The business case for paperless medicine

A strong argument can now be made that doctors in small and midsize practices should invest in electronic health records. Here's how to get your physicians on board.

When the Vioxx recall hit in late September 2004, it was almost a yawner for Peter Basch. "It took us two or three minutes to figure out which of our patients were on it," says Basch, who is part of an eight-doctor practice in Washington, D.C. That two to three minutes was how much time it took to structure and execute a search for the practice's electronic records database.

Basch says that the Vioxx recall was a noncrisis for his practice largely because he and the other doctors have been using electronic health records (EHRs) for the past nine years. In fact, the first major drug recall occurred the same year Basch's practice started using EHRs. In September 1997, the Food and Drug Administration warned doctors against prescribing fenfluramine and phentermine (Fen-Phen) together as appetite suppressants. At that time, Basch's practice needed about 30 minutes to find all of its patients who were taking the diet pills. Basch, though, doesn't even think that quick-search capability is the best reason to use electronic health records. Instead, he points to not having to write out prescriptions.

One of his patients was on more than 15 medications and would never get them refilled. He had to write them all out for her twice a year. "That was incredibly painful," he says. "When I could do it in a couple of clicks, I was able to smile at her and say, 'Anything else?'"

Basch is a great white-coated hope for much of the medical industry--a doctor in a small practice who is using electronic health records and believes in them, he says, "with almost religious fervor." But such faith is sparse among doctors. Basch estimates that EHRs are used by no more than 15 percent of the 800 doctors employed by MedStar Health, the seven-hospital corporation that owns his practice. And so far only 14 percent of all the physicians in the United States have invested in EHRs, according to a 2005 survey by the Medical Group Management Association.

Many physicians say they simply don't see the financial upside for their practices, and some are concerned about retaining the confidentiality of patient information.

"How do you convince a practice to spend between $US20,000 and $US40,000 a physician and decrease productivity and disrupt the practice for a year to make the change to these systems?" Basch asks. "That's a tough argument to make in the current environment."

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