Lost Opportunity: EMR Reform Was within Our Grasp

In October of 2007, the government (or specifically, CMS—the Centers for Medicare and Medicaid Services) had a great idea: It announced a 5-year EHR demonstration project. The project had goals similar to the EMR Reform concept detailed in last week’s EMR Straight Talk. The government set about to scientifically investigate whether “investing time and money to convert . . . to EHR is worthwhile [for physicians] or not.” The project would also specifically measure physician satisfaction, exploring how EHRs affect workflow and identifying which functions physicians actually use. The goal was to “examine practices’ experience in implementing and using EHRs” and to evaluate “providers’ perceptions of the effects on their practice and patients.” This was a great start at a sorely needed objective evaluation of the efficacy of EMR in physician offices.

Why did the government fund this program to the tune of $150 million? My guess is that it was because they recognized that no study existed to support the commonly held—but undocumented—assumptions regarding the value of EMRs to physicians. The few landmark studies that have been conducted have focused on the value to other stakeholders—insurance companies, the government, etc.—but not to physicians.

The demonstration project had a start date of June 1, 2009, and will encompass 5 years of data collection. Yet on February 17, 2009, in a rush to push through legislation, and encouraged by special interest groups, President Obama signed the Stimulus Bill before the first demonstration test site was even operational. The government will now spend $36 billion supporting the very same EHRs they had wanted to study, but without the benefit of the potentially valuable information that the demonstration project could have provided. Nor will they have heard from physicians about what actually works in the real world of medical practice.

So here we are, embarking on a massive government program enticing physicians to invest in and implement software that the government itself has acknowledged is unproven in value—and urging physicians strongly that the time to do so is now—despite the fact that the demonstration project’s Phase I is just beginning and preliminary results will not be available until 2014.

Don’t we have a responsibility to provide physicians with at least the level of decision support to which they have access when they buy a car? Regrettably, this failure represents a lost opportunity to produce an EMR report card that would let physicians see what is really going on “under the hood”—before we expect them to invest their hard-earned money. Never before has the argument for EMR Reform been so compelling.