A NYT article today points out some of the current problems with digitizing health records. It focuses on the potential for fraud and abuse by hospitals around coding and billing. But what about the potential for abuse by the companies that sell EMR technology?

“Hospitals have spent tens of billions of dollars buying systems that many have discovered are complicated to use … critics have raised serious concerns about both patient privacy and safety.”

Indeed, hospitals are facing these issues, but what about the small (and sometimes technically unsavvy) practices that are forced to implement an EMR, or else face reimbursement cuts?

Systems that are complicated to use are one thing. Cost is quite another. On a recent visit to my children’s pediatrician she confided to me that her new EMR is costing her $10,000 a month. I wondered how she could stay in business with that kind of expense, and she explained that she’s been living off of her savings for the past two years.

That’s very disturbing to me. She’s an excellent doctor, respected and loved in our community. But these days she can’t earn a living.

She also told me that the two major hospital systems in our area were constantly courting her, offering to buy up her practice and absorb the operating costs. Understandably, she declines these offers. She’s had an independent practice for the past 20 years and doesn’t want to change that. But what about her operating costs?

Last year I finally got my act together and decided to start seeing a primary care provider. She was a part of one of the two major hospital systems in my area and was able to offer the convenience of an EMR that was already in place. As much as I hate going to the doctor, it pleased me to be able to look up my labs (the nurse in me!), and it was great for managing prescriptions.

Six months later I was having ear aches with a slight fever. I called my doctor’s office and was told I couldn’t be seen for at least a week. This definitely annoyed me (remind me again why I needed a PCP?), but I went to a Minute Clinic, got a diagnosis of a bacterial ear infection and an antibiotic prescription within an hour.

Another six months later, I was ready for a yearly check-up. I hesitated to make the appointment with my new doctor. Was it really worth seeing her, if she couldn’t see me when I was sick? On the other hand it was pretty sweet to have access to a well-functioning health record.

I was just about ready to make an appointment, and I received a letter in the mail telling me that her practice was closing. It was no longer financially viable to keep the office open.

Fortunately these aren’t big problems for me. I’m relatively healthy and there are still many health care providers to choose from. But it paints a picture of where we are headed. Right now we’re moving towards a fragmented system where Minute Clinics and Patient First take over the role of treating minor problems and illnesses, but the hospital systems remain the gatekeepers of the medical record. This is problematic because the Minute Clinics and the hospitals don’t share patient information. In light of this, shouldn’t the patient be the gatekeeper of her own health record? Perhaps the Accountable Care Organizations will pave the way towards a more connected system, but in the meantime, expect to see a lot of shake-ups and discord.

Edit: A reader pointed out that 10K a month for an EMR sounds outrageously excessive, and I agree. I suspect that amount included the implementation as well as monthly expenses, with a healthy dose of exaggeration baked in. Nonetheless it illustrates the point that many doctors in private practice have no idea what they are supposed to be paying for EMRs, and that paves the way to being taken advantage of by unscrupulous tech companies.