Electronic Medical Records EMR's Need a Window Sticker

*Imagine walking into a car dealership blindfolded, not knowing for certain what exactly you were paying for when buying that shiny, brand-new vehicle on the showroom floor. Imagine not being able to see a list price for each individual vehicle option and add on, not knowing for sure how much the destination charge was, or even what the list price, speed or mileage of the vehicle itself was. Instead, you'd have to trust the dealer's word on all of that. Sounds a little bit crazy, right?

Up until 1958, that's basically how new car transactions were conducted — minus the actual physical blindfold, of course. Car buyers were expected to pay for a car without truly knowing or understanding the math behind a car's asking price. It was impossible to know if you'd gotten a great deal.

What's on a Monroney sheet?

Enter the window sticker or, as it's commonly referred to, a new vehicle's Monroney. This handy sheet of paper is affixed to every single new car, truck, and SUV sold in the U.S. On it, you'll find a complete explanation about where the car was built, warranty details, a list of engine specifications, what options have been added, the Manufacturer's Suggested Retail Price (MSRP) of the car, along with the price of individual options. More recently, performance metrics such as official EPA-endorsed fuel mileage data and crash test ratings have been added to the Monroney, helping give car buyers more information when comparing vehicles when making a purchase decision.

Now imagine you are a physician or a medical center or hospital forced by government mandates to lease Electronic Medical Record (EMR or EHR respectively) software and buy supporting hardware or suffer the consequences of Government fines and diminished reimbursement for your professional work. Imagine talking to an EMR company salesperson or marketeer and not knowing for certain what exactly you were paying for when leasing that shiny, brand new EMR on the salesman's laptop. Imagine not being able to see a list of prices and data for each individual function such as tabulating and submitting MIPS, processing labs, average time similar physicians spend logging on during the day and at night and how many clicks the average physician or physician extender uses per day on different EMR workflow functions. In addition, EHR companies never inform patients if they are selling the personal health information data which physicians pay the EHR companies to input or how much earnings they EHR companies realize from the sale of patient data which physicians input. All this data is routinely tabulated by every EMR company yet never revealed to potential users. Imagine not knowing if the EMR has proven in other office or hospital settings to improve office efficiency, productivity or benefit patients and physicians outcomes or costs.

Up until today, that's basically how new EHR transactions are conducted — minus the actual physical blindfold, of course. EHR buyers are expected to pay for software without truly knowing or understanding the math behind a EHR's prices. It is impossible to know if you're getting a great deal, if the EMR has proven to improve office or patient workflow efficiency or wastes time, enhances or diminishes productivity or benefits patients and physicians value (outcomes or costs) among physicians with similar practice specialties.

The question now is, who (or what) is Monroney? Almer Stilwell "Mike" Monroney was born in 1902 and served as a U.S. senator from Oklahoma from 1951 until 1969. During his long tenure when Congressmen actually passed bills, Monroney did many things, not least of which was his sponsorship of the Federal Aviation Act of 1958, which helped establish the Federal Aviation Administration. Airline safety wasn't the only thing on Sen. Monroney's busy work agenda in 1958, however.

That same year, he sponsored a bill titled the Automobile Information Disclosure Act. At its core, this bill was intended to help consumers understand why the price of a new car was what it was. Until that time, there were no window stickers on cars, no clear and concise explanation about the price and cost of optional extras.

Despite what you might thank about the car buying experience at a typical dealership, this bill wasn't just about weeding out unscrupulous dealers. In fact, the origins of the bill started with dealerships battling automobile manufacturers, though primarily over the handling of franchises. The Automobile Dealers Day in Court Act, passed in 1956, helped to balance some of the power between dealerships and automakers.

But in the process, the many hidden fees and extraneous expenses or performance claims being foisted onto consumers by greedy dealers soon took centerstage. That's when Monroney was tasked with coming up with a solution, to help protect car buyers from fuzzy math or outright fraud when buying a new vehicle.

When someone rents or buys a house, car or boat ‘buyers beware’ risk relieves the owner of after-sale responsibilities or liability. However, when one purchases or rents a house, automobile or boat, the dealer is required by law and capitalistic market competition to provide the potential renter or leaser with a minimum of information concerning fixed and additive operating costs and performance and functional data such as SPEED, horsepower, mileage, property taxes, etc. Our Government created the profitable EMR industry shifting valuable resources from patients and their physicians to HIT companies by forcing physicians to lease these clinically valueless and very expensive tools and purchase expensive new hardware. One can only imagine how bad Fords would be if the government forced every citizen to buy or lease an automobile, removed the window stickers which informed consumers of operating metrics and costs, and then compounded the farce of the forced car lease by building no roads (interoperability).

During the last two decades, the government subsidized EHR industry has failed to provide any value=outcomes/costs or ROI for either patients or their physicians. Hopefully with some transparency in the marketing practices of EMR companies creating capitalistic competition based on quality, cost and workflow, other physicians and their patients will not suffer the same consequences. When purchasing or upgrading EMR's Physicians must ask tough questions about workflow, clicks, login time and costs of their EMR companies, and the government subsidized EHR industry must provide that transparent information.

When physicians are shopping for EMR's they are operating in the dark. Isn't it time that physicians are provided a Monroney sheet for EHR's and EMR's to protect physicians and patients and institutions from fuzzy claims or outright fraud when leasing an EHR? Another modern day Senator Monroney who hasn't received contributions from the EHR industry must do something to protect physicians and their patients from an EHR industry run amok.

*The Monroney sheet: a window sticker history. The window sticker's story, and why you should be glad we have it Nick Kurczewski AutoBlog.com