EHR use puts physicians between a rock and a hard place

The electronic health record landscape is pretty gloomy for physicians these days. For every report that says that physicians are adopting EHRs in record numbers, there seems to be one that relates to a problem with EHR adoption. Only 12 percent of physicians have attained Meaningful Use. Physician practices continue to suffer from usability and financial woes in making the transition. They suffer increased muscle strain when using the tools. Physicians who use EHRs are even perceived by some patients as less capable.

And now a study published this month in Health Affairs says that EHRs are not worth the investment for physicians, with the average physician losing nearly $44,000 over five years and just a fourth of practices seeing a five year positive return on investment. This study blames physicians for the losses for not changing their operations to take advantage of the benefits that EHRs offer. For instance, almost half of the physicians examined didn't obtain savings in part because they were still using paper records; many weren't using their EHRs to increase revenue, according to the study.

Let's take a look at this for a minute.

The use of electronic records clearly adds efficiency to tasks involving things like searchability, portability and interoperability. But it's still hard for many physicians to give up their paper records, and not just because they're used to them; it's because they view paper records as more reliable.

For instance, one primary care physician I spoke with told me that while her office uses an EHR system, she still refers to her paper records because she doesn't trust that information in the EHR will be accurate. It's not her own EHR that she's worried about; it's the information she receives from other physicians, who regularly send her electronic information about her patients that doesn't match her own records. So while it's burdensome and more costly to use both electronic and paper records, she believes that she needs to do so from a patient care standpoint.

Or, look at EHRs as revenue enhancers. The study states that many physicians weren't seeing a positive return on investment because they weren't using the tools in the EHRs to capture all of the codes for which they could bill, thus, increasing their billings when submitting claims. Now, there's a lot to be said for accurate billing and "right coding," and there's nothing wrong with physicians billing for what they're entitled to; but then we're back to concerns about EHRs enabling providers to improperly upcode, clone notes, and otherwise engage in improper billing activity.

So physicians are between a rock and a hard place. Sure, in some ways they probably do need to change their way of doing business to reap the benefits of EHRs. At the same time, they don't want to do something that adversely affects patient care or gets them into legal trouble. They're not being cut any breaks.

At least there's one kernel of good news--sort of. Physicians will still get their day in court. The physicians bringing the class action suit against Allscripts for the cancelation of its MyWay product will be allowed to proceed, according to a recent judge's ruling in Miami-Dade County. Allscripts had tried to force the physicians into binding arbitration.

Perhaps that's a small comfort. - Marla (@MarlaHirsch)