Sens. Frist and Clinton are both on record as supporting the push for computerizing medical record keeping. Since on most issues they take diametrically opposed positions, such agreement surely reflects a case of received (aka conventional) wisdom, something “everyone knows is true” because no one has bothered to challenge it. So let's take a closer look at the widely accepted contention that electronic health records (EHR) not only lower costs but also reduce medical errors.
Based on this assumption:
• Both the House and the Senate have passed laws to encourage EHR.
• Secretary of Health and Human Services Michael Leavitt has termed the arrival of EHR “the most important thing happening in healthcare.”
• And President Bush has set up an Office of the National Health Information Technology Coordinator so as to develop a technology infrastructure that will “reduce healthcare costs resulting from inefficiency [and] medical errors…”
Now for a personal encounter.
On a recent Monday I had occasion to drive someone to the emergency room of a prestigious area hospital. Intake involved three separate and overlapping interviews, each carefully keyboarded. Having been erroneously discharged, the patient went back to the same ER on Thursday. Despite the suggestion that all the information should be in their database, the triple-decker intake procedure was repeated. This time the patient was admitted to the telemetry floor, where a nurse showed up to take down the same information on paper.
One anecdote proves nothing, and up to now EHR critics have focused on specific details, not the underlying concept. Some have raised concerns about patient confidentiality. Others have pointed out that solo practitioners can't afford the startup cost, and that, while electronic input permits speedy sharing of data, it is equally efficient in disseminating mistakes. Finally one vascular surgeon pointed out that his keyboarding patient data has turned him into a very expensive secretary.
But it was left to Jann Sidorov, an associate at the Geisinger Medical Center in Danville, PA, to raise the uncomfortable possibility that the e-emperor has no white coat or any other clothes. In an article in Health Affairs he questioned whether the efficiencies of computerized record keeping that have been demonstrated in such industries as financial services and telecommunications really apply to healthcare.
Citing a study that claims that electronic data entry could save $13,000 per physician per year, Sidorov asks why computerized practices haven't reduced their fees. And since advocates claim on the one hand that EHR will reduce costs and at the same time lead to better “capture of charges,” adding a five-year revenue increase of up to $86,400 per provider, that sure looks like an inconsistency. Won't those added charges increase healthcare costs?
So what about the claim that EHR will reduce medical errors? Again, the author looks at the data which shows, he says, that electronic “decision support has no effect on adherence to primary care guidelines for asthma or angina management,” nor has it improved evidence-based interventions for heart disease. Then comes the clincher: adoption of EHR has not reduced malpractice premiums.
It certainly has not improved the intake procedure of a certain nearby hospital.
Warren Ross is MM&M's editor at large