There is Gold in the Hills

The ‘gold rush’ of Electronic Health Records is on. Or so says every major media outlet and President/CEO of a healthcare vendor. Now is the time that America will finally get electronic health records that will catapult this country into the future of healthcare delivery. Or is it?

The romantic ideal of a gold rush doesn’t take into account how many dreams were shattered in the hills of Colorado, Nevada, California, and Utah. There was and is some gold in the mountains and streams, but to profit from the endeavor sure wasn’t as easy as people made it out to be. Not only did many of the actual miners fail and end up settling on other dreams in other parts of the country, but the land itself suffered from the ruthless attacks on its beautiful and serene nature. To this day there remains unsafe and unprotected mine shafts from years of recklessness.

So why are vendors and media outlets declaring the migration to electronic medical records a gold rush? Why is it that the gold is coming out of the physicians’ pockets? The gold rush for $44,000 from the Federal Government barely covers a month of collections in a small practice and is payable over an arduous 5 year period. Uprooting an entire workflow and dissolving every last shred of pleasure from the practice of medicine doesn’t seem to be worthy of a golden moniker, does it?

In 2015, the Federal Government, through its own insurance agency, Medicare, will begin the process of penalizing practitioners of medicine for not demonstrating ‘meaningful use of electronic health care technologies’. This penalty, which begins at 1% and is capped at 5% total, doesn’t actually start to show up on reimbursements until 2016.

2016 is a whopping five full years away. Five years is a very long time. My own daughter will go from a gurgling infant to a kindergartener. She’ll be reading, talking, walking, running, biking, and hopefully using the potty before my doctor (wife) is penalized a measly 1%. As I write this, my daughter doesn’t sleep through the night and is eight days from being six months old.

In technological terms, five years is an epoch. Five years ago, laptops were uncommon in medical practices, WiFi was a gurgling infant, a smartphone was the one closest phone to you when you needed it, and people actually bought books and the daily newspaper.

I’d be very cavalier to predict what the world will look like in five years. I would guess, however, that every electronic health record application in the market today will look, feel, and operate in a completely different manner. In my estimation, the EHR being used today will be completely obsolete before penalties come to pass. If you think about it, there isn’t a lightbulb in my house that won’t need to be changed by then and we’ve been using lightbulbs a lot longer than EMRs.

When our customers ask me what I think about EMRs and Meaningful Use and the future of healthcare, I get very excited. The idealistic vision of going to any medical practice or hospital and resting assured that the physicians and staff will have FULL access to my complete history, the knowledge that they can continue following the same ‘best practice’ for my care as I would get anywhere else in the country, the fact that I won’t be subject to any unnecessary risks or procedures, and that I will be less susceptible to infection or error is worthy of excitement.  But that doesn’t mean I believe we are here today. I am not even sure we are on the right path.

Currently there are over 300 known EMRs in the market today.  Of those EMRs, in the end, there will most likely be 10-20 that exist with significant marketshare in 5-7 years.  The consolidation of these companies and their products will be unprecedented.

Due to this trimming of the fat, a purchase of an EMR today means nothing for your security in five years.  In most cases, a purchase today guarantees another migration before 2015, possibly two.  If you look in the recent news, the rash of EMR consolidations is in full swing. If you are one of the unlucky ones to have your EMR vendor acquired, what are your prospects of remaining on that application for the next five years?  Honestly, is there a book-maker in Las Vegas willing to take any odds on that?

So when we are brought into the conversation with our customers and prospects about EMR, Meaningful Use, healthcare reform and what to do in the future, our answer is relatively simple.  Stay comfortable, stay profitable, get your accounts in order and begin the process of going digital and disregard the incentives.  $44k is not a lot of money when you think of lost productivity, lost happiness, and the fact that you’ll most likely need to do it all again sometime in the future.  A practice that can work to get paperless charts, a fully-functioning Practice Management System that will increase their efficiency as well as ease the burden of managing claims, but keep their patient volume as high as possible, will be perfectly positioned to meet healthcare reform’s principles when the dust settles.

When the gold rush ended and people were entrenched in Colorado, Nevada, California, and Utah, the dust settled and they immediately came to realize that the gold wasn’t the draw to these places, it was the serene beauty of the land itself and the calm of living in the natural wonder of the western United States.  In our industry, when the same dust settles, the same realization will hold true, there is something special and magical about practicing medicine, it isn’t the gold in the ground that motivates us, but the reward in providing patients and their families the best medical care in the world.