by Stephen J. Keeler, Director of Document Management Solutions, MRO Corp

The medical records and documents management landscape in the United States is as varied as the topography of the country itself. Systems used range from basic paper charts and filing rooms to high-tech equipment and software that captures all data digitally, with a wealth of solutions in between to fit any budget. Hundreds of vendors exist in this space, from household names in the Fortune 500 to entrepreneurs that started by providing billing and practice management software. The focus now is on clinical software and/or installations for use by providers for treatment, tests, procedures and ongoing care. These clinical systems go by two names generally, electronic medical records (EMRs) and electronic health records (EHRs). While often used interchangeably, as rough rule of thumb, EMRs are what doctors use in their offices (M=medical doctor) and EHRs are what they use in the hospital (H=hospital). EMRs typically cost much less, using this nomenclature, than EHRs, as you may imagine.

It is important to note that no correlation exists between type and depth of medical record deployment and population density; for example, several rural health systems have cutting edge installations, even as some urban institutions are among the most antiquated. What is important to consider is that hospitals and health systems as a category are targeted to be the prime beneficiaries of federal stimulus dollars in the Stimulus Act passed earlier this year. Next in line are ambulatory practices (the larger the better in terms of ability to garner stimulus funding), and finally all other ambulatory settings and provider locations.

If you are asking yourself why so much attention is being paid to medical records in particular and healthcare in general, including the government, consider this: by most estimates, healthcare costs represent nearly 20 percent of all goods and services spent in the United States. As such, some economists would view about one-fifth of the cost of every type of goods or service to be a healthcare cost; by this measure, for example, about $4,000 of the $20,000 you may spend on a new car goes to pay for the healthcare of all those associated with designing, building and selling your car. If the costs of healthcare increase at a higher rate than other costs, soon $5,000 of that $20,000 will be healthcare costs, and then $6,000, etc. If cars from other countries have healthcare costs of less than 20 percent, then those cars are more attractive to you; for the same $20,000, you would get more features in the car itself. At some point, if these trends continue, nobody will buy cars — or anything else for that matter — with such a high percentage of the cost absorbed by healthcare. Hence, the rising cost of healthcare is — or at least should be — everyone’s concern.

It is not within the scope of this article to speculate on how to address the impact of rising healthcare costs. Suffice it say that the government has other reasons, in addition to national productivity and competitiveness, to accurately understand and deal with the cost drivers in healthcare. By most estimates, well over half of all spending for healthcare services is paid for via some routing through the federal government, and often then via state governments and/or private insurers. Just like shipping and handling add to the cost of anything you buy, all the hands touching healthcare payments add to the overall cost of healthcare. So anything that reduces the cost of healthcare leaves more money for the government to give back to taxpayers or spend elsewhere.

Finally, the promise of technology to healthcare is estimated to reduce costs significantly, by reducing redundant tests and procedures, improving access to records which improves productivity and efficiency, and by mining data that allows for the best understanding of disease treatment, to name just three. Much of the value of these benefits is centered on the creation, use, and storage of medical records and the exchange of data therein. This accounts for the high publicity in the media and by the government, which, for example, is developing incentives to get more and better use of EMRs and EHRs. As always, follow the money to understand who might win or lose — or had the better lobbyists — in the coming shakeup.

What does all this mean for you?

1. Get educated. While you may not qualify for funding for a certified EMR or EHR, there are nonetheless great software applications available that will dramatically make your job easier, and help patients more, for a fraction of the cost. Just easing the burden of paper, for example, can yield tremendous results.
2. Stay abreast of trends and insights by understanding where to go for the right information, and get it delivered in a format and via a medium that works for you.
3. Take advantage of what you learn. For example, technology is allowing healthcare to enrich the environment around patients in their own homes, rather than schlepping patients around to richer healthcare environments. What can you do to be a part of this megatrend?
4. Stay close to the patient. Whatever else may happen, healthcare is transacted between a provider and the patient. Who better to help patients and their families navvigate through the enriched home environment than the low-cost provider, who is probably already in the home anyway, delivering high value healthcare services?
5. Use technology. Try it out. If you find something you like, keep it; if not, ditch it and try something else. Match it with your own pain points. Can’t see enough patients in one day? There’s a solution for that. Want to know who is most at risk, so that you can prioritize your interventions? There’s a solution for that too.
6. Don’t think you need to make a big, upfront investment. Many technologies are available delivered over the Internet for a subscription, like a magazine, known as “software as a service” or SAS. The upfront cost is less than traditional hardware installations, and there is typically a sliding scale usage fee in addition to an access fee, just like your gas or electric utility bill. Pay for what you use; if you don’t like it, don’t pay for it, and find something that meets your needs and budget.

If you have questions for the author, Stephen Keeler at MRO (Medical Records Online), you can reach him at This e-mail address is being protected from spambots. You need JavaScript enabled to view it . For more information about MRO, go to www.mrocorp.com.

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