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Dermatologists struggle with electronic health record implementation


While the implementation of health information technology (HIT) systems in medical practices has the potential of improving healthcare efficiency and patient care, there are obstacles that medical practices must overcome, and those problems are especially acute for small practices such as those operated by many dermatologists.

Key Points

Sasha Kramer, M.D., an Olympia, Wash., dermatologist, said in testimony before the House Small Business Health and Technology Subcommittee in June that she fully supports "the infusion of health information technology into physician practices," adding that it is critical to improving the healthcare delivery system and providing optimal patient safety and care.

But she recounted the difficulties that she has experienced in her practice over the past two to three years, during which she first invested in a $41,349 electronic health record (EHR) system with the help of a $19,964 grant from the Washington Health Information Collaborative for Health Information Technology.

Dr. Kramer spent $25,385 of her business cash reserves to cover the remaining cost, and she spent more than 80 hours selecting the vendor and another 80 hours undergoing training. During that time, her patient volume had to be reduced from the normal four to six patients per hour to one per hour.

But just 18 months after implementing that system, her software vendor notified her that another company had acquired it and the new vendor's products would not support her current network platform. That forced Dr. Kramer to seek another vendor, and, at the time of her appearance before the subcommittee, she was considering a new system that would cost more than $27,000 with $6,000 in annual charges. Then there would once again be the time required for implementation and training, with time taken away from patients.

The financial cost is exacerbated by an unpredictable marketplace in which it is impossible to anticipate technology changes and the lack of system interoperability, as well as the difficulty of obtaining capital for such investments, she said.

Insufficient assistance

Dr. Kramer said the $20 billion provided under the American Recovery and Reinvestment Act of 2009 is insufficient and that requirements in the law for physicians and hospitals to receive incentive funds to help cover the cost are unreasonable at best.

To become eligible, providers need to meet several requirements, including using a certified EHR system and becoming meaningful users, "the regulations for which are currently flawed and unmanageable for many specialists," she said, citing as an example a potential requirement that 10 percent of patients/families view and download their health information, which would have to be made available within 24 hours of the patient's visit.

"The physician does not have control over the patient's ability, nor their desire, to view and download their longitudinal health information," Dr. Kramer told lawmakers. "In addition, a 24-hour requirement for making the information available to patients is a burden that affects a physician's workflow."

She pointed out that dermatologists and other providers investing in EHRs are struggling with the structure of the meaningful use time line established by the Centers for Medicare and Medicaid Services (CMS). For those early adopters who purchased a system and have contracts with technology service providers to meet 2011 and 2012 requirements (phase 1), there will be a very short window between the release of phase 2 requirements sometime this year and the deadline for physicians' vendors to update their systems so they (the physicians) can qualify for 2013 incentive payments. That puts doctors in a position where they are dependent on whether the vendor can implement their changes in time.

Dr. Kramer urged the subcommittee to address these issues:

"It is imperative that HIT is adopted and implemented in a timely manner that is achievable for dermatologists and all physicians," she said. "We need to develop an interoperable and secure health information exchange network that is user friendly and protects patient's privacy."

But, she said, "We must strike the right balance between modernizing the practice of medicine, delivering high quality care and protecting patient care."

Bob Gatty, former congressional aide, covers Washington for businesses specializing in healthcare and related issues. Contact him at bob@gattyedits.com

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