Memo from the Editor

This magazine firmly supports the use of electronic health records. We believe they can cut costs and help provide better patient care. But we also recognize that EHR systems are expensive, requiring a substantial up-front outlay and significant ongoing charges. Any move by the federal government toward requiring physicians to adopt EHRs must take that cost-and its impact on a practice-into consideration.

Just how important that total-picture context is crystallized for me last week when I received an e-mail from internist Leslie Strouse from New Albany, IN. Let me share some of what Dr. Strouse had to say:

"I agree with President Bush that the EHR and paperless prescribing are desirable. However, as a solo physician, my EHR may be the straw that breaks this camel's back. I have had an EHR for the last seven years. I have upgraded three times and have just been told that my 6-year-old server is a dinosaur and needs at the very least a significant upgrade. The labor alone is $95 an hour in my local market.

"Unlike other businesses, I cannot pass my increased operating costs along. My reimbursements are fixed. I may not be able to afford to practice medicine at all much longer, let alone practice with luxuries like an EHR. Rather than upgrade my system to accommodate the 'new and improved' version of my EHR, I will likely have to dump the whole thing and go back to pen and paper. We have a very serious crisis going on in the healthcare industry right now without needing the added stress or financial liability of electronic carpetbagging."

Dr. Strouse also says that some of that nipping and tucking-going from six phone lines to three, no longer mailing reports or prescriptions-has made her patients angry. And, she says, "I'm angry, too."

There are too many doctors like Dr. Strouse-forced by circumstances to draw straws to see which services they'll be able to continue to offer, which practice improvements they'll be forced to forgo. As the straws get shorter and shorter, patients are the ultimate losers.

Our government representatives need to know that; patients need to know that. Please share this memo with them.