Thursday, June 19, 2008

Electronic Health Records too Expensive

A survey sponsored by the Federal Government and the Robert Wood Johnson Foundation and published online by New England Journal of Medicine suggests that costs of adaptation of EHR (also called EMRs and PHRs and MDRs) by the medical community are a road block to wide adaptation of EHR. This is ironic since EHRs are supposed to cut costs from the health care system.

The detailed study briefly mentions that the number of years in practice was taken into account when analyzing the results, but does not provide detailed data broken down by this variable. It is highly probable that physicians in practice 1-20 years are much more likely to use EMR than those in practice 21-40 years and beyond. Older physicians are less computer savvy, were not “raised” on computers, and have a more difficult time adapting to EMR, e-Prescribing and even computerized practice management systems. Additionally, when younger physicians join a mature practice they are likely to push the senior physicians in the practice into a computerization process. As a result, the “4%” mentioned in this article may be innacurate if the doctors surveyed tended to be on the “older” side. is currently performing an online physician survey on the subject of EMR. The physicians who participate in our surveys tend to be more computer friendly, and our preliminary results indicate a much higher EMR implementation than the 4% mentioned in this article.

Some additional interesting data from our survey reveals that only 53% of doctors who purchased an EMR system find that it is of benefit to their practice efficiency and that it was worth the cost of purchase and maintenance. Only 50% of doctors felt that their EMR system helped them provide better care for their patients. (No wonder that EMR hasn’t taken off). 69% of physicians polled were in favor of having a secure and privacy-protected universal, online EMR system.

Interestingly, 11% of physicians have found that patients are asking for copies of their medical records for the purpose of posting them on line on systems such as Microsoft HealthVault and GoogleHealth. This could become a major new trend and indicates that Google’s and Microsoft’s strategies are working. (If this trend mushrooms, many doctors’ offices may be overwhelmed by fulfilling the numerous requests for copies of their medical records).

We will be posting the results of this June 2008 survey soon. To view our October 2007 survey on EMR and Healthvault visit this link.

Robert Cykiert, M.D.

Eye on Genentech: Similar drug, 40 times more expensive

Genentech is restricting the use of its cancer drug Avastin, which is also widely used for patients with wet macular degeneration. There is suspicion that Genentech is doing this because Avastin competes directly with its other wet macular degeneration drug called Lucentis. Avastin costs about $50 per dose and Lucentis costs about $2,000 per dose. You can read more about this saga that has drawn the attention of FDA and senate investigators at Jacob Goldstein's WSJ blog.

As an ophthalmologist, I have seen incredible results in patients who are being treated for wet macular degeneration with Lucentis and Avastin.

Most ophthalmologists and retinal specialists seem to think that the two drugs are equivalent, but there are some anecdotal reports that Lucentis may be the preferred initial treatment, and Avastin may work better for follow up treatments, since most of these patients need monthly injections of these drugs into their eyes. performed an online physician survey of ophthalmologists to find out what their preferences are. The December 2007 poll revealed that doctors preferred Avastin over Lucentis by a 2 to 1 margin. 84% believed that Avastin and Lucentis were equivalent medications, and 94% of ophthalmologists said that Genentech should not place any restrictions on the sale or distribution of Avastin to ophthalmologists or pharmacies that prepare Avastin for use by ophthalmologists.

Click here to see survey results.

We’re all awaiting the results of the NIH study to find out what’s best for our patients.

Robert Cykiert, M.D.