Debate on EMR curiously pharma-free

January 11, 2010 – 6:02 pm by Chris

As the value of electronic medical records/electronic health records continues to be debated, some would say the pharmaceutical industry needs to take a visible, positive stand on that issue. But the crowd who attended a thought leader panel discussion in December, “EMRgency Medicine – Are you Ready,” held by the American College of Healthcare Executives and Cegedim Dendrite at the latter’s Bedminster, N.J., headquarters, seemed curiously pharma-free. And that was a pity.

The discussion, moderated by the acerbic Dr. Michael Fossel, a physician executive with the healthcare technology provider Cerner, featured Dr. Kennedy Ganti, chair of the New Jersey Health Information Technology Commission; Paul Roemer, managing partner of the consulting firm Healthcare IT Strategy; Jean-Michael Van of Cegedim Dendrite, who is responsible for the development of the Cegedim Healthcare Software business unit in the United States; physician executive Dr. David Memel; Dr. Spencer Kroll, a board-certified internist; and Dr. Naomi Grobstein, a private practice doctor on Montclair, N.J.

I was told by one Cegedim Dendrite executive that experts from Novartis and other companies were supposed to be on the panel, but had canceled.

“What’s pharma’s stake in EMR?” I asked this executive.

“That’s a good question,” he replied, and then proceeded to tell me how pharma companies had initially invested in providing EMR software to physicians in Europe, but then a curious thing happened. Or maybe not so curious, when you think about it – when physicians were having problems with the software, they started bugging the sales reps whenever they were in the office to fix it. The reps were so busy being tech support, they could not detail their products. Needless to stay, pharmaceutical companies stopped their spending on providing EMR systems to physicians.

I did live-Tweet the panel’s debate, which focused on how physicians perceive and use EMR and electronic health records (although some of the panelists – Dr. Grobstein and Dr. Kroll – saw them as one and the same, others – Dr. Ganti in particular – sought a finer delineation).

Most of all, I was struck by the experiences of Dr. Grobstein with her office’s EMR system. Dr. Grobstein had complained that every single time a patient’s record was updated after a visit, the system would demand the list of drugs the patient was on. This turned out to be problematic for patients who were not being treated for chronic conditions and were not on a “fixed” set of medications. “If a patient is coming in to get out stitches, we can’t put in the list of of drugs the patient was previously on, because that’s no longer accurate,” Dr. Grobstein stated.

Complaints such as Dr. Grobstein’s aside, no one on the panel actually disagreed that using EMR/EHR systems and e-prescribing can be beneficial to physicians, hospitals, and patients. But can it be beneficial to the pharmaceutical industry as well?

According to Paulo Machado at Health Innovation Partners LLC, a consultancy for the healthcare industry, yes, it can.

“Pharma has used different digital means that doctors can ‘prescribe’ information to patients about a condition, or what to expect during a procedure,” Mr. Machado says. “Some pharma companies are looking at this much more holistically, and are trying to get tools into physicians hands to make recommendations for patients. Some of these solutions can go through the EMR, and they have proven most effective when in an integrated delivery network rather than individual practices.”

According to Mr. Machado, physicians are fine with information that is “branded” after the prescribing decision has been made. “The challenge is for pharma to know when to push it, than not push, the branding aspect,” he says.

Other places that pharma could take a place in the EMR system is through sponsoring personal coaching or behavioral coaching for new patients with certain conditions, Mr. Machado says. “Ideally, the physician would have electronic intake system where patient can take a survey and figure out where patient is along in the treatment continuum,” he says.

Just a day after the panel at Cegedim Dendrite took place, Pfizer espoused its support of EMR/EHR systems, saying physicians would be more likely to report medical errors through these systems. The company had conducted its own survey of physicians:

“Patient safety continues to be a top priority at Pfizer,� said Freda Lewis-Hall, MD, Pfizer’s chief medical officer. “This survey furthers our understanding about how we can best use electronic health records systems to collect critical information about the safe and appropriate use of our products so that we can improve patient safety.�

Of the 300 physicians surveyed, two-thirds utilized some form of an EHR system and one-third used a paper-based system. Half of all respondents and 60 percent of fully-functional EHR users reported that they would be much more likely to submit information about adverse events using an EHR system. Of those still using paper-based systems, 80 percent cited cost as a deterrent to investing in an EHR system.

The cost is still the rub, although 43.9 percent of physicians used EMR/EHR systems in 2009, the CDC found, up from 18 percent in 2001.

The drumbeat for EMR/EHR systems continues in the new year, as the European Commission concluded in a study that implementing EMRs is challenging, but the results can be beneficial over time.

Tags: EMR, healthcare, pharma