Content: We have had two very stimulating lectures from Dr. Johnson and the perspective of an economist is different than a medical perspective. Key points include trying to find the most cost effective solution, which is not necessarily the cheapest alternative. I will now be able to plan my vacuum cleaner purchases in a better way. Cost benefit analysis is monetized by cost efficiency analysis may depend on non-monetized benefits. Driving from Tucson, twice a week, certainly emphasizes how much safer it might be if the speed limit was reduced. Each day, I see a lot of crazy drivers and I am concerned that they have a shortened life span. I have now focused my attention on not taking the 10 through Phoenix. I have become acquainted with the Hispanic and native American community on Avenida Yacqui which is actually longer in distance but shorter in time than taking the highway. Soon, I will consider stopping there for dinner, but I will have to review the safety, i.e. utility, of that decision. From a cost standpoint, I am spending 25% less on gas by going slower through Avenida Yacqui after taking 7th St. down instead of the 10 all the way to Tucson. This is my own personal perspective, but I am not sure that society would view this perspective differently. Initially, I would think that driving by a longer route in distance at a slower miles per hour, would have a higher indirect cost for me due to greater time. However, the cost of gas reduces my direct cost and the time during rush hour is not different. My opportunity cost is equivalent. Nevertheless, the indirect cost of driving no matter the route is significant from a time standpoint and indeed has a economic cost.




I have talked previously about the dilemma that I have with my present EMR, upon which my practice revolves. The software will not pass muster in the future based on the federal standards, but in February, despite 6000 users, the company stopped technical support and soon after, when there were complaints, stopped the software internet forum. Recently, with I suspect, a huge exodus of users, who did not want to upgrade for $20,000 to the company’s new software, the forum has gone back live and technical support has again been able to be reached. Nevertheless, the inducement to go to the better software that can not transfer my existing templates (at all) and notes (fully) and ? my data including all labs is difficult to balance against the promised transfer cost to me of $44,000 should I switch to their new software. Will I be able to net $24,000 starting in 2012? If so, What do I do with my current records if technical support ends in 2010 and follow my patients after this? In this case, there is a transfer payment, but my opportunity cost and indirect costs exceed this possible payment, particularly in terms of my ability to deliver quality care to my patients. In essence, I have a penalty for adopting this standard of EMR, before it was mainstream. The profit is significant to the EMR manufacturer but perhaps, they have underestimated, the proportion of the 6000 users that will not upgrade and will go to another supplier. Interestingly, this vendor is the vendor that provided the software that created an error and diminished usability and error checking that was discussed by Dr. Patel with one of her cases related to excessive potassium chloride in the ICU patient. Great. Sell the software and do not support it. I guess the concept that is so popular among American car dealers is alive and well in the EMR industry for doctors and hospitals. Unfortunately, the government provides this subsidy to physicians at the taxpayers expense for inducing me to purchase a program that does not allow me to take care of existing patients and these patient, who are the taxpayers suffer. This subsidy is not a neutral situation from a societal perspective. It is actually an indirect cost now. Further, the cost of the software, when initially purchased now has deteriorated from multiple 1000s of dollars to a value of zero—a real decline in its original present value.



Stuart

Posted by