Looking For ROI In EHR

By John Oncea, Editor

Follow John on Twitter: @buck25

From multi-million dollar losses to less than overwhelming physician support, the electronic health record (EHR) has seen its share of adversity.

Electronic Health Records (EHRs) were designed, among other things, to save money and not contribute to $13.4 million operating losses. But that is exactly what happened at Maine Medical Center, the state’s largest hospital, according to Whit Richardson of the Bangor, ME Daily News. Richardson writes, “The loss occurred in the first half of the hospital’s fiscal year, which runs from Oct. 1 to Sept. 30.” He goes on to quote CEO Richard Petersen as saying the hospital is in “a negative financial position that it has not witnessed in recent memory.”

A variety of factors have played a role in Maine Medical Center’s financial shortfall – including a drop in inpatient and outpatient volume, slow recovery from the recession, and better managed patient care. Richardson writes one other factor “was a glitch in the launch of the hospital’s Shared Electronic Health Record” which had, according to Peterson, “some unintended financial consequences.” Mark Harris, Maine Medical Center’s vice president of planning and marketing told Richardson a “new electronic health record system has led in some cases to an inability to accurately charge for services.”

EHR-related financial losses are not be limited to hospitals either, according to the results of a study of 49 community practices in a large EHR pilot program conducted by the University of Michigan. Julia Adler-Milstein, assistant professor at the U-M School of Information and School of Public Health, summarized the study by writing, “The average physician lost $43,743 over five years, and only 27% of practices showed a positive return on investment.”

Adler-Milstein did say that physician offices that “make additional changes in the practice to enhance revenue and cut costs for services no longer needed” could avoid losing money but research shows, “A substantial fraction of physicians who adopt these systems don't make the additional changes in the practice that they need to recoup the cost of adoption."

An overview of physician’s opinions of EHRs is summarized in a 2012 survey of 21,202 respondents across 25 specialties presented by Medscape. It found three out of four physicians were using an EHR, but 26% or respondents reported their EHR was decreasing productivity at their practice. Ronald B. Sterling, CPA, MBA, and author of Keys to EMR Success, said of the 75% of physicians using EHRs, “Incentives have put everything on the front burners for (them). They said to themselves, 'If the government is going to pay me to get an EHR, I can't not do it.'"

Adler-Milstein’s study for U-M found incentives only resulted in an additional 14% of practices achieving a positive return on investment. "The incentive helps, but in a very uneven way," said Adler-Milstein, who explained it would result in the vast majority of large practices achieving a positive return but would do little to help the smaller physician practices.

Interestingly, when Medscape asked respondents to advise colleagues who had yet to adopt EHRs, the potential to lose money was not addressed, taking a backset to making informed choices. A sampling of advice:

• "If the company sends a PR person instead of a programmer, reject the company's product," said a pediatric endocrinologist.
• "Be aware of all the hoops, buttons, and clicks that need to be done to attain meaningful use; don't learn them after you have started (like I did)," said one respondent.
• "Actually use a system on a 'fake' patient before deciding on an EHR. It is a totally different animal to hear what the EHR can do until you start entering data yourself," said an emergency physician.
• "Have a physician teach you how to use it, not an IT person," said a family physician.

Perhaps the best advice, however, came from a family physician who said, "Bite the bullet and get it done; stop living in the Stone Age."