 Electronic health records (EHR) have burst onto the scene as a central component of efforts by federal and state governments to streamline the nation’s health care system. Ideally, EHR promises to improve quality and decrease cost by enabling providers to organize and communicate patient-related information with levels of speed and efficiency only dreamed of in the past.
Over the next few years, individual chiropractors (and other health professionals) face a stark choice: either become players in this integrated system or be consigned to an island status outside the mainstream, facing not only isolation but escalating penalties for failure to participate. Whether doctors like it or not, the evidence is now overwhelming that during the next decade EHR will become as commonplace at American health care facilities as computers or telephones.
High Hopes, Pragmatic Goals
The goals of health information technology (HIT) enthusiasts extend far beyond saving one’s office notes in an electronic format instead of a handwritten paper-based chart. Among the purposes of EHR are to format patient information so that the doctor can instantaneously bring desired data to the top of the chart as needed; to have built-in prompts and reminders to improve quality of care; to enable seamless two-way transmission of information among doctors, hospitals and others with a legitimate need to know; to prevent and detect fraud; to provide an opportunity to reimburse providers for best outcomes; and to enable researchers to access large quantities of data in efforts to determine the relative effectiveness of competing treatments. What remains unknown is the extent to which EHR can live up to these high hopes while keeping unintended side effects to a minimum.
Carrots and Sticks
Economic stimulus legislation signed into law by President Obama in early 2009 set in motion procedures that will enable many doctors to be reimbursed for investing in health information technology. In some cases, this could reach as high as $44,000 per physician. But according to current plans, there will be a limited window of time during which such reimbursement will be available and then only for software that meets the government’s exacting specifications for interoperability.
From the perspective of new chiropractors or those with smaller practices, one possible sticking point is that it is not yet clear whether doctors must surpass a minimum $25,000 per year threshold in approved Medicare billings in order to qualify for reimbursement from the federal government. If, as early reports indicated, such a threshold were to be included in forthcoming federal regulations, it would run counter to the legislation’s stated intent of removing financial impediments for all providers to go digital, as it would make conversion easier for those who can afford it most without helping those who can afford it least. As we go to press, it appears possible that the regulations will include reimbursement on a pro-rated basis for doctors not meeting the $25,000 threshold. Such a policy decision would be both effective and just.
If stimulus funds for doctors implementing EHR are the carrot, then laws punishing noncompliance are the stick. A handful of states have passed statutes requiring all health providers to implement a certified EHR system within the next several years as a condition for being able to continue to practice. Minnesota, for example, has mandated a 2015 deadline. “Chiropractic clinics” are specifically included on the long list of provider types that will need to implement EHR or shut down.
Questions Not Yet Answered
There is clearly a mystique surrounding EHR. Listening to its proponents, one hears promises of a glittering future in which clarity, speed, and organization will lead to enhanced quality of care, improved health outcomes and substantial cost savings across the health care system. |
