Hurricane not likely to blow more EMRs into doctor offices

After Hurricane Katrina flooded her office, Regina Benjamin, MD, a solo family physician in Bayou La Batre, Ala., attempted to save her patients' paper medical records by spreading them out in her backyard.

"They got soaked and we're trying to dry them out in the sun," said Dr. Benjamin, a former AMA trustee. "We're fortunate because we haven't had much rain, and we're out there turning them over hoping they will dry."

Since Katrina displaced more than a million people in the New Orleans area and destroyed or washed away most of their paper-based medical records stored in physician offices and hospitals, several high-profile federal officials, including Dept. of Health and Human Services Secretary Mike Leavitt and Senate Majority Leader Bill Frist, MD (R, Tenn.) have said the natural disaster underscored the need for electronic medical records and a national health network.

Had patient records been automated, clinicians would have been able to access them, and the medical response to Katrina survivors would have been improved, they said. Electronic records are now being used after the fact; on Sept. 22, for example, a private-public effort, including HHS' Office of the National Coordinator for Health Information Technology and the AMA, launched a secure online service that will enable physicians and other authorized health professionals to access medication records of Katrina evacuees scattered all over the country.

While industry observers agree that electronic records would be beneficial in times of natural disaster, public health emergencies or even the destruction of a physician's individual office, they caution that EMRs aren't a silver bullet. They also say Katrina won't spur a surge of physician investment in and adoption of EMRs.

"I think electronic records could have helped, but they wouldn't have solved the problem" because there's no guarantee that doctors who had EMRs would have been able to access their patients' data, either immediately or at all, said William F. Jessee, MD, president and CEO of the Medical Group Management Assn., in Englewood, Colo.

"I get so nervous about how much hype there is [because] unless those records were backed up someplace and patients were in a facility that had electricity and the ability to access [electronic records], it wouldn't matter what form the record was stored in," Dr. Jessee said.

Also, if physicians have a client-server system and data aren't backed up offsite, "you could have the same loss as you would have with paper records," said Bruce Bagley, MD, medical director for quality improvement at the American Academy of Family Physicians.

Doctors who lease and access an EMR system over the Internet from an application service provider would probably be more able to access patient data than doctors who have client-server systems, because ASPs back up their data, Dr. Bagley said. But a doctor's ability to access those data would depend on whether the ASP's backups are physically located not just offsite, but outside the damaged area, he said.

Still, Dr. Bagley believes it would be wise for any doctors whose office and medical records are wiped out by storm, fire or other extraordinary event to buy an EMR when they restart their practices. "If you're hanging out a shingle or starting anew, you would be crazy not to start with an EMR," he said. "Why start a paper system up again?"

Some doctors might agree with that, but still not be in position to buy an EMR. For example, Dr. Benjamin, a member of the AMA Council on Ethical and Judicial Affairs, has wanted to buy an EMR since Hurricane George washed away all her records in 1998. Going through the same experience a second time with Katrina has only reinforced that desire, she said. Three weeks after that hurricane, she was still drying out paper records, unsure how many she could save.

"But I've never been able to afford" an EMR system, Dr. Benjamin said. "They've come down in price but still cost $50,000 or so. It is out of my price range."

Cost is the biggest reason why most physicians aren't using EMRs, said Dr. Jessee, of the MGMA. The average startup capital cost for an EMR is $33,000 per physician and another $1,500 per physician per month for maintenance and support fees, according to a recent survey by MGMA and the University of Minnesota School of Public Health.

Many physicians he speaks to recognize the value of EMRs, but balk at the cost, which "is a big issue with physician reimbursement relatively flat and Medicare predicting a 4.3% cut next year," Dr. Jessee said.

Two other major reasons why physicians aren't investing in EMRs is that they fear selecting a buggy or soon-to-be-obsolete system, and also fear loss of productivity during the transition from paper to electronic records, he added.

So, while "Katrina is an example of why EMRs would be a wonderful thing," said AMA Secretary Joseph M. Heyman, MD, "I don't think that's going to be the thing that pushes somebody over the edge."

When doctors are convinced that the return on investment is worth the cost and pain of implementing EMRs, they will buy the systems, said Dr. Heyman, who uses an EMR.

The AMA has supported a national health network, but it also has stated that the cost of one should not be inordinately borne by physicians.