Point/Counterpoint: Is it better to adopt an EHR or pay a federal penalty in 2015?


YES on adoption

EHR Adoption Offers Advantages

By Don E. Detmer, M.D., FACS

There are many good reasons for surgeons to adopt electronic health record systems sooner rather than later.

One of the biggest advantages in adopting EHRs now is the chance to earn financial incentives from the federal government. Under the Medicare EHR Incentive Program, eligible physicians who adopt certified EHR systems and meet quality metrics for the "meaningful use" of the technology can earn up to $44,000 over 5 years. Under Medicaid, physicians can earn up to $63,750.

The program also carries penalties: Physicians who fail to implement EHR technology will face a 1% cut to their Medicare payments starting in 2015. That penalty will gradually increase over time. Despite this, the most compelling reasons for "taking the EHR dive" relate to changes in care itself. Electronic records are critical to managing patients with increasingly complex conditions who are receiving care within complex care systems.

Health care now faces major challenges. First, there is a growing need to coordinate care effectively and efficiently, especially for older patients with chronic illnesses. Second, technology relating to care continues to change, especially with a greater focus on monitoring patients outside hospital settings. These technologies are typically computer based. In short, patients today have multiple illnesses, are seen by multiple doctors, and are often taking a long list of medications.

EHRs aren’t just a way to move away from paper charts. They are truly a new way of practicing medicine that allows for improved communication with our colleagues in other specialties and with our patients. For me, one of the most exciting opportunities presented by EHRs is using secure online portals so patients can ask questions and share data. This allows physicians to communicate with their patients in a much better way than we have in the past. This is critical, because good patient communication may result in fewer complications, shorter lengths of stay, better outcomes, greater patient satisfaction, and even fewer lawsuits.

Even within their current limitations, which are quite real, EHRs can really improve the way surgeons deliver care. If you don’t believe me, just ask those who have made the switch to an electronic system. While many to most had reservations going into the process, 6-10 months later, most would never go back to a paper-based system.

I don’t want to underestimate the challenges of selecting and implementing an EHR. It is a major transition for your practice, aside from the financial implications, which are also real. Further, research shows that adequate training on EHR use is key to surgeon satisfaction.

The current systems aren’t perfect, and neither is the federal EHR incentive program. The "meaningful use" requirements aren’t designed with surgeons in mind and it shows. But that doesn’t mean surgeons can’t still participate in the program and earn money to offset some of the costs of their EHR systems.

Surgeons shouldn’t hold off on adoption while they wait for the perfect system for a surgical practice. It’s more important to find an EHR system that is interoperable and allows you to exchange data with referring physicians, pharmacies, and patients. More surgeons using EHRs will also improve EHR products for surgical use.

I think we’re approaching a tipping point within health care. Surgeons will need to adopt EHRs sooner or later. As long as that is the case, why not take advantage of federal incentives while they are still available?

Dr. Don E. Detmer is a vascular surgeon and Medical Director for Advocacy and Health Policy at the American College of Surgeons. He previously served as president of the American Medical Informatics Association.

NO on adoption

Implementation Can Wait

By Robert Shelton Viney, M.D., FACS

After a failed attempt to implement an EHR system, my colleagues and I decided to hold off on switching over to an electronic system.

Don’t get me wrong, I’m a big proponent of technology. I was the chief of staff at Midland Memorial Hospital in Texas, when we adopted a fully computerized medical record. At the time, only about 10% of hospitals in the country had computerized medical records. I championed the switch, and I love working with that electronic record. I will not go back to a paper hospital chart.

But when it comes to our six-physician general and vascular surgery group, we haven’t had the same success. We have tirelessly searched for an EHR system over the last 3 years, but none of them are designed for surgical offices. They all seem to be configured around the practice of primary care physicians.

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