Health Information Technology in the United States, 2009 – RWJF [Internet]. Robert Wood Johnson Foundation; 2009.
Himmelstein DU, Woolhandler S. Hospital Computing and the Costs and Quality of Care: A National Study
Health Information Technology is becoming a bit of a family affair, since my brother, who is an (excellent) ophthalmologist practicing in a fee for service environment, has been pondering electronic health records. His practice is far from the halls of the US Capitol, so I think his viewpoint is an important view of the reality of the overwhelming majority of medical practices in this country. It’s worth a read, so I’m reposting it here. Our conversation was stimulated by two pieces of research recently published (linked on the right).
Sure, you’re welcome to publish anything you want.
I agreed with your assessment. Just as a computer at home or having a smartphone doesn’t really save any time or money, it does make us more productive.
I have no doubt a well written emr will be beneficial to medicine, but I doubt it would be any huge time or money saver.
I dont know any doc with emr, that is more than marginally happy, and no one that saves money or time. And, the records I get are useless, as they are all macro’d out and two pages for a 30 second exam.
In fact they may cost insurers more, because some are marketed as ‘printing money’ for being able to tell you what you need to add in order to upcode the visit.
Right now, I think it is the quality of emr’s that is the problem, at least for ophthalm as we do alot of drawing and do alot of tests that need to be digitally incorporated.
But, I can’t imagine not having an employee file and pull charts wouldn’t save money. And, I would just love for a referring doc to just transmit a patient’s history to be incorporated into my records when they are referred. Likewise, instead of sending an email regarding a patient I am sending a retinal doctor, (which they probably forget), I would love to just send my records over so they know what I had the question about.
The big issue now is the privacy/audit issue. There are now companies that specialize in auditing charts for medicare and private insurers, and getting commission. Much easier to do with emr, as we can just transmit the chart. But, with paper charts, they can’t read them well, and they don’t plan on doctors copying dozens of charts, so they kind of give up.
What do you think? If we believe (as I do) that all doctors are driven to perform well for their patients, what’s the gap here, and what needs to be fixed?
Click below to see what my original response to him was….
Funny you should send that (studies regarding the penetration and impact of hospital electronic health records, click here and here) to me, I happened to be reviewing them at the same time.
I think it’s no different than the computer in your house – you spend money & time on it and you get a better quality of life. You probably wouldn’t throw it out the window. You probably optimize it to your life so that you squeeze maximum value out of it.
Davis K, Doty MM, Shea K, Stremikis K. Health information technology and physician perceptions of quality of care and satisfaction [Internet]. Health Policy 2009 May;90(2-3):239-246.
On that theme, this paper shows that physicians with EHR feel better prepared, more responsive to patients, more satisfied with their practices, with greater ability to provide quality care for patients
A lot of the problems in hospitals are that the doctors / nurses are not involved in setting the system up and optimizing it because hospitals usually have very skeleton medical leadership to maximize billing, so when they put in a computer system to make ordering easier, they could very well be wiring the same kind of care (good/bad) they were practicing before computerization.
When hospitals involve their doctors and nurses (and patients) as much as possible in setting things up, they usually find out that those people are more than happy to help, even from their own time, if it makes their lives easier. No one wants to wake up and find a computer on their desk that makes their job painful.
When they talk about Kaiser Permanente below, they’re right, we are seeing benefit in quality ( see this presentation, Kaiser Permanente is #1 in the US in mammography screening, and probably in the world now ).
I think overall doctors and nurses should get involved in putting these systems in. In eye care especially, because a lot of the stuff out there is designed for primary care and some specialization, but not very good at manipulating images, and just getting there in measuring for quality. It’s possible that we will end up paying more, somehow (reduced payments, increased taxes), but like the computer in your house, there will probably be increased quality too, it will be one of those things you can’t go without, like a CT or MRI.
Hope that helps…
FW: More on HIT and Cost Saving (NOT!):
Health Information Technology in the United States, 2009 – RWJF [Interne… http://bit.ly/8RNLS9
"I have no doubt a well written emr will be beneficial to medicine, but I doubt it would be any huge time or money saver."
Isn't the fact that an electronic medical record proves "beneficial to medicine" one way of getting a better diagnosis the first time and, hence, saving time and money?
Good question – glad you picked up on the concerns. I think the feeling is agreement with what you are saying, assuming that the EHR products are easy to use, easy to install, and don't require a significant more amount of time to get information out of. These are the elements that are challenging to some, all manageable (I think) with good support of users and patients,
As usual, great articles and comments that help inform the discussion!
Here's my $0.02:
Sometimes, a remodel is inadequate. When you’ve got a rickety little house with a bad floor plan and poor construction, it usually makes sense to start over with a new foundation.
Most of today’s EMRs are barely habitable and held together by makeshift patches. This seems to be the result of inadequate initial investment and limited planning, followed by years of hard use and neglect.
Across the healthcare industry, it appears that huge sums are wasted on amateur architects and builders designing redundant and inadequate HIT systems, which are then run by staff people who don’t understand their idiosyncratic design and construction.
I left the healthcare industry 25 years ago to work in IT. When I returned I was flabbergasted to see how little had changed in HIT. The rest of the world has moved on in computer technology. HIT is now waaay behind. It looks to me like it’s time to pour a new foundation.
When hospital systems and providers have a few well-designed, integrated EMRs to choose from, developed and managed by professional software teams, I think we’ll see long-term savings and healthcare benefits. What software companies will step up? They payoff could be fantastic!
I agree with kathleen.
Most EMR systems are not well designed, and not very customizable. Different doctors and specialties have different needs, and these haven't yet been addressed well.
Furthermore, the different systems do not communicate well, so I just couldn't transmit my records to a referring doctor, and have the data integrated into his system.
At this point, I don't see them contributing to early diagnosis, because of these issues. The airlines have a universal system, so that sites such as expedia can collect and interpret the data to give you the best options. That isn't the case with todays HIT technology.
In fact, I have seen several instances where a mistaken mouse click by the physician's scribe has put in wrong information into the patients records. By the way emr works, this information gets carried into each subsequent visit, and has actually lead to delayed diagnosis.
A properly implemented system will contribute to better coordinated care, and perhaps some cost savings, but nowhere near what is projected by the current administration.
FW: More on HIT and Cost Saving (NOT!) http://bit.ly/8Y4rPB