Why I Feel Sorry for Doctors

The $19 billion push for electronic health records will mean big headaches for physicians who run small practices, says tech consultant Gene Marks

I've never really felt sorry for my older sister Vicki, especially given all the times she made fun of me when we were little. For the record, I am not, nor have I ever been, a "creepy little rat." Well, not all the time.

But I'm starting to feel sorry for her now. Because with the passage of the new stimulus bill, Vicki, a doctor who runs her own practice, is being forced to turn all of her patient data into electronic files. Electronic health records are going to be mandated for each citizen, and it will fall upon medical practitioners like her to accomplish this task. Plenty of business owners, doctors or not, face technology conundrums all the time, as I've shown you in previous columns. But being forced into buying technology? That's the worst situation to be in.

The government wants new electronic records of patient data to follow us around for the course of our lifetimes. Software and hardware companies are drooling. Database consultants and other technology geniuses can barely contain their excitement. And the doctors/small business owners like Vicki? They feel like vomiting. Lucky that she's at least got access to some good drugs.

What's a Sister To Do?

The plan is that these doctors/small business owners will buy this…stuff… and then get reimbursed by the government for their efforts. And then starting in 2015, government Medicare reimbursements to those terrible souls who choose not to participate in this effort will decline. It's kind of like an offer they can't refuse. There will be a health-care czar, too who will have $19 billion of taxpayer money to work with.

So what's my big sister going to do? "Nothing, until I'm forced to!" she says. Why? Because like all technologies, there's a lot of slip between the cup and the lip. And there are too many details that need to be figured out. Details that would significantly affect her business.

For example, right now there are dozens and dozens of companies offering technologies that claim to provide electronic health records. And guess what? None of their systems talk to each other. Surprise! And none of them have the same architecture. And they don't exchange data with all the same hospitals. That's because most hospitals' systems are all over the place too. What, you think those big hospitals actually have their act together?

Relying on Resellers

"At my hospital, the emergency room database doesn't even talk to the cardiology database." Vicki grumbles. "How's it all going to come together?"

How indeed.

Oh, and by the way: these systems are sold by companies, both big and small. And they're sold through technology resellers, also big and small. Some may be around in a few years. Some may not. Who's to know? If Vicki chooses the wrong one, she's hosed.

Bad Luck with Software

And does this stuff even work very well? Has it been tested? We read every day of security breaches, missing data, and privacy encroachments. Is Vicki feeling comfortable that any of these vendors can protect her patients' medical information from the outside? Take a guess.

Unfortunately, like many business owners, Vicki's had bad luck with technology before. Her current practice management software is still, if you can believe it, based in MS-DOS (it has a pretty Windows-like covering, but we all know what's behind the scenes). She says the reseller who sold her the system nine years ago has a revolving door of technicians and salespeople who only want to talk about upgrades, not service. But service is what she needs. No matter what she spends on an electronic health records system, Vicki doesn't expect things to be a whole lot different.

Vicki's going to be forced to spend some big time money. Sure, the government will reimburse her for (hopefully) up to $65,000.

But that will maybe cover the cost of the hardware and software for her two office locations.

A Grand Idea

What about training? Data migration? Customization? But what about the lost time spent learning the new system? And the time spent doing the data entry? And the time spent dealing with all of the inevitable problems that are ultimately going to happen as a result of software makers ramming their products into the marketplace before they're really ready for prime time. There will be bugs. And lost information. And unhappy patients. And lots of downtime. All of this will cost her.

And remember, this is only a database. The idea of a big electronic system in the sky is a grand one. But Vicki's personal Rolodex is a mess. You think her practice's database is going to be any cleaner? Databases are only as good as the data going into them. And the data's only as good as the people doing the data entry. So now Vicki's going to have to employ and train more experienced (and costly) staff to do this work. Yay.

Well at least there will be a good return on her investment, right? Nope. Vicki's manual records are in pretty good shape right now. Being my sister, I personally wouldn't let her cut my toenails. But I'm told she's an excellent doctor. Will all this money and effort make her a better doctor? Most likely not. "Maybe the insurance companies will benefit, but not me," she complains. "And they'll probably raise my rates again anyway!"

Waiting for Guidance

So what's a doctor/small business owner going to do? Nothing. For now.

"I guess I'll wait for someone to tell me what to do," she sighs. No one, and I mean no one tells my sister what to do. But here she is, quaking in her boots. Waiting for some direction. Some details. Some guidance. Will it come? Or will, like the transition from analog to digital TV, these rules be pushed so far back that Vicki can retire before she's forced to do anything. She just doesn't know. There are too many questions.

I hate to admit it (being my sister and all) but I actually think Vicki's got the right idea. The whole landscape's going to change. Database formats will be preferred. Some companies will consolidate. Some will disappear altogether. Others will dominate. Hospitals may recommend certain systems. The government may wind up giving its seal of approval to others. As with any technology, it's never a good idea to be on the bleeding edge. So doctors like my sister are best advised to just sit on the sidelines.

Anyway, that's what I think is best. But what do I know? I'm just a creepy little rat, right, Vicki?

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