Get with the Times, NYTimes: A Letter from Our CEO

In response to the New York Times' Article "How to Make Electronic Medical Records A Reality":

While it is undeniable that the adoption of electronic medical records (EMR) is hard, the solution selected by the City of New York to endorse one product and spend a great deal of resources on that one product only makes the problem worse. There are many reasons why adoption is difficult, but the most important one is value creation for the practice. Regulatory uncertainty adds to the confusion and uncertainty about adopting EMR.

If all EMRs unquestionably created value for a practice, all other problems would not matter very much. The truth is that many EMRs on the market today slow down doctors in the examination room and either add to or are neutral as to the administrative burden of the practice. In addition, a general-purpose EMR is not the best solution for most medical specialties. Better EMRs that do indeed create clinical and administrative efficiencies are slowly gaining acceptance -- as experience validates the value they create in the medical practice and word gets around. The worst possible thing governments can do at this point is to adopt a "One Size Fits All" mentality, select a single EMR product to cover all medical specialties and to make it the "official choice." This will stifle innovation and slow the process of value creation that competition fosters. This is a good time to let “a thousand flowers bloom."

Government can help the adoption of EMR by dealing with the regulatory environment. Government programs, agencies, and quasi-governmental agencies such as the Certification Commission for Healthcare Information Technology (CCHIT), the primary association certifying EMRs, need be to sensitive to the need to create value in practices as they regulate EMR. An example of poor priorities is to set future public benefits before present need of value creation. Currently, CCHIT certification requires that EMRs communicate with (mostly non-existent) central data repositories, but not that they support practitioner workflow in the exam room by efficient recording of data or help practices with patient communication or insurance billing. If medical practices do not get value from EMRs, they will not implement them and any value that improved communications can offer will not be realized. Government regulation and policy should not eliminate innovators from the EMR field by well-meant but overly burdensome requirements; they should foster value creation by supporting many solutions for the varied and complex needs of the different specialties in the medical world.

While value creation for practices must come first, the regulatory environment must be clear as well. Practices are reluctant to purchase EMRs from companies that may not meet regulatory rules. Therefore, a clear regulatory path is essential to promote EMR adoption. Congress and/or Medicare needs to enact national standards for EMR that clearly state what regulations will be implemented and when.

Government programs designed to help practices implement EMRs are doomed to fail if the EMRs don’t create value for practices.

Sincerely,

Gregory Leopold

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