Effect of EHR Implementation On Short Term Hospital Revenue.

Here at The Happy Hospitalist, we have a strong bias toward utilizing all aspects of technology to make our patients safer and our lives as hospitalists more efficient.   If physicians want to maintain their income in a constantly unstable payment environment, they will have to become more efficient in all aspects of their care model or find alternative revenue streams outside the insurance model.   That's often difficult to do when opposing forces are constantly tugging at the seams holding the baggage together.  I firmly believe that excellent electronic health record platforms, implemented with the end user in mind at all times, with no exception, can transform all aspects of the patient experience.  

If doctors, nurses, pharmacists and all other end users find their jobs more difficult after EHR implementation, the consequences can be disastrous.  Errors will increase.  Efficiency will plummet.  Patient satisfaction will suffer.  Ultimately, hospital revenue will decline as doctors have less time to see patients, choose to leave hospital care or send their patients to other hospital systems that are easier to navigate.  These sacrifices will all occur on the backdrop of  promises to make everything better.  The Medicare National Bank is forcing hospital systems and doctors' offices to implement EHR systems now or face stiff penalties in the future.  

Unfortunately, I do not believe current EHR tools are being built with the end user in mind.  I say that because every experience I have with offices that have implemented EHR platforms generate pages of worthless medical records that provide no insight into the patients' medical needs.   These systems are being built by engineers to better mine data that will be used to reward and punish doctors and hospital systems with a never ending list of sticks and carrots that are fabricated using false assumptions and bad policy. For example, many policy folks believed that electronic availability of prior lab tests  would decrease unnecessary testing. But recent data contradicts that assumption and suggests that EHRs increase the amount of testing performed.  

Instead of creating something amazing to help doctors and nurses increase their time and resources with the patient, EHR vendors are helping physicians and hospitals stay in compliance with government rules and regulations.     As a patient, that means you are going to get even less face time with your health care professionals as more  time is spent navigating inefficient computer platforms.    The March 2012 issue of Hospitalist News described the rapid deterioration in hospital economics when a nearly 500 bed hospital rolled out their hospital and clinic EHR system.  Their article titled  Rapid EHR rollout rattles rhythms, revenues indicated:
"...patient volume dropped 30% in the first month, another 16% in the second month, and another 5% in the third month"
That is shocking.   I doubt most hospitals are planning for this type of short term catastrophic  decline in cash-flow. Imagine being the only hospital in town.  This immediate loss of access would create a community emergency of disastrous proportions.   If you weren't the only hospital in town, years of work building market share would be gone in an instant as patients tell their friends and families how the uncaring doctors and nurses made you sit for hours in the  office waiting room, the emergency room and hospital room before being acknowledged.  

In fairness, the article goes on to point out that after a year, their experience actually improved and patient volumes increased.  However, with hospital profit margins from Medicare being negative for nearly a decade, I can't imagine any hospital that is barely surviving getting through a major EHR implementation unscathed, especially inner city hospitals that may find it hard to recuperate lost market share or even to find short term financing during this difficult credit environment.

For hospitalists in the  middle of a major EHR role out that does not have the end user in mind, implementing a fully digitalized EHR is going to be like a fast moving wrecking ball that destroys all other aspects of patient safety and patient satisfaction initiatives.    While there will always be a learning curve to any new system, at the end of the day, once all the learning is done, if the process is not more efficient than the alternative, patient satisfaction scores will suffer,  hospitalist satisfaction scores will suffer and hospital systems will lose the best and brightest doctors and nurses to offices or hospital systems that offer a better end user experience.  

But don't worry, at least The Medicare National Bank will have their data and whomever else wants to buy it for a steep price.   Perhaps that is one way hospitals will make up the lost revenue that they weren't budgeted for.  Even physicians might decide to get in the game and sell their anonymous patient data to the highest bidder.   Part time physician.  Full time data miner.  I like the ring of that.  Telling your grand kids that you were a miner in your day even has a nice dangerous ring to it.

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