Well, the company is State Volunteer Mutual Insurace
Company, and it is physician run an owned. They have
regular education programs with the idea of promoting
good practice patterns to AVOID malpractice cases in
the first place.
I guess they believe that an EMR will reduce
malpractice events.
Kevin
--- Michael Ginsburg <[EMAIL PROTECTED]> wrote:
> Kevin,
>
> I am most interested in your first sentence. Why is
> your medical
> malpractice company hosting the conference?
>
> Mike
>
> >>> [EMAIL PROTECTED] 10/19/2004 8:17:45 AM >>>
>
> Hello all,
>
> In Tennessee, our medical malpractice company is
> hosting an EMR conference this December (and why it
> is
> them is interesting) . My office manager and I will
> be attending at the request of my medical group.
> The
> group had previously agreed (tenatively) to go with
> VistA, but they still want me to look at other
> alternatives. I haven't seen the actual report, but
> I
> have heard that AAFP is now "strongly recommending"
> that physicians get an EMR system. I think this
> will
> push many into buying in--perhaps for fear of
> liability if something happens after such a strong
> directive is ignored. This will be an business
> expense, not an investment, because there will be
> little (and I suspect no) financial return on this
> expendature.
>
> But frankly, I worry that this will be an expensive
> wild goose chase. I believe the power of an EMR
> will
> not be realized unless there is interoperability.
> For
> example, if labs are not obtained in a standard
> format
> that could be shared with others, then users will
> end
> up scanning the report and storing it as a graphic.
> This is no better than a paper chart. And while
> many
> labs probably have such an interface, I know that my
> hospital doesn't. And I suspect a majority of small
> hospitals don't (and remember that MUCH of America's
> health care is given by small practices working with
> small hospitals).
>
> So after AAFP and other organizations push doctors
> into coughing up the $100-200k needed to get a new
> system up and running, will patient care be better?
> I'm not convinced it will. I have heard that
> thought
> leaders feel that a good EMR could achieve a 20%
> reduction in health care expendatures. But unless
> my
> EMR will somehow let me instantly access a lab/study
> ordered by another physician in another city, I
> don't
> see how this could happen. And now system I have
> seen
> addresses this issue. With HIPPA nervousness
> abounding, no one will release records without a
> written signature from a patient, and I not heard of
> any quicker electronic solution to this problem.
>
> I keep a relatively well organized paper chart with
> tabs etc. It is fast and complete. It easily
> stores
> the carbon copies of scripts that I write, letters
> that patients write me, copies of their advance
> directives etc etc. All these things would have to
> be
> scanned in an EMR, and then possibly lost in a
> shuffle
> of filenames (i.e. "image1462"). My charts are
> portable: they can travel in the car with me, or I
> can
> take them to the hospital when admitting a patient.
> They're flexible: I could have a visit in a
> patient's
> home if required (i.e. I don't have to have a
> computer
> station set up.) They're "hi-res": Most computer
> screens have to magnify the image so that a scanned
> image is readable. Thus a full scanned page often
> won't fit on a screen and still be legible. So you
> have to scroll around. Paper doesn't have this
> problem.
>
> As one who has put in a significant amount of time
> working with VistA, I don't want to sound like a
> Luddite anti-technologist. But I am seriously
> concerned that physicians are being pushed into
> making
> a sudden technology change away from a system that
> has
> withstood the test of time. I'm also concerned about
> a
> "lock-in" issue. I suspect that none of us use the
> same word processor that we did 10 years ago, but
> rather technology has progressed and we regularly
> purchase the latest and greatest. But will
> physicians
> be willing to purchase system after system the way
> we
> do computers now? I doubt it. If our group buys a
> non-VistA EMR, I imagine we will keep it at least 10
> years. We'll be locked into 2004 technology until
> 2014. (Our current system is 1980's technology)
>
> So what do I think the solution is to all this?
> Well,
> VistA goes a long way. First, it is easily
> conceivable that VistA could be established in an
> office for ~$10-20k, one-tenth the cost of a
> commercial system. (And my goal is to make the cost
> much less than this). This will make it much less
> painful for small practices, and still quite
> attractive for vendors (multiply the "272,428
> practices" below by $10,000 makes for a nice
> retirement plan.) And if we have a critical mass of
> physicians on the same system, we have more chance
> of
> interoperability.
>
> So in summary, I support getting EMRs into
> physicians
> offices, but I think we need to have realistic
> goals.
> We need to provide inexpensive solutions, and plan
> for
> gradual transitions. And VistA has a great potential
> meeting some of these goals.
>
> Hope to see you all at the WorldVistA conference.
>
> Kevin
>
>
>
>
>
> --- Joseph Conn <[EMAIL PROTECTED]> wrote:
>
> > Re: market size
> >
> > According to an AMA survey from 2001, 33% of what
> it
> > calls "patient care physicians" are in solo
> > practice, another 11% are in practice in
> > two-physician offices, 8.5% in three-physician
> > offices. These exclude government and military
> docs.
> > That 52.5% is in practices so small most EMR
> > vendors I've spoken with don't want to bother with
> > them because the sales costs excede the returns.
> >
> > The vendors' interests might change some if an
> > Oklahoma gold rush mentality develops to get an
> EMR,
> > and say a salesman's batting average rises to one
> > hit for every three times up to bat, as opposed to
> > one hit in 10, but while physicians are much more
> > receptive to the idea of buying an EMR today than
> > just four years ago, price is still the No. 1
> > barrier to EMR purchase, as cited by the recent
> MGMA
> > survey and the Modern Physician IT survey last
> year.
> >
> >
> > The AMA says there is no direct number of "patient
> > care physicians" to multiply these percentages
> > against, because they are for a sample, not a
> total
> > count, but that said, there are about 514,016 docs
> > in what the AMA calls "office-based physicians in
> > patient care,"which is not exactly the same as
> > patient care physicians, I'm told, but it is
> > probably close enough for handgrenades and this
> > estimate.
> >
> > So, doing the math, that's 171,167 in solo
> > practice, 57,570 in dual-practice, 43,691 in
> > trio-practice, and 272,428 in those three
> combined.
> > That's the market that's being underserved right
> now
> > and where EMR penetration rates are lowest (10%)
> > according to the latest MGMA survey.
> >
> >
> >
> >
> >
> >
> >
> > Joseph Conn
>
=== message truncated ===
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