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signs in order to meet the measure of this objective and successfully demonstrate meaningful use.” Texas should not repeat the mistakes of the federal government.


Texas must recognize that not every medical practice will benefit from an EHR. In fact, it could be disruptive to some and could hurt patient care. Requiring a physician to rely on a system that is counter-intuitive to his or her clinical training could result in adverse outcomes for the patient.


In some cases, EHRs are cost-prohibitive regardless of federal incentives. Not all physicians are eligible for the Medicare or Medicaid EHR incentives. The average EHR purchase cost is about $40,000 per physician,31


not including productivity dips that


hurt practice revenues. Some medical practices operate on such thin profit margins that the capital investment of an EHR could lead to bankruptcy.


Health Information Exchanges Health information exchanges (HIEs) are designed to help physicians and providers share patient information securely. To promote the electronic exchange of medical information, patients and physicians must be assured that patient data are adequately protected by those who operate the HIE.


Stop potentially preventable hospitalizations


From 2005 to 2009, the Texas Department of State Health Services (DSHS) estimates that


Texas spent $32 billion on hospital charges for potentially preventable conditions. For example, a recent University of North Texas study of chronic obstructive pulmonary disease (COPD), which is considered a potentially preventable condition, found that from 2005 to 2008, COPD cost Texas $2.7 billion.


Potentially preventable hospital readmissions cost Texas Medicaid an estimated $105.9 million in fiscal year 2010. This does not include physician services or other care that is related to the readmission. A January 2012 Health and Human Services Commission report found there were about 15,000 hospital readmissions within the Medicaid program in 2010. Of these, 23 percent were for treatment of the same condition as the initial admission, almost 30 percent were for an acute condition that may have had some relationship to the initial admission, and 23 percent were for mental health or substance abuse readmissions based on conditions related to the initial admission. Correspondingly, it appears that just 2 percent were from post-surgical complications.32


While these are all potentially preventable readmissions, not all are actually preventable. Many of these costs and associated morbidity are avoidable if patients have access to appropriate outpatient health care and proven preventive services such as vaccinations and obesity reduction. The savings from better management, including both patient compliance and use of evidence-based


Top Five Potentially Preventable Hospitalizations for Adult Residents of Texas (2005-09) Number of


Congestive Heart Failure Bacterial Pneumonia


Diabetes Long-Term Complications Chronic Obstructive Pulmonary Disease Urinary Tract Infection


68 TEXAS MEDICINE September 2012


Hospitalizations 308,725 262,409 106,019 140,504 155,903


Average Hospital Charge


$28,755 $28,291 $35,916 $26,218 $19,619


Total Hospital Charges


$8,877,387,375 $7,423,813,019 $3,807,778,404 $3,683,733,872 $3,058,660,957


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