Lyle Berkowitz is not an electronic health-record systems basher; far from it.
Nor is he opposed to the federal government subsidizing hospitals and physician offices, although he says the proposed maximum payments of $44,000 for most office-based physicians like himself in the American Recovery and Reinvestment Act of 2009 wont cover the true cost of installing an EHR.
No, what gets Berkowitz going is the poor quality of the user interface of the current crop of EHR systems on the market.
I think the stimulus bill money is not worth it for the current EMR systems that we have, said Berkowitz, a practicing internist, an EHR system user and medical director of clinical information systems with the Northwestern Memorial Physicians Group, Chicago, Berkowitz was also a presenter at the recent Healthcare Information and Management Systems Society convention in Chicago on How to Improve EMRs and Incorporate Innovation In All We Do.
The actual cost of buying and implementing these systems as well as factoring in the lost time and problemsits significantly more than $50,000, Berkowitz said. Its probably more than $100,000. The systems alone are not the real cost, when you factor in the change management that has to take place.
One potential problem is the stimulus law, with its deadlines for purchasing an EHR system, and, eventually, penalizing them financially if they dont, that could make physicians buy something and rush into an inadequate system, he said. And they all are inadequate; theyre not all evil, but certainly none of them are perfect.
If that is all the federal IT subsidy program achieves, then, all were going to do is stick doctors with bad systems, Berkowitz said. If the end goal is to just get doctors to use EMRs, thats a bad end goal, a horrible end goal. If the goal is to increase quality and efficiency, we have to rethink our entire reimbursement system and reward quality and not quantity.
The key, Berkowitz said, will be federal interpretation of the meaningful use requirement in the stimulus law. The National Committee for Vital and Health Statistics, an HHS advisory panel, held two days of public hearings this week on the meaning of the phrase in advance of HHS rule-making on the stimulus bill to be completed this year.
Everyone is still wondering what the phrase means, Berkowitz said, but by putting in that language, I think they got some good advice from some people and they realize their end goal is not simply getting everybody to use an EMR.
Berkowitz is a board member of the Association of Medical Directors of Information Systems, a professional association for physician informatics. He also heads an IT consulting firm and serves as the program director of the Szollosi Healthcare Innovation Program, a not-for-profit organization working to improve information sharing among collaborating physicians as well as between physicians and patients. Better communication, according to an explanation on the organizations Web site, includes a concept called information visualization, an exploration of ways to improve the interface between information source and the healthcare information userboth clinician and patient.
So, Berkowitz has done a good deal of thinking in the past few years on the ideal physician/computer interface.
Any screen I see should essentially have two parts, Berkowitz said. It should have historical information or data I need to make a decision. And that data is going to be pulled in from all parts of the record, vitals, labs, meds history, evidence-based medicine guidelines. The other half should be todays history, physical exam and plan. This is where Im going to document what I see today and what Im going to do today. There is no reason a computer cant pull most of this information in and pre-populate everything Im going to do. It significantly cuts down my work and leads me in the right direction.
To get this information now, I have to jump to every different screen to find all this, or if its on one screen, its not an articulate screen, its just mashed all together, he said. I dont know if the EHR vendors should be doing this, or whether they should be giving us the tools to do it, because they havent done it too well thus far.