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Continued Barriers and Issues with eHRs

More on the electronic documentation of medical information

By Carol S. Miller BSN, MBA, PMP

Many providers of health care are moving forward with electronic medical records [eMRs] and documentation of related information.

However,  there are still significant perceived and real barriers impacting some doctors and practitioners of care in moving forward with this process.

Here’s why in four brief points:

  • High Start-up Cost is probably the foremost barrier or concern of providers.  The EHR product, hardware, initial and annual software license, training both initially during implementation and ongoing, and other peripherals,  and the follow on module updates, maintenance, and/or replacements are all associated with a cost that can be quite an expensive proposition especially to a small provider practice.
  • Loss of productivity does occur as the staff and providers learn the new system and associated process changes in day-to-day operation.
  • There are many EHR products in the marketplace.  Providers are faced with decision points on which vendor system to purchase and the degree of modules needed to successfully support the clinical work within that practice.  In general, technical integration such as uncertain quality of system purchased, functionality issues, lack of integration with other applications and other like issues can impact a smooth transition to EHRs and actually create more problems and cost than the existing process in place.  In addition, incompatibility between systems (user interface, system architecture and functionality) can vary between suppliers’ products.
  • Certification, security, ethical matters, privacy and confidentiality issues are still a high concern.  The increased portability and accessibility of electronic medical records may increase the ease with which they can be accessed and stolen by unauthorized persons or unscrupulous users.  Even today large-scale breaches in confidential records occur and others can easily happen whena more integrated connectivity exists between systems, providers, hospitals, and wireless devices.  Continued concerns about security contribute to the widespread adoption of EHRs still are pervasive in the provider community.  Still lingering is the privacy concern and the adequate protection of individual records being managed electronically.  As an example, with an electronic record in a hospital setting, there can easily be over 100 individuals from doctors, nurses, technicians, admissions, quality control, billing staffing and many more who have access to at least part of a patient’s record during an average hospital stay.  In addition, there are multiple individuals at payers, clearinghouses, research firms, and others that have access to patient information at any given time.

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Carol S. Miller has an extensive healthcare background in operations, business development and capture in both the public and private sector. Over the last 10 years she has provided management support to projects in the Department of Health and Human Services, Veterans Affairs, and Department of Defense medical programs. In most recent years, Carol has served as Vice President and Senior Account Executive for NCI Information Systems, Inc., Assistant Vice President at SAIC, and Program Manager at MITRE. She has led the successful capture of large IDIQ/GWAC programs, managed the operations of multiple government contracts, interacted with many government key executives, and increased the new account portfolios for each firm she supported.

She earned her MBA from Marymount University; BS in Business from Saint Joseph’s College, and BS in Nursing from the University of Pittsburgh. She is a Certified PMI Project Management Professional (PMP) (PMI PMP) and a Certified HIPAA Professional (CHP), with Top Secret Security clearance issued by the DoD in 2006. Ms. Miller is also a HIMSS Fellow, Past President and current Board member and an ACT/IAC Fellow.


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13 Responses

  1. The loss of eloquence in EMR notes

    Well done, Carol.

    There is another pressing issue to me personally, as Editor-in-Chief of this ME-P, that is rarely discussed regarding the use of EMRs; the loss of verbal eloquence.


    Dr. David Edward Marcinko MBA


  2. Study Finds Wide Interest in EHR Incentives

    Carol – Most Florida doctors caring for Medicaid patients would be interested in applying for federal electronic health-record incentives, according to a study published in this month’s issue of Health Affairs.

    For example, more than 60% would be interested in the incentives payments, according to research presented by Dr. Nir Menachemi, associate professor in the department of healthcare organization and policy at the University of Alabama at Birmingham. Of those already using EHR, 86% replied that they would apply for incentives.

    The Health IT Economic and Clinical Health Act of 2009 established the federal meaningful-use criteria, which cited improved healthcare quality and better organization. However, doctors are slow to move toward those standards. The study showed 69% of physicians worried about the cost of adoption, while 42% needed more information about the incentives and another 42% are confused on which EHR system to buy

    Source: Ashok Selvam, Modern Healthcare [8/10/11]


  3. EHRs … More work than with Paper Charts

    Carol – Here is an essay on the EHR features that doctors hate the most: http://www.medscape.com/viewarticle/750110



  4. Why EMR is a dirty word to many doctors

    Don’t get me wrong, EMRs (electronic medical records) are inevitable. Over the long-run they are almost certainly good for physicians, patients and the healthcare industry.

    However, their origin and the ulterior motives currently driving their adoption is sowing the seeds of their failure.

    First, what is actually happening out there? The most recent CDC data would seem to be encouraging for EMR adoption, with EMR use (finally) passing 50%.

    Too bad there is more to the story.




  5. On “going paperless”

    “The paperless hospital is as likely as the paperless bathroom.”
    Dr. John Halamka

    CIO – Beth Israel Deaconess Medical Center
    NPR Morning Edition
    March 26, 2012.



