perform each would ultimate go down.
June 25, 2008 at 12:17am by Steve McNally
Not many people in any profession embrace change. Doctors are generally on the latter part of the adoption curve. eRecords are new, different, expensive, and "get in the way" of care during the adoption phase.
The benefit is less for the doctor herself than for the insurance company and the patient who may want to take her records to another physician.
June 25, 2008 at 8:06pm by Michael Springer
Speaking as a family doctor who is also very tech savy, and having used electronic medical records (EMR) in several practices... i can say that i have not found a single EMR that can be called usable. They have been very clunky, poorly designed and very cumbersome. This is coming from someone who is very comfortable with computers. Many doctors that i know are very slow to embrace technology. Having poorly designed interfaces makes it much more complicated to get them to use an EMR.
Also, patients shouldnt get the idea that because a doctor uses an EMR he/she is a better clinician. A great deal of information can be HIDDEN in an EMR, never to be seen again. Rely more on a physician's intelligence and insight. Of course, interpersonal skills would be a HUGE bonus, as would the ability to actually listen to a patient.
Michael R. Springer, MD
family medicine,
bloomington, IL
June 25, 2008 at 9:34pm by Steve Monte
As a healthcare program manager in the Silicon Valley, I'm SHOCKED at the delay in adopting electronic medical records. My own nonprofit agency has delayed in part due to lack of money and expertise. I champion the cause at every turn, but have found few sources of support, either inside or outside the agency. What are you doing to champion the cause in your own practices?
June 26, 2008 at 4:45pm by
First, I think we really overestimate the technical acumen of doctors. You may need to be brilliant(ish) to get out of med school, but that doesn't mean you know how to navigate the latest technology. I've seen that in every field - brilliant people who can't fax and scan, much less upload. So, there's a learning curve combined with egos not very well-suited for admitting there is a learning curve.
Then, there is the fear - irrational or no - of jobs being displaced and patients thinking the "man" will use their health against them.
June 27, 2008 at 2:55pm by Richard Kane
Doctors pass off all clerical to the nurses who are working 50-60 hours a week as it is.
June 27, 2008 at 5:57pm by Paul Verberne
Here's a few real reasons: www.jpands.org/vol11no3/christman.pdf
July 7, 2008 at 8:28pm by Cynde Tiesling
INSURANCE COMPANIES
DENIAL OF COVERAGE TO PATIENTS & THEMSELVES.
RECORDS BEING USED TO DENY CARE FOR PEOPLE/COVERAGE/INCREASE RATES FOR COMPANIES/MORE UNINSURED PEOPLE.
July 8, 2008 at 11:35am by Ray Myers
IMHO, most are control freaks; it's their job. And, too, their treatment regimen, good or bad, is all there for the world to see.
July 17, 2008 at 11:21am by Mark Hettinger
They are used to doing things the way they have always done them, they dont want to spend the money to head in that direction.
July 17, 2008 at 7:33pm by Elizabeth Wonseski
After speaking with several doctors about this issue thir response was one word..Cost
July 26, 2008 at 9:50pm by Rahul Shankar
1)startup costs
2)unwillingness to adapt to change
3)Also 'proven' is a strong word, pros and cons are both present as with any new technological advance.
It will take some time before the pros dominate the other reasons preventing adoption.
July 27, 2008 at 3:48pm by Joe Nieto
Does anyone know of a weblog discussing electronic medical records and their implentation?
August 10, 2008 at 12:02pm by Margaret King
They are not rushing to digital records because security is in-effective, the risks of "leakages" are astronomical and in the end, read the fine print "exclusions" in their insurance policies regarding general liabilities.
August 12, 2008 at 4:36am by Ujwal Watgule
Doctors are known to be the professionals who always try to make maximum use of their medical education (spaning more than 5+ yrs.).But when it comes to the task of collaborating the accumulated knowledge with the patients live health profile, they often disparage its siginificance.One of the reasons may be short of time,and another can be their lack of awareness bout such kind of medical records.
August 19, 2008 at 12:53pm by Luke Widmer
One of the major problems with Electronic Medical Records (EMR)is that each physician's practice is run a little differently from the next. An EMR company will sell you their product with the promise that they will customize the software to your individual practice. After you have purchased the software, there is no incentive for the EMR company to follow-up on their promise.
I disagree with the comment that medical records have been proven to improve care, and I speak from experience. While EMR may increase the effectiveness of record storage, with assembly line-type, uncustomizable EMR software, it actually takes physicians more time to see patients and complete notes than it does with paper records. This decreases the number of patients a physician can see per day and increases the amount of time it takes new patients to get in for appointments with physicians as well as increases the amount of time it takes established patients to get in for follow-up appointments. Please explain how this improves patient care.
August 26, 2008 at 2:37am by Bhavin Shah
Having worked for an EMR Software company and having successfully implemented the EMR system in over 50 clinics personally, I believe that the biggest reason for the resistance to move towards an electronic system is "Change". It is not just the doctor who needs to change, but the entire office, including the support staff (Front Office Staff, Receptionists, Nurses, Billing staff) that needs to undergo the "change". It may seem like an expensive proposition to begin with in the short term, but the long term benefits far outweigh the COST factor of the short term.
September 28, 2008 at 9:39pm by Jose Carcano
My Dr. is using digital records. When I filled out all the paperwork at the receptionist and saw the dr for the first time, he quickly review my forms on his labtop and knew my problems. Its a quick way for them to refresh their memory of your past history. When my MRI was completed he was able to show me the results. I believe more dr should use them.