Monday, April 5, 2010

A Reminder: EMRs Are Not An Effective Research Tool

EMRs have been widely touted as a miraculous tool for advancing scientific research, as well as managing costs, reducing diagnostic errors, reducing duplication, aiding diagnosis, facilitating communication between health care professionals, and conducting effectiveness studies.

These are premises behind the federal government’s stimulus package containing $20 billion to promote Health Information Technologies (HIT) under its stimulus bill passed in 2009. Twenty billion dollars is quite a HIT.

In any case, in a recent WSJ letter to the editor on April 3, entitled, "Concern About Medical Records Is Not Misplaced," Scot Silverstein. MD, an expert in health information systems at Drexel medical school in Philadelphia writes,

“EMRs remain an experimental technology of uncertain risks and benefits. EMR data, itself uncontrolled as entered into multiple vendors' disparate EMR systems by multiple personnel of varied medical backgrounds and research experience, under widely varied circumstances, make statistically meaningful EMR-based research quite difficult if not impossible.”

“The gold standard of medical research is the randomized controlled clinical trial (RCT), and the irrational exuberance over EMRs as somehow able to bypass or surpass the RCT is dollar sign-studded nonsense. Perhaps one day EMRs will be used to rigorously gather RCT-quality data, but not today. EMRs are not magic bullets. “

In 1996 Alan Greenspan coined the term “irrational exuberance” to describe dangers of overconfidence in a market economy. Perhaps today, we ought to think of excessive confidence in a government solution in the same vein. If I may coin other term, with your permission, the term “irrational protuberance” might be used to describe the government sticking its head into 1/6 of the nation’s economy.

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