Paper Medical Records Are Here to Stay

Seems Permanent . . .

About 14 years ago, I got involved with automating medical claims. For those not familiar with the process, as it turns out doctors still lick stamps and send paper medical bills (or claims) to health insurance companies for payment. Sure they can submit electronic bills as EDI, but many don’t. There are a couple big reasons (and a million small ones) that lots of paper claims are still out there:

– Loose Standards (837 the EDI format is implemented in lots of different ways)

– Addressing / Delivery (imagine a doctor needing a separate phone line for every payer – while it is not quite this bad, it certainly isn’t like dropping an envelope in a mailbox (or sending an email for that matter) and knowing it will get to an address despite the fact that you have never talked to them)

So while the above could be overcome, it is easier in lots of cases to just keep doing what you are doing. When it comes down to it, there is a utility to paper that is hard to beat in the short term. This is a common theme to PaperInbox, but in this case I want to discuss how it applies to Medical Records.

Whether it is industry news or even mainstream news covering the new healthcare bill, people talk a lot about the EMR or Electronic Medical Records. EMRs are slated to give us all kinds of great efficiencies from better care due from access to patient history at point of care to huge administrative savings that come from eliminating clerical work. These are pretty great things and somewhat inevitable in the long term. In the short term, I think something quite different will take place.

If you had told me 14 years ago that we would still be processing paper medical claims, I would laugh at you. I would think it would be largely gone in 5-6 let alone more than double that. I was clearly dead wrong. Now couple the massive investments in EMRs and practice management systems with the requirements baked into the healthcare legislation and the EMR is looking like a winner. I’ll take the opportunity to quote my favorite college professor from University of Maryland Dr. Nichols here: “Almost everybody, almost all the time, is almost always wrong.”

Let me take this opportunity to introduce you to the PMR. You see, in the past you had the MR (or medical record) and then the EMR. Something interesting is happening with the facilities and networks that have adopted the EMR. Let’s say that someone needs their medical records because they are applying for life insurance or maybe because they are going to see a new doctor or a specialist. The facility goes to their EMR system (so far so good. . .) and (wait for it . . .) prints out your medical record!

Turns out pretty much every EMR out there uses different standards. While there is some encouraging open source stuff happening, it looks like we are going to fall into a predictable pattern here: overestimating short term gains while underestimating long term gains.

It is not like I love paper – heck I make a living killing it off – but there is a utility to paper that is undeniable. Anyone can use it without training. It is cheap to integrate with when we consider at least on a single user basis and doesn’t require any up front investment. The PMR or Paper Medical Record is going to go away kicking and screaming. In the meantime, it is open season on PMRs and there is no bag limit.

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