Letters to the Editor - Sept. 13, 2004

Push for electronic medical records developing into yet another hassle for primary care physicians - Gingrich's EMR vision raises questions of price, standardization and cost - Paper kills? That tears it

Push for electronic medical records developing into yet another hassle for primary care physicians

Regarding "Health IT chief: Public-private partnership needed for EMRs" (Article, July 26): As a family physician and primary care provider, I have great reservations about computerized medical records. It appears we will soon have another unfunded government mandate to take all of our thousands of charts and place them on a computer database. Coming from the experience of the computerized billing mandate for Medicare patients, this is a bad idea.

Primary care physicians are the lowest paid and the most utilized by patients. These unfunded mandates are huge burdens financially, mentally and emotionally.

Our paper records have stood the test of time and are far more reliable and confidential than electronic records. Yet we are asked to change to an expensive technology after spending thousands of dollars on computer hardware and software which is less than perfect, just for our billing purposes.

I can only guess how much more expensive computerized medical records will be to our practice. The cost and time involved to initiate and maintain computer medical records are the main detriments to implementation reported thus far in professional publications.

In addition, imagine the number of HIPAA violations that probably will occur with the touch of a keyboard on a computer medical record, and how many fines will be assessed against physicians as a result.

Computer information is only as good as the input from overworked and shorthanded medical staffs that have been made necessary because of reimbursement cutbacks, again mandated by the government.

This family physician wants assurances from the government that our professional viability and reputation will not be further damaged by programs designed to improve one thing and, in the process, damage many other things.

I am glad that David Brailer, MD, PhD, who is heading the national health information technology initiative, is at least negotiating less-expensive access to computer software for primary care providers. This may blunt some of the financial impact before full compliance with computerized medical records is federal law.

--William V. Choisser, MD, Orange Park, Fla.

Gingrich's EMR vision raises questions of price, standardization and cost

Regarding "Gingrich's grand vision" (Article, Aug. 9): I am a pediatrician in practice for one year and consider myself to be one of the younger doctors who think electronic medical records are doable.

However, I had several questions I would have liked to ask the former House speaker.

First of all, thank you for pressing Newt Gingrich on the upfront costs estimated for current e-medical records systems. I have heard minimum $50,000 for these systems. That is a major hurdle that needs to be addressed. Some other hurdles include standardization and privacy.

I believe Mr. Gingrich wants to implement a Web-based system, which may dramatically lower the cost of start-up.

First of all, we need to choose one system that every doctor, hospital and insurance company will be able to use and access. Either one program, or standardization, is needed to allow universal communication. (This is currently lacking in the private e-medical records system industry.) We also need to have a flexible program with the capacity to change readily when new technology becomes available.

Next, we need to consider how the newly implemented Health Insurance Portability and Accountability Act will affect electronic medical records if our goal is to have them accessible from a Web-based system by different hospitals, doctors, and even pharmacists and insurance companies. The bureaucracy has put up a wall of red tape preventing easy communication.

Finally, we have to deal with the cost. Doctors are wary about the high costs of private company systems to start an electronic medical record. What would happen if a better system comes out in two to three years? As will likely happen, if the U.S. government mandates electronic medical records or creates the standardization necessary, what will doctors do if their systems aren't compliant?

In an environment when reimbursement is decreasing and insurance costs are increasing, electronic medical records systems are a gamble most physicians aren't willing to consider.

--Lawrence E. Daykin, MD, Springfield, Ohio

Paper kills? That tears it

Regarding "Gingrich's grand vision" (Article, Aug. 9): "Paper kills." Paper kills??!! Former Speaker Newt Gingrich should be ashamed of himself for uttering such a phrase, and so should AMNews for printing it.

I'll bet as speaker of the House much of the business was conducted on paper. How many people did he kill during his tenure?

--G.D. Bentz, MD, PhD, Sterling, Va.