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Cautionary Tales from (The Crypt) HIT Consultants


At times when I hear the words EMR, ONCHIT, and Meaningful use and incentive payments,  it brings me back to the television program

Digital Health Space continues to monitor the progress of EMR implementation, HIX development and Meaningful Use Incentives.

Should you apply for EMR incentives at this time? (or ever).  CMS continues to promote EMR and incentive programs, but are they honest or just driving a data collection system that has not yet proven it’s worth.  They report a continual growth in physicians who have adopted some form of  EMR which is compliant with meaningful use criteria.

If you are confident that EMR is a good thing, promotes better patient care and is in the best interest of the patient, and if you are willing to take a one in four chance that your EMR will not have an ROI in four years. Those are the latest statistics from Sunday’ Health Affairs.  Factor another risk factor into your equation. The likelihood your EMR vendor will become insolvent, be acquired or merged with a stronger financial partner.  Or what about your software being purchased and then deprecated, losing support.

In addition to those numbers, loss of efficiency, possible loss of staff from workflow frustration and disruptive technology may cancel or even negate use of EMR.

Incentivization only covers the cost of immediate capital outlay, not ongoing maintenance which has been shown to cost as much as the initial system acquisition.

Julia Adler-Milstein of the University of Michigan and colleagues reviewed survey data from forty-nine community practices in a large Massachusetts EHR pilot and projected that only 27 percent of practices would achieve a positive return on investment in five years; an additional 14 percent would be in the black assuming they received the $44,000 federal meaningful-use incentive, the researchers write in the March issue of Health Affairs. The biggest determinant of whether practices achieved a positive return was whether they used EHRs to increase revenue by seeing more patients or through improved billing. The incentives had a larger impact on practices with more than six physicians and those that provided primary care, compared to smaller and specialty practices.

Truth and lies

And this very feature flies in the face of a paradigm shift for payments to eliminate procedural based fees.

Most current EMRs are not designed to base billings on  outcome studies, or increased efficiency. Each philosophy is counter to the other.   At this time there is little  connection (if any) between hospital billing and physician outpatient billing.

The unstated purpose and result of ACO formation is to employ physicians to be paid by a larger entity such as a hospital or a healthplan. (which in many cases is already in place)  There are fewer plans now based truly on indemnification.

Health Train Express and Digital Health Space’s mission is to aggregate, focus and opine on the course of health reform, giving the healthcare community a knowledge base to bring factual information to physicians, hospitals, health consultants and legislators.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at

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