| Before we leave the topic of what happens inside a practice, let me touch on one thing that’s important. One of the greatest challenges that we’re having as we evaluate electronic health records is economies of scale. If I’m a chiropractor practicing by myself, affording electronic records is not high on my list. It just isn’t. When you start to talk in terms of anywhere from $20,000 to $50,000 to make that happen, where am I going to recoup that? And what is the benefit to me?
Just today, the Wall Street Journal’s health blog had an interview with a medical physician, who said that he had spent $300,000 to get his practice up and running with electronic health records. That sounded unusual to me. Are the figures you just cited more common? Might he have been dealing with a larger or more complex practice?
One can always make bad choices. $300,000 is an extraordinary number. I’ve never heard of one that large. It may be that he scanned all of his existing records. I believe that is a massive waste of time.
So your recommendation is to make everything electronic from the day you start to use EHR, but not to go back and scan your old records. Scanned records are not searchable electronically, which undercuts most of the purpose of going electronic. Now, going back to the still sizeable $20,000-plus price tag, it’s my understanding that because the federal government considers health information technology to be a key priority in reforming the health care system, there’s a substantial allocation in the recent American Recovery and Reinvestment Act, the “stimulus bill,” for doctors to get started on this. Do we know yet to what extent these funds may be available to individual practitioners, including chiropractors?
The $19 billion that they set aside for EHR is tied to Medicare, and would be available only in the form of enhanced reimbursement for treatment of Medicare patients. Let’s talk about what is happening in this bill and then take it down to the chiropractor. First, it’s important to understand that this is not just the Obama Administration. I was working on this for three years before he was elected. There was an executive order from the Bush Administration.
What we’ve been trying to drive is continuity of care. That’s what this is all about. The first leg is getting EHRs adopted. The second is that once I have records into the EHR, I want to be able to look at the continuity of patient care on the community level. So I want to know what drugs that patient is on, what allergies they have, what primary care physicians they’re seeing, what specialists they’re seeing, what chiropractors they’re seeing and what hospitals they’ve been in.
I want to be able to look at a quick snapshot of the patient’s care. That’s really what we’re working on in deploying health information exchanges (HIEs) regionally. This is what I’ve worked on for the last three years. They are connecting together the local hospitals, clinics, specialists, and pharmacies, and they’re able to share all of those records.
What does an individual chiropractor gain or lose by being in or out of this health information exchange.
If we’re thinking in terms of holistic patient care, I need to know what treatments they’re having and what medications they’re taking. And other doctors need to know that I’m treating them, as well. We can take an island perspective if we want, but this legislation is effectively going to throw up an embargo. So you can choose not to be part of a care delivery system, but chiropractors who do that will be on the outside.
So assuming that a chiropractor, or chiropractors in general, want to be integrated into this system, does it look like they will they need to contract with private vendors, and pay the tens of thousands of dollars you mentioned earlier, in order to become part of the system?
Yes, they will.
Do chiropractors qualify for government aid or subsidies in order to make this transition? |
