What Is Clinical Paranoia
On the Bleeding Edge of Medicine – Will Obama’s HITECH Act Improve Patient Care?
There is now more than $29 billion devoted to healthcare IT over the next several years thanks to the Obama stimulus plan, specifically the HITECH act. How will this affect individual patients and their physicians?
Several small clinics in the Silicon Valley are beginning to make a full commitment to Electronic Medical Records. Initial costs often exceed $30,000 or more including the software packages, hardware for running the software, IT labor for installation and configuration, and to provide training and support for the physician users. Even some alternative healthcare service providers, such as chiropractors and acupuncturists, are deploying electronic medical records. Several startup companies, for instance Fremont, CA based PracticeChoice, Inc., and MA based eClinicalWorks, are beginning to offer “hosted”, and web versions of EMR and other features.
Given the size of the Obama plan, more vendors are rushing into the space, and many open source projects are available. Prices are dropping. eClinicalWorks offers a feature rich EMR for around $500 per month per doctor, while upstarts like PracticeChoice are offering provider accounts as low as $99 per month, making it affordable to smaller clinics like chiropractor Dr. Rishi Shahani, DC of Vitality Health Services. “I used to spend hours every evening after seeing patients doing paperwork. Now I leave [the clinic] and it’s already done!”
Besides the productivity gains for physicians, EMR provides patients options for electronic access to physicians. The Noe Valley Clinic, located in upscale Noe Valley, a neighborhood in San Francisco home to many of the urban upper class, uses EMR to allow “Email access to your doctor” and “Online personal health records and prescription renewals,” according to their site. While this is also being offered by healthcare giants Blue Cross, Kaiser, Sutter Health, and others, it is remarkable that a small boutique clinic can now provide such advanced services securely, and affordably.
EMR is not without its detractors. Despite several years of active marketing by established EMR vendors, adoption at hospitals and private practices remains well below 30% nationally. Critics argue that the Obama money would be best spent on preventative care, educational programs, and increasing access to quality healthcare for the poor. Even within the framework of the HITECH act, upstarts claim that it unfairly rewards established vendors, with outdated technology, rather than encouraging innovation. Unlike the corporate world, where open source initiatives, outsourcing, and an increase in standards-based frameworks have lowered the cost of business productivity applications, healthcare IT technology remains a relatively closed market, dominated by a few large vendors who use relationships with large hospitals to fend off incursions by smaller vendors. One site, best-emr.com, hopes to provide an unbiased forum for physicians to submit reviews, comments, and criticisms of vendor packages, large and small. According to their site, “We will present the reader with clear and compelling reviews of the best EMR solutions in the market.”
Considering the security and privacy concerns of digital health records, it is reasonable to put more trust in larger, established players to safeguard their systems. Public opinion on EMR seems to vary from mistrust to outright paranoia, fear of the theft or mishandling of records being the most oft cited criticism on sites like Digg, where many articles have 100s of comments from opinionated readers. Still, small players do have some credibility. “Our systems use more modern software technology [than larger competitors] that has been used in banking and payment systems, Homeland Security, and government systems safely for years,” responds Neeraj Datta, CEO of PracticeChoice. “The answer to security concerns is not merely to trust in established products, but rather to use open, peer-reviewed, and independently audited software technology, like open source.”
Most agree, however, that it will be several years before the result of the spending initiative is determined. Perhaps imperfect, President Obama might later be credited for providing the ounce of prevention that will help heal a suffering US care system. If it fails to deliver on its promises, it could be a bitter – and expensive – pill to swallow.
About the Author
Robert Ficcaglia is a veteran software technology executive, author of several patents, and former engineer in several public and venture capital funded private software companies. He is an active advisor to several Silicon Valley companies in the areas of information security, healthcare, and consumer services.
Clinical Jitters
