The Georgia Office of Health Information Technology and Transparency announced that in January it would begin an initiative to build an electronic health information exchange for the 10,000 physicians who treat Medicaid patients in the state.
With the full understanding that I'm an outsider from a different state, I had some thoughts while reading about the varied reactions of many of the Medicaid providers.
One of the arguments is that the system would cost too much, and estimates are said to run $20,000 to $100,000 for software and staff training. I would check those figures, especially for software-as-a-service models.
Another criticism is that even when the system is up and running and troubles shot down, "the system won't be foolproof." An office manager at one ob/gyn office was quoted as saying, "Even (with) electronic medical records, the accuracy is going to be totally dependent upon who enters that information into the record. There's still going to be human error." First of all, very few things are foolproof, and EHRs and EMRs are being touted as helping to reduce medical errors. Big difference between that claim and foolproof. Number two, the accuracy of paper records is also dependent on the person who adds information to that record - be it clinical or administrative staff. Has there ever been human error in the recording or transfer of information in paper records?
One pediatric office in Georgia switched to EHRs in 1995. Although I don't know for sure, it sounds like the office paid $100,000 for the system in 1995, given that the system paid for itself within a year. There was no mention of what additional costs were incurred from the time it was implemented to this time today. Anyway, an interesting note is that the pediatric office purchased its system from an independent software company and not a legacy health IT company. Just an interesting note. I'd be curious to know if the prices have come down significantly since then, not unlike how laptops and flat-screen TVs have dropped in price significantly over the years.
And then there is resentment of government interference and pressure to deploy EHRs. This is valid. Nobody likes being told what to do, especially from an outside entity that doesn't live your workday. That said, Medicaid is a government program. It's not unlike when eBay changed its policy and made everyone use the PayPal system for financial transactions. If you want to participate, you have to play by their rules. It's a much more serious situation if providers drop their Medicaid patients in protest, but is that fair to the patients? I'm told by many physicians that the paperwork for Medicaid patients is incredibly burdensome. For some, having an EHR reduced the paperwork burden. I believe that's what the federal government is trying to do - make the system more efficient so we don't have to scrap the whole program down the road because there's no money to pay for the program. I don't believe there's a Big Brother mentality about EHRs.
Good luck to the Georgia Office of Health Information Technology and Transparency. My one piece of advice for officials is to engage all providers and figure out a way to address their concerns going forward.
