Letters

E-H-R spells trouble

To the Editor:

What you said in your article "Why It's Time to Purchase an Electronic Health Record System" [November/December 2004, page 43] is all true - until a virus comes in and attacks the Microsoft operating system Windows 2000, destroying your data. This happened in our practice, and then we found out that the backup system our computer consultant said was flawless had not been working for the past three months. Most recently, the power supply blew in our server and brought the office to a grinding halt for a week.

Now we are returning to paper scheduling and outsourcing our billing. The fragility of the computer systems and their expense, particularly in a poor reimbursement area like California, make the EHR just a dream at the moment.

John Bakos, MD, PhD
Lincoln, Calif.

More EHR woes

To the Editor:

Our practice's implementation of electronic health records (EHRs) was a miserable failure that cost us significant cash and time. We gave up after struggling for eight weeks to implement our EHR. Unfortunately, I was starting a new practice so I did not have paper charts to go back to. I had to attempt to transfer the information from the EHR to paper and create a charting and filing system. The old-fashioned charts are now working seamlessly, which is more than can be said for the EHR system, but the vendor withheld 30 percent of my actual cash payment when I canceled our contract.

Unfortunately I lost two months' production at an estimated $35,000. I spent over $10,000 in staff time troubleshooting the system and providing technical support. To top it off, the software company would not reimburse the $9,000 I had paid for training costs.

As a solo physician opening a new practice and trying to "do it right," this was quite a learning experience. I was astonished to find out how unprepared EHRs are to work in the real world - and how expensive their mistakes can be.

My cancellation contract with the software company effectively placed a gag order on me, so I cannot post the name of the company or the product. However, I can answer questions about the product and the company. Readers may e-mail me at lcrasmussen@srfm.org. I've been amazed at how many other doctors have had similar experiences with EHR implementations.

Lyndsey Rasmussen, DO
Snoqualmie, Wash.

How will data standards affect EHRs?

To the Editor:

Much work is currently being done to develop standards that organize and make transportable a set of basic information about a patient's health care, known as the Continuity of Care Record that can be read or processed by various EHR systems. [Read more about the Continuity of Care Record on the AAFP Web site at http://www.centerforhit.org/x201.xml.]

Does the contract Dr. Kenneth Adler's practice signed with its EHR vendor ["Why It's Time to Purchase an Electronic Health Record System," November/December 2004, page 43] provide for updates that may be needed to bring their system into compliance with these standards down the road?

Robert Dufour, PhD
Indianapolis

Author's response:

The vendor we partnered with, like all the other vendors we looked at, charges an annual software license subscription fee. This fee entitles us to ongoing technical support and access to software upgrades as they occur. Our vendor anticipates at least one major upgrade per year.

Hopefully future upgrades will include the CCR standards. The CCR is a voluntary standard data set designed to provide a snapshot of a patient's health status at one point in time. Ideally, the CCR would form a bridge between EHRs that can't and don't talk to one another.

Currently, implementation of the CCR depends on its voluntary adoption by EHR software vendors. This will only happen if EHR users demand it or, more likely, if the newly formed Certification Commission for Healthcare Information Technology (CCHIT) requires it. [Editor's note: Read more about the CCHIT in this issue's Monitor.]

Full financial disclosure would help EHR assessment

To the Editor:

I am one of the physicians still very uncertain as to the value of EHRs. Our 50-partner multispecialty group is beginning to look at it. I'm not on the committee, but I have read at least 10 articles on the subject. I'm sure there have been hundreds more that I've missed. Like the other articles I've read, Dr. Kenneth Adler's "Why It's Time to Purchase an Electronic Health Record System," [November/December 2004, page 43] does not specifically discuss the cost of the project.

I don't question the eventual savings - we have three staff who now spend about 20 percent of their time looking for paper charts - but how much physician productivity was lost during the transition? If for a year I see 20 people a day rather than 30, that's a lot of lost income. I'd be interested in seeing the revenue, total expenses, salary costs and personal income for the year before and first three years after the installation.

Jonathan B. Tocks, MD
Harrisburg, Pa.

We want to hear from you

Send your comments to FPM Letters Editor by e-mail, fpmedit@aafp.org; by mail, Family Practice Management, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672; or by fax, 913-906-6010. Include your address, daytime phone number and fax number. Submission of a letter will be construed as granting AAFP permission to publish the letter in any of its publications in any form. We cannot respond to all letters we receive. Those chosen for publication will be edited for length and style.

Author's response:

I would like to see that data too. In fact we are collecting it for our group, but we haven't been using our EHR for three years yet, so I can't provide it at this time.

When we implemented our EHR, we lightened our schedule for the first week and a half after implementation. After that we returned to normal schedules. We were able to maintain our productivity, but we ended up working longer hours the first several months as we converted our patient data from paper to electronic format.

So yes, adopting an EHR requires a definite investment of time and money. The payoff, however, is much more than financial. Among other advantages, EHRs allow you to easily monitor and measure what you do.

A maxim in management is that you can't improve what you can't measure. I believe that improving care is the primary promise of electronic health record systems. The purpose of my article was to show that you can accomplish that noble goal without having to sacrifice your paycheck.

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