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Unhappy Camper (Vol. 2, Issue 3)

News from Montana is that the State legislature is revolting against the whole concept of health IT, so it gave me considerable pause as to just why this was occurring (See: http://www.healthcareitnews.com/news/governor-pleas-states-35m-ehr-incen... ). According to sources quoted in the Helena Independent Record (http://helenair.com/news/article_9ece13de-505f-11e0-a641-001cc4c03286.html ), there are significant philosophical concerns raised in the process of adopting EHR, such as too much personal health information being available to hospital administrators and insurance companies. “Rep. Don Roberts, a Billings Republican and oral surgeon, said many doctors are skeptical of the plan to create electronic medical records available to all hospitals. Roberts said patient privacy could be compromised with so many having such easy access to the information.”

Now, even I’m not that paranoid. I personally see no threat by allowing hospital administrators and health insurance companies access to medical records. By their very design these entities always have had, and will continue to have, such access. Those of us in Rhode Island tend to be of a more liberal bent, and, like myself, might view the debate out West with some suspicion, perhaps as more of a ruse by the Republican-controlled Montana State legislature to decrease tax and spend cycles. “Republican leaders have said that turning away the money sends a signal, especially if other states do the same. And they point out that the federal government may be giving money to start the program, but could eventually require the states to chip in to maintain it.”

Hmmm, that sound familiar, doesn’t it? Except that in the future I envision the states will be not be paying the costs of maintaining the EMR infrastructure—we will. Eventually that EMR Meaningful Use money will dry up, no more governmental health care dollars will follow us, and we’ll be stuck holding the bill.

First, consider all of the inevitable health IT shake-outs, mergers, and acquisitions that will occur within the relatively small, niche marketplace of EMR vendors. The company that just sold their EMR system to you may be out of business in a few short years, resulting in a forced transition to a competitor’s much more expensive system.

Second, as EMR systems evolve, mandatory upgrades loom in your future, and you may realize that the expensive EMR system that you just purchased may be no longer be up to standard in a few years. If you are lucky enough to have an EMR system that’s around in the years ahead you’ll be paying plenty for the EMR vendor support contracts that encompass all the upgrades and software support you’ll need.

Third, as software evolves, so must the hardware that runs it. EMR tablet computers are lucky to make it 3 years in service, that is, if they’re not stolen first (you do have all these devices encrypted, right?). And it’s already a serious question as to whether those costly servers will need to be replaced in time to handle the forthcoming upgrades required to run ICD-10 in our billing systems.

Fourth, OMG, there’s the IT support contracts. For my 1 and ½ physician practice I’m paying, and will be paying, $550 per month for such IT support on the EMR infrastructure. In the world of small private-practice you’re given a choice to either practice medicine and pay through the nose for IT support, or morph yourself into a part-time physician/full-time IT person. I’ll take the former, please.

The State of Montana has about 1.15 million inhabitants, just slightly more than the 1.1 million citizens in Rhode Island. Montana Governor Brian Schweitzer says that failure to accept the federal EHR incentive funds will cost his state 505 jobs. One can assume, then, that Rhode Island will have approximately the same numbers, or about 500 jobs devoted to supporting EMR in the future years. Most of these people will have become an integral and necessary part of the operations of EMR systems. So who will be paying the salaries (and benefits) of all these IT people? (Hint: It's not the Government). We physicians will.