Report: Making Electronic Health Records a Reality

A new report from consultancy Capgemini offers prescriptions on how to make electronic health records happen in the United States over the next decade.

Urged on by clients—mostly large health care provider organizations such as Childrens Hospital of Orange County and the Phoenix Childrens Hospital—consultant firm Capgemini recently released a white paper analyzing the next steps toward instituting EHRs (electronic health records).

Provider organizations are wondering, How do I do this? said Lewis Redd, national practice leader for Capgemini Health. Theyre worried about where "to get the funding to support any kind of electronic health record."

Redd argues that health care providers have to see the business case for the implementation of electronic medical records before any large-scale systems will be put into place. However, among providers, "there continues to be a fair amount of skepticism as to what amount of efficiency and cost reduction is likely to be had" from using electronic medical records, he noted.

According to a Markle Foundation study cited in the Capgemini report, financial incentives in the range of $3 to $6 per patient visit would be enough to encourage widespread adoption of EHRs by small, primary care practices. This represents about 1 percent to 2 percent of the total amount spent on outpatient care a year.

Supportive overall of the bottom-up approach to EHRs adopted so far by the Bush administration, Health and Human Services Secretary Tommy Thompson, and National Health IT Coordinator David Brailer, Redd also observed that since this is an election year, little federal action for EHR implementation is likely to be forthcoming any time soon.

He argues that with a continued Bush administration, more funding as well as decisions on technology and data standards, may be around the corner and supported by the necessary legislation. Still, the report maintains that there needs to be a "stronger financial impetus" for provider organizations to implement EHRs. Subsidies and increased reimbursement, along with tax breaks, are all viable approaches, Redd said.

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Redd worries that holding out for consensus decisions on standards among all the stakeholders will slow an already lengthy process and urges more proscriptive leadership from the Bush administration.

Another complicating factor, Redd argues, is that some of the more vocal stakeholders are the technology vendors, whose interests on the standards front can be diametrically opposed to providers. Vendors are invested in seeing their own approach endorsed, whereas providers are looking for assurance that the standard they choose will not be outdated shortly.

Communities with a few large provider organizations with significant market shares, like Pittsburgh, are the most likely to see them team up to implement EHRs on a major scale, said Redd. Since they are likely to see a patient repeatedly for all sorts of different health issues, unlike a small provider with an insignificant market share, making the case for the continuity of patient records is easier.

"The more I am treating a patient across the continuum of care, the more incentive I have to implement an EHR system, therefore the faster Im going to do it," said Redd.

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