In response to reader commentary on Joseph Conn's "Few ambulatory docs have full-function EHR systems":
Contrary to A. Scott Holmes assertion that this is not opinion, much of what he says is opinion.
He asserts that almost as much money as the cost of Iraq has been lost on electronic health records, computerized physician order entry, and trying to prevent medication errors. The cost of Iraq isto dateseveral hundred billion dollars, with some econometric estimates running as high as $3 trillion. Moreover, his use of the term lost implies that these expenditures were valueless.
One study (Health Affairs, 2005), provided the following estimates: the cumulative cost for 90% of hospitals to adopt an electronic medical-record system is $98 billion if 20% of hospitals now have such a system. ... Our models for adoption by physicians show that the cumulative costs to reach 90% adoption are $17.2 billion.
These are not insignificant sums, to be sure, but they are largely one-time costs, and are an order of magnitude lower than that which Holmes suggests. Another 2005 Health Affairs study states that Initial EHR costs averaged $44,000 per full-time-equivalent provider, and ongoing costs averaged $8,500 per provider per year. For comparison, the most recent government data indicate that healthcare in the U.S. accounts for about $2.1 trillion last year.
An American Hospital Association survey in 2007 suggests the following estimates: between 13% and 18% of capital budget and between 2% and 3% of operating budget for EHR implementation in a hospital environment.
The New England Journal of Medicine article, which engendered the discussion, concluded that physicians who use EHRs believe such systems improve the quality of care. Tellingly, quality of clinical decisions was perceived to be significantly better for those using EHRs. The literature generally indicates a payback period of around 2.5 years for EHR implementation. These suggest that EHR expenditures are far from being lost.
His concluding sentence raises the tired canard about what the current administration disparagingly refers to as government-run healthcare. We know from the experience of several other nationsas well as our own: e.g., the State Children's Health Insurance Programthat this is not the same thing as the universal health insurance he seems to dread. Leaving aside why anyone would not want universal health insurance.
I agree that funding initiatives to reduce nosocomial infections and operative errors would be well-spent and correspondingly reduce unnecessary medical expense, as well as improving patient outcomes. And I have no doubt that payers have data to support that. But even these are amenable to EHR enhancement. For instance, a registry of patients with past methicillin-resistant Staphylococcus aureus infection would help to prevent future episodes for those same patients without the questionable efficiency of screening all patients for MRSA. Similarly, a digital image of the operative site in the operating room is worth a lot more than a film left in the reading room or the office. And ask any payer whether they would rather process an electronic claim or one on paper.
Michael MundorffProject manager Primary Childrens Medical Center Salt Lake City To submit a letter to YOUR VIEWS, click here. Please include your name, title and hometown.