  6. RAND says “never-mind”

    Optimistic predictions by RAND in 2005 helped drive explosive growth in the electronic records industry and encouraged the federal government to give billions of dollars in financial incentives to hospitals and doctors that put the systems in place.


    Yet, the conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new-er analysis by the influential RAND Corporation.

    So, what gives?

    Dr. Kingston


  7. EHRs Lose Money for Most Physicians, Study Says

    Adopting an electronic health record (EHR) system is a money-losing proposition for most physicians, even with the availability of federal bonuses for meaningful use of the technology, according to a study published online recently in the journal Health Affairs.

    Lead author Julia Adler-Milstein, PhD, an assistant professor at the University of Michigan, and co-authors projected the average physician to lose $43,743 over 5 years, and only 27% of practices to achieve a positive return on investment (ROI). That percentage of in-the-black practices would increase to 41% if they received $44,000 in meaningful-use incentive payments over 5 years.

    The good news in the otherwise discouraging report is that practices achieving a positive ROI did so in part by using their EHRs to significantly boost their revenue.

    Source: Robert Lowes, Medscape News [3/4/13]


  8. Electronic Health Records Not Only Don’t Save Money


    They may actually increase healthcare costs?

    Hope R. Hetico RN MHA


  9. Share the Government Fine

    It has been almost a decade since President George W. Bush promised fence-to-fence interoperable electronic health records for all Americans by 2014.

    Shortly afterward, RAND published its questionable 2005 study which said EHRs will save $80 billion a year and 100,000 lives. Only months ago, even RAND officials admitted that the history-proven biased results that were offered to Congress to help promote stimulus money for EHR adoption, was rigged in favor of EHR vendors. The EHR stakeholders continue to lose favor, and are desperately trying to buy it back from voters using healthcare dollars.

    Tens of billions of taxpayer stimulus dollars have been borrowed from our grandchildren to prepare unbroken ground for widespread mandated growth. Ominously, HHS recently-revealed her intention to share HIPAA fine revenue with patients who can claim harm from violations by HIPAA-covered healthcare providers.


    HIPAA/HITECH fines start at $100 (default minimum regardless of guilt) and can be as high as $1.5 million for willfully-negligent providers who don’t respect authority. With bounty like this, if HHS successfully pushes through the feel-good, share-the-wealth rule, it won’t be difficult for those who claim harm to find lawyers to happily help them reap benefits from providers’ misfortune.

    I predict some attorneys will advertise on late-night TV that they accept HIPAA violation cases on contingency – thereby eliminating all financial risk for those who might not be able to prove harm. Even if the allegation is groundless beyond an attorney’s persuasive talents, the ensuing OCR audit will cost a dentist a minimum of $100, and several nights’ sleep. Crap like this happens when professionals have no leadership.

    Windfall fruits are wonderful while they last, but as for the promise of interoperability between providers, HHS would feed us our seed corn.

    D. Kellus Pruitt DDS


  10. Are eHRs Dangerous?

    As data breach weary Americans increasingly fail to provide personal information in their medical histories, at what point do EHRs become dangerous to everyone?

    “Many withhold medical information over privacy fears, study finds” by Joseph Conn was posted yesterday on ModernHealthcare.com.


    Conn: “A substantial number of Americans are worried about the security of their medical information. Nearly 1 in 8 people have withheld information about themselves from a healthcare provider due to concerns about security and privacy, according to a study published online by the Journal of the American Medical Informatics Association.”

    Privacy attorney Jim Pyles of the Washington D.C. based law-firm Powers Pyles Sutter and Verville, tells ModernHealthcare.com,

    “It is likely that the public concern reflected in the study would be even greater if the public appreciated that the HIPAA privacy rule and the HITECH law provide the individual with few rights to control the use and disclosure of their health information and provide federal permission to disclose health information in a manner that is inconsistent with professional ethics.”

    D. Kellus Pruitt DDS


  11. National survey: Physician EHR outcry will shake the health information technology sector

    EHR functionality and costs have pushed up the misery index for physicians, according to the results of a new national survey from Medical Economics. The opinions of nearly 1,000 physicians about health information technology may just surprise you.

    Full article: http://medicaleconomics.modernmedicine.com/medical-economics/news/physician-outcry-ehr-functionality-cost-will-shake-health-information-technol

    So, what’s really driving physician dissatisfaction with EHRs? These data tables guide you through the results of the exclusive Medical Economics survey.

    Full article: http://medicaleconomics.modernmedicine.com/medical-economics/news/slideshow-medical-economics-ehr-survey-probes-physician-angst-about-adoption-

    Ann Miller RN MHA


  12. The inside story of a doctor who quit over EHR upcoding

    Physicians who are barred from seeing billing records and do not have authority over the process could be liable for fraud and held personally accountable for what goes on behind their back.




  13. EHRs

    “We have made great progress in adopting EHRs in the last six years, but now our charge is even more difficult. Now we must develop and implement strategies that allow all stakeholders – patients, clinicians, researchers, developers and policymakers – to truly benefit from a connected, innovative health ecosystem.”

    Douglas Fridsma MD PhD
    [President & CEO, AMIA


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