Last week, I presented the views of Dr. Donald Simborg on how the health IT stimulus would effect the industry. In his note, Dr. Simborg lays out two alternate futures for health IT stimulus funding. One involves massive disappointment, fraud, raised costs and wasted money, while the other describes a future in which physician EMR implementation blossoms and comparative effectiveness research speeds the process of leveraging newly available clinical data.
Then, I asked readers to tell me whether they felt Scenario 1 or Scenario 2 was more likely to occur. Sadly, the consensus was that the first, pessimistic prediction was fair more likely to be accurate:
"I hate to say it, but I am of the opinion that Scenario No. 1 is the likely outcome. Physicians at the grassroots level already acknowledge the need for EMR/PHR. With the pressures of running a practice, reductions in payments, and other issues, the additional pressure of forced "conversion" by a specific time is a large burden that will be a disincentive physicians and will likely drive many out of the business.
Really, how many physicians these days can afford a $25k-$40k system? Without much clarity on the process or requirements and the timeliness of the grants, this is a very large agenda that will likely fail. Private industry works much more efficiently and effectively--we all know that. All that is required are the standards and guidelines; and then let private industry determine the systems, markets, pricing, implementation, etc. What substantiates the $19.1 billion? What research was done to determine those numbers and the underlying assumptions?" - Physician/attorney
"I definitely share your vision No. 1 scenario!! On a small scale the New York experiment to develop their own EMR was a wasteful disaster. After starting out spending millions to develop an electronic medical record, they then changed paths and purchased software. It only works in doctors offices--not for hospitals. And, the physicians I know who use this system hate it. Can't practice medicine, and interact with the computer at the same time. So I wouldn't bet much money on scenario No. 2 coming true." - Physician practice/hospital executive
I'm sorry to say that I share my readers' pessimism to a large degree. It's not that I don't think federal money can help, but that I'm not sure the money is being handed out in a thoughtful enough manner. As my first correspondent notes, it would help a great deal to see what assumptions federal planners made in generating their funding number, and what models they examined to determine what type of funding (incentives vs. outright purchase, paid through Medicare vs. grants, and so on).
The bottom line is that no matter how much money you throw at a problem like EMR adoption (heck, any form of IT adoption that forces end users to change their habits) it's going to be very challenging. Let's hope the government is ready to help private industry manage these challenges. Doling out cash alone just won't get the job done. - Anne