Thursday, March 8, 2012

Notes, Quotes, and No Votes from EHR True Believers, Reacting to A Study That EHRs Increase Testing and Imaging

When we believe ourselves possessive of the only truth, we are likely to be indifferent to common everyday truths.

Eric Hoffer (1902-1983), American longshoreman and social writer, The Passionate State of Mind (1955)

If it sounds too good to be true, it probably is.

Popular Saying

March 8, 2012 - Out there in the digital biosphere, there is a passionate state of mind about electronic health records.

EHR believers hold these truths to be self-evident.

• Electronic records can do no wrong.

. They are the answer to much of what ails the system.

• They are worth any cost.

• They represent a good cause for which government will pay any price.

• They will assure transparency.

• They will empower patients, making them co-equal with doctors.

• They will bring truth into doctor-patient relationships.

• They will insert data-borne objectivity into the subjective art of medicine.

• They will make possible evidence-based and outcome based care.

• They will move doctors to do the right thing, rather than the convenient or profitable thing.

• They are the wave of an enlightened future.

• They will leave the past in their dust

• They will end waste.

• They will prevent duplication.

• They are essential for coordinating continuous care.

• They will contain costs and improve care.

At one stroke, say the yea-sayers, they will bring effectiveness and efficiency into the health care system. Furthermore, they will give authorities and payers the tools to track, document, reward, and enforce physician performance.

All of these truths are true to some extent. But they are also half-truths, half-tools, and half-measures for an imperfect society with an imperfect health system. They overlook certain aspects of the human condition –public expectations, even demands,for what they perceive to be the standard of care; our perverse litigious climate, from which defensive medicine axiomatically follows; the differences between statistical averages and individual desires; and distorted hopes and half-answers engendered by universal connectedness.

In any event, when a study out of the Harvard-affiliated Cambridge Health Alliance, appeared in the March issue of Health Affairs challenging their fundamental belief in the sanctity of EHRs, the true believers reacted with disbelief, skepticism, criticism, and dismissiveness.

• In “Digital Records May Not Cut Health Costs,” New York Times, March 5, David Blumenthal, MD, the second national coordinator of Health Information Technology, remarked, “It is one of a small minority of studies that have doubted the value of health information techniques. His predecessor as HIT czar, David Brailer, MD, said he was unconvinced of the study’s conclusions.

• In the March 7 Kaiser Health News, Farzad Mustashari MD., the current national coordinator, was dismissive. He sniffed, “The study tells us little about the ability of electronic health records to reduce costs and nothing about in the impact of EHRs in improving care.”

• In the March 6 edition of The Health Care Blog, Merrill Goozner, health care journalist, in “Research Shows. The Obvious, “ expounded on EHR virtues, “Electronic records…are an extremely important tool for tracking patients, avoiding errors, learning what works and what doesn’t, and eliminating duplication. But until it is linked to payment and delivery system reforms (bundled payments to integrated delivery systems) and greater incentives for physicians to deliver evidence-based care and better understanding of risks and benefits of excessive imaging and reducing defensive medicine, it will have little impact on reducing overuse and lowering costs.”

• In a March 7 New York Times editorial, “Do Electronic Records save Money?”, the editorial writer concludes, “We still believe that widespread adoption of electronic medical records will improve care and reduce costs. It is also clear that many office-based physicians will need help in making the transition. No matter how adept doctors become with computerized records, they will need to be pushed to rein in excessive use of tests.”

The EHR Gospel

There you have the Gospel of Electronic Health Records, as seen by true believers. Of the irreverent study that EHRs might actually increase overuse of testing and imaging, true believers seem to be saying: “It ain’t so, and if it is so , it’s the fault of doctors and the health system, nor our cherished records.”

Tweet: EHR true believers react with disbelief, criticism, and dismissiveness to a study that EHRs increase overuse of testing and imaging.

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